Embed Size (px)
Citation preview
Opioid Substitution Treatment and Public Health
Kenneth W. Tupper, Ph.D. Adjunct Professor
School of Population and Public Health University of British Columbia
MMT 101-Hospitalist Workshop – Vancouver, BC
October 1st, 2016
BC Illicit Drug Overdoses – 1990-2016
2
Source: BC Coroners Service. (2016, September 21). Illicit Drug Overdose Deaths in BC January 1, 2007 – August 31, 2016
BC Illicit Drug OD Rates – 2007-2016
3
Source: BC Coroners Service. (2016, September 21). Illicit Drug Overdose Deaths in BC January 1, 2007 – August 31, 2016
BC Illicit Drug OD Deaths With Fentanyl Detected: 2012 – July 2016
4
Source: BC Coroners Service. (2016, September 21). Fentanyl-Detected Illicit Drug Overdose Deaths, 2012 to July 2016
Canada vs BC HIV infection rate – 1986-2014
5
Source: BC Centre for Disease Control. (2015, November). HIV in British Columbia: Annual Surveillance Report 2014. Vancouver, BC. p. 5
Canadian HIV infection trends – by exposure category
6 Source: Government of Canada. (2014). Estimates of HIV incidence, prevalence and proportion undiagnosed in Canada
BC HIV infection trends – by exposure category
7 Source: BC Centre for Disease Control. (2015, November). HIV in British Columbia: Annual Surveillance Report 2014. Vancouver, BC. p. 14
Opioid Substitution Patients, by HA
8 Office of the Provincial Health Officer. (2015). BC opioid substitution treatment system: Performance measures 2013/2014. Victoria, BC: Office of the Provincial Health Officer.
08/09 09/10 10/11 11/12 12/13 13/14IH 1,318 1,513 1,774 2,067 2,338 2,523FH 3,983 4,493 5,381 6,120 6,716 7,349VCH 3,784 3,901 4,187 4,465 4,723 4,852IslH 2,034 2,202 2,469 2,674 2,787 2,915NH 320 333 347 410 430 482BC Total 10,341 11,359 12,917 14,494 15,720 16,668
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
Cum
ulat
ive
Patie
nt C
ount
OST Dispensing Pharmacies, by HA
08/09 09/10 10/11 11/12 12/13 13/1401 IHA 101 104 111 127 146 16002 FHA 176 199 221 254 279 31603 VCHA 131 133 157 181 197 20804 VIHA 104 105 111 121 137 15105 NHA 34 35 37 41 45 4706 BC Total 546 576 637 724 804 881
0100200300400500600700800900
1,000
Phar
mac
y Co
unt
9 Office of the Provincial Health Officer. (2015). BC opioid substitution treatment system: Performance measures 2013/2014. Victoria, BC: Office of the Provincial Health Officer.
OST Active Prescribers, by HA
08/09 09/10 10/11 11/12 12/13 13/1401 IHA 18 25 25 25 29 3302 FHA 65 66 66 73 76 7303 VCHA 143 147 166 168 173 18604 VIHA 44 48 43 45 61 5805 NHA 20 19 20 22 21 2106 BC Total 284 297 317 328 344 365
0
50
100
150
200
250
300
350
400
Pres
crib
er C
ount
10 Office of the Provincial Health Officer. (2015). BC opioid substitution treatment system: Performance measures 2013/2014. Victoria, BC: Office of the Provincial Health Officer.
New MMT Patients Retained at 12 Months
07/08 08/09 09/10 10/11 11/12 12/1301 IHA 42% 50% 46% 43% 38% 36%02 FHA 44% 47% 46% 42% 37% 36%03 VCHA 35% 38% 38% 38% 34% 32%04 VIHA 52% 50% 52% 51% 46% 45%05 NHA 49% 42% 42% 35% 39% 30%06 BC Total 41% 45% 44% 42% 38% 36%
0%
10%
20%
30%
40%
50%
60%
Perc
enta
ge R
etai
ned
11 Office of the Provincial Health Officer. (2015). BC opioid substitution treatment system: Performance measures 2013/2014. Victoria, BC: Office of the Provincial Health Officer.
All-cause Mortality during OST
08/09 09/10 10/11 11/12 12/13 13/14Total Deaths in OST
Treatment 112 112 114 120 128 128
Deaths per 100 Person Years 1.4 1.2 1.1 1.1 1.1 1.0
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
100
105
110
115
120
125
130
Deat
hs p
er 1
00 P
erso
n-Ye
ars
Tota
l Dea
ths p
er Y
ear
12
Office of the Provincial Health Officer. (2015). BC opioid substitution treatment system: Performance measures 2013/2014. Victoria, BC: Office of the Provincial Health Officer.
Take-Home Naloxone
13
http://towardtheheart.com/naloxone/
http://www.bcpharmacists.org/naloxone
Contributors to Health Outcomes
Health Care System
25%
Biology & Genetics
15%
Physical Environment
10%
Socio-economic determinants
50%
14
Source: Estimation by the Canadian Institute for Advanced Research. Graph reproduced from the Standing Senate Committee on Social Affairs, Science and Technology, The Health of Canadians - The Federal Role, Volume One: The Story so Far, March 2001.
International Context • UN Treaties
– 1961 Convention on Narcotic Drugs – 1971 Convention on Psychotropic
Substances – 1988 Convention Against Illicit Traffic in
Narcotic Drugs and Psychotropic Substances
15
• World Health Organization (WHO) – Methadone and buprenorphine = “essential medicine”
• UNGASS – New York, April 19-21, 2016: – Supply reduction – Demand reduction
Harm Reduction
• Principles: – Pragmatism – Human rights – Focus on harms – Maximize intervention options – Priority of immediate goals – Involvement of people who
use drugs – Reduction of stigma
16
BC Ministry of Health. (2005). Harm reduction: A British Columbia community guide. Victoria, BC: Ministry of Health.
Language & Public Policy
Clinical Practice
Policy (e.g., Legislation & Regulation)
Scientific Research
17
Mass media and public discourse
Language & Drugs • “addiction”
– Latin etymology: dictum (to speak, to say)
• “prescription” – Latin etymology: scriptum (to write)
• “drug” – e.g., “alcohol and drug”
• (drug) “user” – to whom is this label applied? to whom is it not applied? (and why?)
• “clean” – (moral) purity vs. pollution
• “abuse” (or euphemistically “misuse”) – (pseudo-scientific and moralistic) binary antonyms of “use”
18
Use at an early age, or use that may have negative impacts for individuals, family/friends, communities or society e.g., use by minors or pregnant women, impaired driving, binge consumption
Recreational, casual or other use that has negligible health or social effects
Use that has positive health, spiritual and/or social impacts e.g., pharmaceutical drugs used as prescribed; ceremonial uses of tobacco, peyote or ayahuasca
Chronic Dependent Use that has become habitual and compulsive despite negative health and social effects; e.g., addiction
Problematic Beneficial
Non-problematic
Spectrum of Psychoactive Substance Use
First Nations Health Authority, Province of British Columbia and Government of Canada. (2013). A Path Forward: BC First Nations and Aboriginal People’s Mental Wellness and Substance Use – 10 Year Plan. Vancouver, BC.
19
