Lessons learned from ramping up a Canadian Take Home Naloxone programme during a public health emergency: a mixed-methods study

Abstract

ObjectivesThis study describes the 2016 expansion of the British Columbia Take Home Naloxone (BCTHN) programme quantitatively and explores the challenges, facilitators and successes during the ramp up from the perspectives of programme stakeholders.DesignMixed-methods study.SettingThe BCTHN programme was implemented in 2012 to reduce opioid overdose deaths by providing naloxone kits and overdose recognition and response training in BC, Canada. An increase in the number of overdose deaths in 2016 in BC led to the declaration of a public health emergency and a rapid ramp up of naloxone kit production and distribution. BCTHN distributes naloxone to the five regional health authorities of BC.ParticipantsFocus groups and key informant interviews were conducted with 18 stakeholders, including BC Centre for Disease Control staff, urban and rural site coordinators, and harm reduction coordinators from the five regional health authorities across BC.Primary and secondary outcome measuresTake Home Naloxone (THN) programme activity, qualitative themes and lessons learnt were identified.ResultsIn 2016, BCTHN responded to a 20-fold increase in demand of naloxone kits and added over 300 distribution sites. Weekly numbers of overdose events and overdose deaths were correlated with increases in THN kits ordered the following week, during 2013–2017. Challenges elicited include forecasting demand, operational logistics, financial, manpower and policy constraints. Facilitators included outsourcing kit production, implementing standing orders and policy changes in naloxone scheduling, which allowed for easier hiring of staff, reduced paperwork and expanded client access.ConclusionFor THN programmes preparing for potential increases in naloxone demand, we recommend creating an online database, implementing standing orders and developing online training resources for standardised knowledge translation to site staff and clients.

Accessing Take-Home Naloxone in British Columbia and the role of community pharmacies: Results from the analysis of administrative data

“…While all Canadian provinces and territories have publicly funded THN programs, research and evaluation of these programs in the scholarly literature is limited. A recent study from Ontario describes uptake of the province’s pharmacy-dispensed naloxone kits in Ontario [ 27 ], and preliminary analyses of provincial THN programs in Ontario [ 28 ], Alberta [ 29 ], Manitoba [ 30 ], and British Columbia [ 15 ] have been published. Data from other jurisdictions are not directly comparable, due to differences in program structure, eligibility criteria, and scope [ 9 ].…”

“…analyses of provincial THN programs in Ontario [28], Alberta [29], Manitoba [30], and British Columbia [15] have been published. Data from other jurisdictions are not directly comparable, due to differences in program structure, eligibility criteria, and scope [9].…”

“…In September 2016, the College of Pharmacists of BC changed the status of naloxone for emergency use to 'unscheduled', making it available outside of pharmacies [14]. Furthermore, the BC THN program removed the requirement to report individual naloxone kit IDs and/or patient names in October 2016 [15].…”

Convenience and comfort: reasons reported for using drugs alone among clients of harm reduction sites in British Columbia, Canada

“…Among others, this includes the BC take-home naloxone (THN) program, expanded opioid agonist treatment (OAT) availability, and observed consumption sites, all of which had a significant impact on preventing overdose deaths [ 14 ]. The THN program, for instance, has been responsive to the overdose crisis by getting naloxone kits into the hands of those that need it most [ 15 , 16 ], with more than 53,000 THN kits reported as used to reverse an overdose between 2017 and 2019 [ 17 ]. However, it is important to note that someone else must be present for naloxone to be administered to an individual experiencing an overdose.…”

Canadian national consensus guidelines for naloxone prescribing by pharmacists

“…7 In Canada specifically, a British Columbia THN program providing low-barrier access to naloxone kits at no cost greatly reduced the number of deaths due to OIRD during a time when there was an increase in the number of fentanyl-related toxicities. 8-10 This THN program, launched in 2012, originally provided naloxone through harm reduction sites and community organizations where there was a high prevalence of OIRD. In December 2017, the program incorporated selected community pharmacies to provide naloxone to other places and populations with limited access to THN kits. Distribution records from participating pharmacies indicated that 3523 kits were distributed by 562 pharmacies between January 1, 2018, and December 31, 2018.…”