This document summarizes a thesis defense presentation on reducing fatal drug overdoses in British Columbia. It outlines the opioid overdose crisis in BC, reviews case studies of overdose prevention programs in other jurisdictions, and proposes two policy options to expand overdose education and naloxone training as well as naloxone distribution in BC. The presentation recommends a combination of the options to increase access to lifesaving measures like naloxone training and kits for those at risk of overdose.

1. Life
Won’t Wait:
Reducing Fatal
Drug Overdoses
In British
Columbia
Jordan Westfall
Thesis Defense
April 2nd, 2015.
10:00 A.M.

2. The largest yearly total since 1998.
Too Many British Columbians are Dying of Drug
Overdoses..

4. What happened?
OxyContin, a prescription drug
is taken off the market.
Fentanyl sold as OxyContin or
heroin illicitly.
Led to worst weekend in
Insite’s history for overdoses
(31).
Prescription pain killer
overdoses are also increasing.
Chronic Pain, 22% of BC adults
(Corneil, 2014).
Interior Region- 25, 000 people
on opioid medications (Corneil,
2014).

5. Overdose Prevention in British Columbia
• Take home naloxone program.
• Provides Overdose Education and Naloxone Training (OENT).
• OENT consists of:
• Prevention of OD
• Recognition/Response to OD.
Challenges:
• Available by physician’s prescription only.
• Must take training course.
• Must have a history of opioid use.
How is policy is practiced?

6. Knowledge Gaps
• Barriers to enhancing overdose prevention.
• Drug user awareness of current policy.
• Good practices from other jurisdictions.

7. Purpose of Research
• AIM: To develop policy at the provincial level to reduce
drug overdose fatalities.
• What role can public policy play in reducing fatal drug overdoses in
BC?
• How can provincial legislation reduce fatal drug overdoses in BC?
• How have other jurisdictions reduced fatal drug overdoses?
• Are drug users in Vancouver aware of the VPD’s overdose
prevention policy?

8. Methodology
1) Case Studies:
• Ontario – document analysis
• North Carolina- 2 interviews with NCHRC
• Massachusetts –Document analysis and
interview with Learn2Cope
2) Stakeholder Interviews:
• British Columbia
• VPD
• BCCDC
• Ministry of Justice
• Pivot Legal
• United States
• Harm Reduction Coalition
• National Alliance for Model State Drug
Laws
• Columbia University
3) Survey:
• 28 respondents
• Street-level People who use drugs
• Sampled from Vancouver Network of Drug
Users
• Questionnaire asks about their awareness of
the Vancouver Police Department’s overdose
prevention policy

9. Case StudiesJurisdiction Distribution
Method
Naloxone
Kits
Dispensed
Kits per 1,000
persons
Overdose
Reversals
Highlights
Massachusetts Standing Order 2,444/year
22, 000
(total)
0.36 kits per
1000 people
1,300 • Uses intranasal
naloxone.
• Learn2cope
provides OENT to
family members.
• Police carry
naloxone
Ontario Directive
(similar to
standing
order)
665/year
1,330
(total)
0.10 kits per
1000 people
120 • Restricted Access
• Implementation
issues stopped
program.
North Carolina Standing Order 2700/year
5400 (total)
0.54 kits per
1000 people
350 • Cost-effective
• Broadest access to
naloxone.
British Columbia Physician’s
prescription
650/year
1300 (total)
0.30 kits per
1000 people
125 • Comparative
purposes only.

10. Stakeholder interviews
British Columbia:
• More
education/destigmatization:
• Friends, family, illicit, and
licit drug users.
• Lack of prescribing directive.
• Inefficiency.
• Naloxone by pharmacist’s
prescription.
• Good Samaritan Law.
United States:
• Misconceptions persist.
• Public endorsements increase
acceptability.
• Celebrities, police.
• No evaluation or awareness $
for Good Sam laws.

11. Were you aware of this policy?

12. Other policy considerations
Both VPD and drug users need to
be considered.
• Why not implement a Good Samaritan law?
• Out of scope.
Intranasal naloxone.
• Federal restrictions.
Staggered welfare cheque
distribution.
• No evidence thus far.
IM naloxone- cost effective
Policy Options are divided into two
categories:
1.) Overdose Education and
Naloxone Training (OENT)
2.) Naloxone Distribution

13. Policy Options- OENT
Findings
9.8% of trainings are for
friends & family.
Only those with a history of
opioid use can be
prescribed naloxone.
“Licit” drug users need
OENT
Findings
Most of the province’s
methadone clinics don’t
provide OENT.
Administering naloxone is
empowering for drug
users.
Option A
OENT for “laypeople”
friends, family members,
& licit drug users.
Option B
Dual-incentive
recruitment for illicit
PWUDs.
OENT at methadone
clinics & detox centres.
Criteria and Measures
Effectiveness- Can
bystanders respond
appropriately to an
overdose.
Equity- increase in
representativeness for
non-illicit drug users.

14. Policy Options- Naloxone Distribution
Findings
Having a physician prescribe
naloxone is inefficient.
Licit drug users are overdosing at
an increasing rate.
Adding naloxone to provincial
formulary would make it free for
Blue Cross members.
Findings
Overdose is leading cause of death
among homeless in BC.
Jurisdictions that have liberalized
access to naloxone have higher
amounts of OD reversals.
Option A
Naloxone available by
pharmacist’s
prescription.
Option B
Nurse’s Decision Support
Tool. (DST)
Criteria and Measures
Health & Safety- # of
overdose reversals.
Effectiveness- # of
naloxone kits dispensed.

15. OENT Option A
Strengths
• OENT for underrepresented
groups (family and friends).
• Provides an access point for
support services
• Addresses licit ODs.
• Effective under current
regulations. when laypersons
cannot receive naloxone kit.
Weaknesses
• No support for illicit drug
users.

16. OENT Option B
Strengths
• Empowerment for drug users.
• Reduced “enacted” and “self-
stigma”
• Methadone clinics
• Secondary trainings
Weaknesses
• PWUDs already well
represented under current
efforts (less of an impact)
• Ideological resistance from
detox centres.

17. Naloxone Distribution Option A
Strengths
• Convenience.
• Access for licit drug users and
methadone patients.
• Easy to get follow-up kits.
• Reduces prescribing burden on
physicians.
• Added to Blue Cross
• No need to use Telehealth in rural
regions.
Weaknesses
• Pharma Net.
• Negative externalities.
• Licit drug users have to make
separate trips for OENT and kit.

18. Naloxone Distribution Option B
Strengths
• Cohesion with OENT options.
• Reduces physician prescriber
burden.
• Outreach efforts (street nurses,
etc)
Weaknesses
• Cost inefficiencies
• Clinic or other healthcare visit
required.
• Follow up kits require healthcare
visit.

19. Recommendations
• OENT efforts should be expanded to
focus on friends, family members and
licit drug users.
• Nurse’s DST: helpful for homeless
populations.
• Naloxone distribution by pharmacist’s
prescription for the rest of the
population.
• Each naloxone distribution option is cost
effective.
Future Considerations
• Reduce waitlists for drug rehabilitation
services.
• Drug reformulations can increase
overdoses.
• Instruct police departments not to
respond to overdose 911 calls.

20. Conclusions
BC is leading Canada toward a
rational, scientific drug policy.
Naloxone is not a “magic-bullet”.
But we’re losing ground
to the United States.
Liberal access to naloxone.
Good Samaritan Laws.
Housing, employment training, rehab
services.
These things help people stay
off of drugs.