Patient and physician resources for naloxone use in BC

Issue: BCMJ, vol. 60, No. 2, March 2018, Pages 84-85 BC Centre for Disease Control
By: Jane A. Buxton, MBBS, MHSc, FRCPC Mark Gilbert, MD, MHSc, FRCPC Margot Wilson, RN, MSN, CHE Emily Ogborne-Hill

Since the overdose crisis was declared a public health emergency in BC in April 2016, the BC Centre for Disease Control (BCCDC), in partnership with the Ministry of Health, health authorities, and community partners, has been leading development of practises and distribution related to take-home naloxone kits in BC.

Since the overdose crisis was declared a public health emergency in BC in April 2016, the BC Centre for Disease Control (BCCDC), in partnership with the Ministry of Health, health authorities, and community partners, has been leading development of practises and distribution related to take-home naloxone kits in BC. Here are the most recent practise updates, including resources for patients, physicians, and other service providers.

BC’s take-home naloxone program
The BCCDC reduces barriers to accessing naloxone by providing no-cost take-home naloxone kits to people at risk of witnessing or experiencing an overdose. Standardized training and kits are provided through more than 1000 distribution locations across BC. Distribution locations include 86 hospitals and emergency departments, 16 corrections facilities, and over 100 sites serving First Nations communities. Most are sites that have long provided harm reduction services to clients and also offer a range of education, services, and supports related to safer substance use.

Where to find take-home naloxone kits
Patients and the general public can locate their nearest take-home naloxone and harm-reduction sites at www.towardtheheart.com. There are currently more than 250 community pharmacies listed at this site, and pharmacy enrollment is ongoing. We estimate that over 65 000 kits have been distributed since the program began in 2012, and over 40 000 kits in 2017 alone.

Where to find training on administering naloxone
Two new training resources have been developed that are relevant for physicians, other service providers, patients, family members, and the general public.

Training for service providers
The Naloxone Administration Quick-Learn Lesson is an online training tool aimed at service providers who may need to respond to an opioid overdose, including not-for-profit and supportive-housing staff, and those who work directly with people at risk of overdose. This interactive, self-guided lesson on overdose recognition and response takes approximately 15 to 20 minutes to complete. It is available at www.towardtheheart.com/naloxone-course.

Training for the patients, families, and the public
Launched in November 2017, the online naloxone training application was developed by Hello Cool World Media in collaboration with St. Paul’s Hospital and the BCCDC’s Harm Reduction Services. The self-guided training app provides standardized patient training for use in busy settings such as emergency departments and pharmacies. Patients, friends, or family of people at risk of opioid overdose can complete a thorough online review of overdose recognition and response scenarios in approximately 5 minutes. A certificate of completion is provided, which can then be displayed on a mobile device or printed and taken to a take-home naloxone site or participating pharmacy to show evidence of training and to receive a kit. The training application is available at www.naloxonetraining.com.

Naloxone use in BC communities
Care providers should encourage patients to report their use of the take-home naloxone kits to the BCCDC. Based on clients’ reports of using the kits (gathered when they are replacing/refilling a kit), we estimate there have been 14 000 administrations (96% of them occurring in 2016 and 2017).

A detailed overdose event reporting form is also included in each kit, and there have been 2700 completed forms returned to date. The information provided in the completed forms has given us a better understanding of important issues such as the frequency of withdrawal symptoms.

Preventing opioid withdrawal in overdose events
Completed overdose event reporting forms show that in 70% of take-home naloxone administration events there are no or mild withdrawal symptoms reported. Training points based on this evidence include: 
-    When an overdose is witnessed, continue giving one breath every 5 seconds until the victim is breathing on their own or help arrives. 
-    To avoid withdrawal symptoms, and to reduce the risk that someone recovering from an overdose will feel the need to use additional substances, give one dose of naloxone every 3 to 5 minutes.

The BCCDC’s take-home naloxone program provides lifesaving training and kits to people who are likely to witness or experience an overdose. Physicians and health care providers play an important role in facilitating access to this lifesaving intervention.
—Jane Buxton, MD
Physician Epidemiologist and Harm Reduction Lead
—Mark Gilbert, MD
Medical Director
—Margot Kuo, Epidemiologist
—Emily Ogborne-Hill, Harm Reduction Operations Coordinator 
—Sara Young, Manager, Harm Reduction and Hepatitis Services

Online naloxone resources
•    Naloxone training application for patients: www.naloxonetraining.com
•    Naloxone Administration Quick-Learn Lesson for service providers: www.towardtheheart.com/naloxone-course
•    Take-home naloxone site finder: www.towardtheheart.com/site-finder
•    Take-home naloxone information for health professionals: www.towardtheheart.com/health-professionals
•    History of take-home naloxone use in BC: www.bccdc.ca/resource-gallery/Documents/THN%20timeline_Colour%2020170628...
•    Take-home naloxone infographic: www.towardtheheart.com/thn-in-bc-infograph

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

Jane A. Buxton, MBBS, MHSc, FRCPC, Mark Gilbert, MD, MHSc, FRCPC, Margot Wilson, RN, MSN, CHE, Emily Ogborne-Hill. Patient and physician resources for naloxone use in BC. BCMJ, Vol. 60, No. 2, March, 2018, Page(s) 84-85 - BC Centre for Disease Control.


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