Increasing access to naloxone in BC to reduce opioid overdose deaths

Opioid overdose is a public health issue in British Columbia. In 2009, more than 200 deaths were identified as illicit drug deaths (IDD),[1] opiates were found in 60%,[2] and an additional 74 deaths were in persons prescribed opioid medication.[3

In May 2011, the BC Coroners Service released a warning about a spike of heroin-related deaths due to increased heroin potency.[4] Unintentional death from opioid overdose is preventable with education and timely administration of naloxone, an opioid antagonist.[5] In BC, the current lack of naloxone availability outside primary care, hospital, and ambulance settings limits its lifesaving potential. 

Naloxone has been approved for the reversal of opioid respiratory de­pression in Canada for over 40 years and is on the WHO Model List of Essential Medicines. Naloxone cannot be abused, and in the absence of narcotics, exhibits no pharmacological ac­tivity. 

Globally, naloxone access takes many forms including take-home-naloxone programs for people who use illicit drugs in Europe, Australia, and over 180 programs in the US; as part of a pain-management toolkit for people prescribed opioids; and availability for anyone who may witness an opioid overdose.[5]

Fourteen subpopulations have been identified at higher risk for overdose. These include previous overdose, recent discharge from prison or drug treatment, high-dose opioid prescription, opioid use with comorbidities (e.g., respiratory/hepatic/renal disease), initiation into opioid substitution therapy, and concurrent treatment involving antidepressants or benzodiaze­pines.[6] Naloxone may particularly benefit individuals who are reluctant to access emergency care or where emergency services are not readily available.

Recently, Ontario responded to the removal of OxyContin from the Canadian market by providing overdose prevention and response training and in­creasing access to naloxone province-wide.[7]

BC, a leader in harm reduction with the first officially sanctioned supervised injection facility (Insite) and the “first jurisdiction in Canada to recognize addiction as a chronic illness,” has not fully utilized naloxone to address morbidity and mortality related to opioid overdose.

The BC Centre for Disease Control harm reduction program has en­gaged with stakeholders to identify barriers and ways to increase provincial naloxone access in order to prevent harms from overdose among people using both prescribed and illegal opioids. 

Current initiatives being ex­plored include training peers to increase community capacity to administer naloxone, providing naloxone to pa­tients discharged from hospital following an overdose, developing a provincial decision support tool for nurses, and adding naloxone to the Pharmacare formulary to reduce monetary barriers. 

Intranasal naloxone is utilized at Insite and Vancouver outreach settings by the Portland Housing Society. However, overdose deaths occur throughout BC.[2] People who use drugs have requested training and access to intramuscular naloxone. Training can provide an opportunity to engage in meaningful dialogue and empower people who use opioids to take responsibility for themselves and others. 

This article seeks to increase phy­sician awareness about the safety, effectiveness, and evidence that in­creasing access to naloxone saves lives, as we proceed with planning and implementing a naloxone program in BC. For more information contact outreach@towardtheheart.com.
—Jane A. Buxton, MBBS, MHSc, FRCPC
—Roy Purssell, MD
—Erin Gibson, BA 
—Despina Tzemiz, MPH
BC Centre for Disease Control

Acknowledgments
The authors would like to acknowledge the health authorities, community partners, and other stakeholders.

This article is the opinion of the BC Centre for Disease Control and has not been peer reviewed by the BCMJ Editorial Board.


References

1.    BC Coroners Service. 2009 Annual Report. Accessed 20 April 2012. www.pssg.gov.bc.ca/coroners/publications/docs/annualreport2009.pdf.
2.    Buxton JA, Skutezky T, Tu AW, et al. The context of illicit drug overdose deaths in British Columbia. Harm Reduct J 2009;6:9.
3.    Prescribed opiate overdose death 2009. BC CDC internal communication with BCCS. 31 January 2012.
4.    Ministry of Public Safety and Solicitor General, BC Coroners Service. BC Coroners Service warns of rise in heroin-related deaths. News release. 5 May 2011. Accessed 4 May 2012. www2.news.gov.bc.ca/news_releases_2009-2013/2011PSSG0059-000493.pdf.
5.    Centers for Disease Control and Prevention (CDC). Community-based opioid overdose prevention programs providing naloxone - United States, 2010. MMWR Morb Mortal Wkly Rep 2012;61:101-105.
6.    Dasgupta N, Brason FW, Albert S, et al. Project Lazarus: Overdose prevention and responsible pain management. North Carolina Medical Board Forum 2008;1:8-12. Accessed 4 May 2012. www.ncmedboard.org/images/uploads/publications_uploads/no108.pdf.
7.    Ontario Ministry of Health and Long-Term Care. Update on OxyContin partnership strategy. Health Bulletin. 4 April 2012. Accessed 4 May 2012. www.health.gov.on.ca/en/news/bulletin/2012/hb_20120404_1.aspx.

Jane A. Buxton, MBBS, MHSc, FRCPC, Roy Purssell, MD, FRCPC, Erin Gibson, BA,, Despina Tzemiz, MPH,. Increasing access to naloxone in BC to reduce opioid overdose deaths. BCMJ, Vol. 54, No. 5, June, 2012, Page(s) 231 - BCCDC.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply