Update on th the Opioid Overdose Emergency Response Mich ichelle - PowerPoint PPT Presentation

Update on th the Opioid Overdose Emergency Response Mich ichelle le La Lawrence, Executive Le Lead Mental l Healt lth an and Su Substance Use se April il 10 10, , 20 2018 18

Epidemiological update Ambulance – ER - deaths

Overdoses attended by BCAS, , BC vs NH, , 2013-2017 2017 BC NH Not for Distribution - NH Internal Planning Use Only 3

NH NH Emergency room visits for overdose remain stable Not for Distribution - NH Internal Planning Use Only 4

Pri rince George has th the hig ighest number of f emergency room visits for overdose Not for Distribution - NH Internal Planning Use Only 5

More il illicit dru rug deaths in in BC than any other unnatural cause of f death Not for Distribution - NH Internal Planning Use Only 6

Lower rate of f death in NH vs. . rest of f BC, , but still much higher than in the past 40 Illicit drug overdose death rate, Deaths per 100,000 people per year 35 NH vs BC, 2013-2017 30 25 20 BC 15 NH 10 5 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2013 2014 2015 2016 2017 Quarter (calendar year) Not for Distribution - NH Internal Planning Use Only 7

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Overdose death rate by HSDA NH vs BC, , 2007-2017 2017 35 BC 30.2 30 Prince George Deaths per 100,000 population Northeast 25.3 25 23.2 NI rural 20 Northwest 19.2 15 10 9.9 5 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year Not for Distribution - NH Internal Planning Use Only 9

Overdose fatalities by type of f location, , NH, , 2016 2016-2017 2017 Private Residence – includes private residences (driveways and garage), trailer home. Own or another’s residence. Other Residence – includes hotels, motels, rooming houses, safe houses, social housing, detox centres, drug recovery house, group home, residential care, retirement/senior residence. Other Inside – includes facilities, occupational sites, public buildings, and businesses. Outside – includes vehicles, streets, sidewalks, parking lots, public parks, wooded areas, and campgrounds Not for Distribution - NH Internal Planning Use Only 10

Risk factors • Demographic • Comorbidities • Age 20-59 • Mental health issues • Male • Chronic pain • First Nations (most ODs occur in urban settings) • Drug use pattern/context • Social factors • Opioid use disorder, • Unemployment or construction not on OAT trade employment • Polysubstance use • Unstable housing • Using alone in a private • Social isolation residence • Disengagement from health care • Interruption and relapse (post- services detox or incarceration) • History of trauma Not for Distribution - NH Internal Planning Use Only 11

Key drivers • Pain • Psychological and physical • Often rooted in childhood trauma • Stigma • Alienates and isolates people who use drugs • Hampers political will to implement solutions • Poorly addressed risk factors • Substance use disorder, mental health, chronic pain • Inappropriate initiation and discontinuation of opioid prescriptions • Social determinants of health • Poverty, homelessness, isolation, violence, discrimination, racism • Unpredictable dosing with black market opioids • More potent substances as a consequence of prohibition (new!) Not for Distribution - NH Internal Planning Use Only 12

Opioid overdose re response in in NH NH and th the Detailed Operational Pla lan

Provincial Overdose Emergency Response Centre (O (OERC) On December 1, 2017, the Ministry of Mental Health and Addictions launched the new Overdose Emergency Response Purpose • The emergency centre will have a strong focus on measures to prevent overdoses and provide life-saving supports that are: • on-the-ground • locally driven and delivered • action-oriented • rapidly implemented Not for Distribution - NH Internal Planning Use Only 14

Provincial Overdose Emergency Response Centre (O (OERC) • With approximately 10 full- and part-time staff will work with all provincial partners to respond to the Overdose Emergency • Expectation of each Health authority is to form a Regional Response Team to ensure regional – level actions and policy development are integrated, responsive and targeted and community action teams (LITs) • 18 specific communities have been targeted throughout the province to be supported by the OERC - In the North, Fort St John and Prince George. This will include some dedicated funding ( up to 100,000) through the Community Action Team Grants. • Additionally funding for the rest of the province will be available through the Community Crisis Innovation Fund (grant process) Not for Distribution - NH Internal Planning Use Only 15

