(O.10) Opioid Crisis & SCS: Case Study

Question 1

Opioids

Answer 1

= prescribed pain relief medications
○ codeine (in Tylenol 3)
○ fentanyl (Duragesic)
○ morphine (Doloral)
○ oxycodone (OxyContin, Percocet)
○ hydromorphone (Dilaudid)
○ medical heroin

**produced or obtained illegally too

Question 2

Opioids may be (3 things)

Answer 2

1. naturally occurring: made from liquid harvested from the unripe seed pods of the opium poppy flower
   - codeine and morphine
2. semi-synthetic: modifying the chemical structure of naturally occurring opioids
   - heroin, oxycodone
3. Synthetic: manufactured chemicals
   - methadone

Question 3

Opioids are taken in many ways, including

Answer 3

• tablets
• skin patches
• injections

Question 4

Use (particularly long-term use) can lead to ….

Answer 4

• increased tolerance
• physical dependence
• substance use disorder (i.e., addiction)
• overdose (among other health issues)

Question 5

Most significant dangers are with _____

Answer 5

fentanyl

(Mostly what we talk about when referring to opioid crisis)

Question 6

Approximately _____ people in Ontario filled an opioid prescription in 2015/16 (___% of the population)

Answer 6

1/7
14%

Question 7

commonly prescribed opioids & their strength

Answer 7

codeine = 0.15x
morphine = 1
oxycodene = 1.5x
hydromorphone = 5x
fentanyl = 50-100x

Question 8

Not having a way to consistently track opioid related deaths across provinces that allows us to measure/compare shows a ______ issue

Answer 8

policy

Question 9

cases of opioid related morbidity & mortality, most common in

Answer 9

• men
• 30s/40s

Question 10

Causes are multifactorial, but primarily include: _______ for legal/licit, and _______ for illegal/illicit

Answer 10

Legal/licit = high rates of opioid prescribing

Illegal/illicit = emergence of strong synthetic opioids (ex. fentanyl) in the illegal drug supply
*fentanyl is a cheap way to make street drugs more powerful

Question 11

Harm reduction

Answer 11

a set of strategies to reduce the negative consequences associated with unhealthy or harmful practices or behaviours

*Acknowledging we will be unsuccessful in completely abolishing
*Putting efforts into helping those who will be using anyways

Question 12

Prevalence reduction

Answer 12

Eliminate/abolish/prohibit unhealthy or harmful practices or behaviours

= often via criminalization

Question 13

policy responses (feeds into prevalence/harm reduction)

Answer 13

• Provide help (in whatever form) to those taking opioids
  ○ Hotlines .etc
• Provide support to individuals to help stop taking opioids
• Provide services to ensure opioid use is as safe as possible
  ○ Needle exchange program, sterile equipment
• Provide resources to the public to prevent opioid-related overdoses
  ○ Free naloxone kits
• Reduce/change opioid prescribing practices
• Change pharmaceutical marketing practices
  ○ Avoid advertising in media
  ○ Change to physician referrals
• Reduce the illegal production, supply, and trafficking of opioids
  *Main issue? = put majority of resources

Question 14

Target individuals taking opioids

Answer 14

• Wellness Together Canada (help line)
  
  • National Overdose Response Service (NORS hotline)
  • Drug rehab services
  • Narcotics anonymous
  • Overdose Intervention App
  • Harm reduction supplies (e.g., sterile needles)
    
    • Supervised consumption sites and services

Question 15

Target the general public

Answer 15

*Raise awareness about opioids, overdoses, and other policies directed at reducing opioid-related harms

*Opioid response training (ex. St. John’s Ambulance)

*Free naloxone kits and training
(Ontario supports)

Question 16

Target health practitioners

Answer 16

*Target those prescribing

*MyPractice
- Identify and track those being dispensed opioid prescription
- Can compare how numbers compare to regional/provincial averages
- Provide good prescribing practices

Question 17

Canadian Drugs and Substances National Strategy (7 strategies)

Answer 17

1. Prevention strategies
   ○ opioid prescribing guidelines, handouts for patients
2. Treatment strategies
   ○ promoting evidence-based approaches to treatment, alternatives, rehabilitation
3. Enforcement strategies
   ○ reduce controlled substances being diverted from otherwise legal activities (pharmacies)
4. Harm reduction strategies
   ○ safe consumption sites
5. Evidence strategies
   ○ systematically collect information about opioids and their harms
6. Funding strategies
   ○ provide grants to community-led organizations to respond to drug issues
7. Consultation strategies
   ○ Consult with those affected to gather input from impacted communities

Question 18

Change laws - Good Samaritan Drug Overdose Act

Answer 18

= federal law that came into force in 2017 that provides some legal protection for people who experience or witness an overdose and call 911 or their local emergency number for help

Can protect individuals from:
1. Charges for possession of a controlled substance
2. Breach of conditions in probation orders, parole, etc.

*applies to anyone seeking emergency support during an overdose

Question 19

Safe consumption sites

Answer 19

= designated sites where people can use their own drugs under the safety and support of trained personnel

Commonly offer a range of evidence-based harm reduction services
- drug checking (check for fentanyl)
- provides access to important health and social services, including substance use treatment

Question 20

Primary objectives of safe consumption sites are to

Answer 20

• Help prevent overdose deaths
  
  • drug checking and emergency medical care
  • people are not rushing or using alone

*Provide health care
- wound care

• Facilitate entry into addiction treatment programs and other health and social services
  
  • housing, employment assistance, and food banks

*Reduce the spread of bloodborne infections (HIV, hepatitis C), by providing access to clean drug use equipment and safe disposal, as well as testing/screening
- Protects public too by avoiding unsafe disposal of equipment

*Reduce the strain on emergency medical services

Question 21

T or F: SCS are part of the prevention approach to the Canadian Drugs and Substances Strategy

Answer 21

F: harm reduction approach

• evidence shows clearly that they help to save lives and improve health
• also shows that SCS are cost effective and do not increase drug use and crime in the surrounding area
• Save lives - primary value

Question 22

___ sites currently offering services in Canada
____visits take place every day
_____ visits per day at busiest SCS

Answer 22

39
~2,700
~400

Question 23

Urgent public health need sites

Answer 23

= similar to supervised consumption sites, but established on a TEMPORARY basis to respond to urgent needs in a specific region or community

• Can put up temporary site if need is urgent and process for SCS is too long

Question 24

T or F: overdose prevention sites = SCS

Answer 24

F: overdose prevention sites = Urgent public health need sites

Question 25

Class exemptions under the Controlled Drugs and Substances Act authorize the _________to establish urgent public heath need sites as required

Answer 25

= Minister of Health in each province and territory

*Minister of Health’s discretion if they wish to implement the class exemption or not
* if your Minister of Health is not establishing any urgent public health need sites in your province or territory, you may apply to set one up in your community by emailing exemption@hcsc.gc.ca”