Post on 25-Dec-2015
transcript
Communicating Illicit Drug HarmsTo warn or not to warn; that is the question
PHPC CPD symposium May 24, 2015
Jane BuxtonDrug Overdose and Alert Partnership
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None to declare• I have no relationship with any pharmaceutical
company or communications firm
Conflict of interest
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• Lessons learned• Communicating Drug Alerts• Sharing information (DOAP)• Mass media campaign (fentanyl)• Do no harm- unintended consequences
Overview
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Coroners warning - heroin potency
Lessons learned re messaging
Didn’t identify where issue was - people assumed was Vancouver DTES
Language – ‘at least twice as potent’; encouraged people to seek out ‘potent’ drugs
Need to engage service providers & people who use drugs (PWUD) to develop appropriate messaging
Recommend use INSITE but often at full capacity and only one in Vancouver DTES
Media message doesn’t reach PWUD who needed to know urgently
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Goal: Develop evidence-based guidelines to effectively communicate drug alerts to service providers and people who use drugs (peers).
• What are the perceptions and beliefs of peers regarding adulterated drugs?
• How do peers suggest drug alerts can be better communicated to meet their needs?
CDA: Research questions
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Literature Review 4 focus groups with peers (n=22)
Age 19+ years (23-70yrs; mean 48yrs)>50% identified as AboriginalUsed illicit drugs in the past 7 days (various drugs)UBC ethics - informed consent
5 interviews with 5 frontline health staff
Methods
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Theme Sub-theme
Drug Quality Assurance Practices
• Relationships esp. dealer• Quality assurance tests
Communication Pathways PWUD know first
Improving communications •Timeliness• Mode of communication• Language•Content of posters
Findings
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Timeliness: “Don’t wait for the third person to die. If somebody OD’s off of it, find out why and which type of dope it was and then report it. Don’t wait for those one or two more to go” – FG 4, Female Participant
Mode: Use every possible means• Local organizations• Health or other service providers• Word on the street• Online sources• Free newspapers
Improving Communication:
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Brief, simple & clear messages Use words that imply harm (toxic, dangerous, lethal)
Date posters and remove Say what to look for & what to do
“… when somebody does come out with the ‘potent’ stuff, the word spreads real quick on who has it” – FG 2, Male Participant
Language & content messages
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Example
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Drug Overdose and Alert Partnership
DOAP
Law Enforcement
Labs
Health
Ambulance
Coroners
Drug & Poison Info
Centre
Researchers (CARBC, CfE)
Peers
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Goal: to coordinate stakeholder communication and action to enable timely alerting and appropriate responses to illicit drug use issues.
Inter-sectoral collaboration
• Collect, collate and share data• Password protected website• Face to face meetings (4x/year + PRN)
• Develop trust between partners• Partners share perspectives to inform and interpret• Identify who and how to contact in urgent situation
• Pharmacy break-in• Sudden increase ODs at Insite
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WEEKLY UPDATES• VCH ODs – ER & Insite• DPIC exposure calls• Ambulance calls for ingestion
poisonings
BC CORONERS• Monthly Illicit Drug OD Deaths• Specific reports PRN
• Fentanyl-detected• Prescription opioids
BC AMBULANCE• Naloxone administration
Surveillance Data
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Inter-sectoral collaboration
• Collect, collate and share data• Password protected website• Face to face meetings (4x/year + PRN)
• Develop trust between partners• Partners share perspectives to inform and interpret• Identify who and how to contact in urgent situation
• Pharmacy break-in protocol• Sudden increase ODs at Insite
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April to June 2012
July to September
2012
October to December
2012
January to March 2013
April to June 2013
July to September
2013
October to December
2013
January to March 2014
April to June 2014
July to September
2014
October to December
2014
0
10
20
30
40
50
60
70
80
90
100
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Fentanyl-Detected Deaths in Apparent Drug Circumstances Non-Fentanyl-Detected Deaths in Apparent Drug Circumstances
Proportion of Fentanyl-Related Deaths Linear (Proportion of Fentanyl-Related Deaths)
Nu
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Pro
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Dea
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PHO alert Coroners alertCoroners data: 2012-2014
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Patches only ex. pharmacy break-in
Powdered fentanyl mixed with/sold as heroin
Fake oxy; green monsters/jellies
Enforcement:• March 2014 - 300 pills seized/tested• Analysis flaps Thanksgiving Insite OD • Fentanyl powder thought imported
and pressed into pills locally
Coroners data• Fentanyl-detected deaths, provisional
data 2014 o young adults, o 2/3 did not inject, o <1/4 in Vancouver in DTES
Photo from CCENDU alert
Fentanyl
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Multi-stakeholder working group
Target audience PWUD:• Inexperienced/infrequent users• Recreational setting• 18-40yrs
Feedback from:• DOAP agencies• MHSU & outreach workers• Youth who use drugs
Facebook ads:• 18-40yrs, 25 mile radius major cities• Mar 2-16: had 213,748 views
PSA campaign
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• Participants (PWUD)• DOAP members• Harm reduction team
at BCCDC • Stream of wonderful
residents, medical and MPH students
• CCENDU funding for CDA project
Acknowledgements
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Take home messages:• Unregulated market -don’t know what you’re taking• PWUD trust their dealer• Alerts – wording (toxic, lethal); timely, multi-modes, facts
• Standard opioid harm reduction messages apply:Don’t use alone Taste (inject) small amount drug
first
Have a plan Don’t mix drugs or drugs/alcohol
Carry naloxone Get help if OD occurs
Discussion:Do no harm - unintended consequences
PMMA in ecstasy; Levamisole in cocaine
Kerr et al 2013; Duty to warn;
Who is the audience?
Paternalistic choose what to inform