Refreshed Provincial Opioid Cri risis response “Comprehensive Suite of Services” Essential Health Sector Actions Essential Actions for Supportive Environments Naloxone and overdose response training Social stabilization - income, housing, supportive relationships Overdose prevention and supervised consumption services Peer employment and engagement Drug checking Cultural safety Acute OD case management Addressing stigma, discrimination, and human rights Treatment services Surveillance Not for Distribution - NH Internal Planning Use Only 16

NH Opioid Crisis Response • Regional Response Team • Monthly internal meetings • Meet with provincial OERC once monthly • 2 Community Action Teams • Funding flowing through CAI • PG and FSJ Not for Distribution - NH Internal Planning Use Only 17

NH Opioid Emergency Response Operational Model Provincial/Regional Central FNHA • Dr. Allison, Michelle • Becky Palmer, Minda Richardson Lawrence Regional FNHA HSDA • Nicole Cross, Tammy Rogers, Karla Tait • Dr. Fumerton, Gray, Local FNHA Kim • Health Director or other • Directors Cooper, • Len Pierre – Wellness coordinator Holland, McLellan • Community Engagement Coordinator Local • HSA, CSM, PHRN Not for Distribution - NH Internal Planning Use Only 18

Detailed Operational Plan Im Implementation Align current status and efforts to support provincial reporting and funding structures Drug Checking Overdose prevention and SCS Stipulate Precision across the Includes Naloxone Region Treatment interventions and supports including surge Stimulate Resonance at the Hospital and ER department services Community Pain Management Professional Education Respond to community needs and readiness Data Analysis Not for Distribution - NH Internal Planning Use Only 19

By the Numbers - Dis istribution of f Take Home Naloxone kit its NH, Jan 2015-Sep 2017 1600 Essential Health Sector Actions 1372 1400 1268 Shipped to 1200 NH sites 1000 Dispensed THN kits 809 to clients 800 608 600 400 220 192 123 200 45 27 20 15 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 2015 2016 2017 Quarter (calendar year) Not for Distribution - NH Internal Planning Use Only 20

Overdose Prevention and Superv rvised Consumption Services - Detailed Operational Plan • Implement overdose prevention service(s) (OPS) and/or supervised Essential Health Sector Actions consumption service(s) (SCS) in communities with high rate of overdoses • Currently, the transition of the OPS site in PG to a full SCS is being considered. Location is still being determined and application will be submitted. • Regionally, Overdose Prevention Services need to be defined and developed • Funding for operation of PG site and some additional FTEs to support services regionally Not for Distribution - NH Internal Planning Use Only 21

Drug Checking – Detailed Operational Plan Essential Health Sector Actions • Drug Checking to occur at Prince George Needle Exchange • To expand through out the North with development of overdose prevention services as appropriate Not for Distribution - NH Internal Planning Use Only 22

Acute OD Risk Case Management Essential Health Sector Actions • Develop NH Standardized approach to:  Responding to an overdose presentation in Emergency Rooms  Responding to an overdose presentation by BCAS including follow-up  /  Offer education on Take home Naloxone  Rapid Initiation of OAT in emergent settings as appropriate  Routine follow-up by Mental Health/Substance Use clinicians Not for Distribution - NH Internal Planning Use Only 23

Hospital and Emergency Department Services – Detailed Operational Plan Essential Health Sector Actions • Exploring the Possibility of immediate Suboxone initiation • Ability for staff to feel competent to due all necessary assessments and triage as appropriate (including social needs) • Funding to include continued support and increase of Psychiatric Liaison Nurses and Addictions Consult supports Not for Distribution - NH Internal Planning Use Only 24

Treatment In Interventions and Supports – Detailed Operational Plan • Understanding and decreasing the gaps and barriers to Essential Health Sector Actions service • Ensure leadership and substance use for the Region including physician leads throughout the North • Increasing access to OAT through: • Developing Specialist and Primary Care collaborative care • Funding to include increasing FTEs for Substance Use Clinicians Support to Specialized Services throughout the North (6), Leadership for Substance Use (Physician and Strategic Lead ) Not for Distribution - NH Internal Planning Use Only 25