We have been addressing the public health emergency with a multi-pronged overdose response strategy that aims to reduce the number of overdose deaths in our region.
Since April 2016, Fraser Health has been addressing the public health emergency with a multi-pronged overdose response strategy that aims to reduce the number of overdose deaths in our region. Based on data from the BC Coroners Service, in 2016 Fraser Health communities saw 329 illicit drug overdose related deaths and so far this year there have already been 291. If these trends continue this year, it is projected that Fraser Health communities will see 499 overdose related deaths, which is a 52 per cent increase from last year. We enhanced our surveillance and analytics to help inform our regional response and to target our efforts to focus on the populations and communities that are the most impacted.
Fraser Health’s strategies focus in four areas:
Prevention: Preventing drug use and overdoses and building resilience and mental wellness
Education: Providing training and building awareness of tools and supports available
Harm Reduction: Reducing the health, social and economic consequences of substance/drug use
Treatment: Caring for patients and clients who suffer from substance use
Prevention
Community engagement: Fraser Health staff have led or participated in over 600 community forums, workshops, community engagement and naloxone training sessions held with multi-sectoral partners.
Community forums: Participated in community forums across the region on the overdose crisis in partnership with municipalities, RCMP, school districts and community groups.
School based support: Working with local school districts to support implementation of activities, such as coordinating School District forums, creating substance use related prevention curricula and accessing to harm reduction strategies and naloxone kits.
Business outreach: Outreach to local businesses to inform them on how they can help with overdose prevention, needle recovery, and engaging with individuals on the street through work with businesses and business improvement associations. Currently active in Maple Ridge, Abbotsford, Langley, Hope, Agassiz, White Rock, and other communities.
Targeted industry outreach: As there is a hidden epidemic is disproportionately affecting men between the ages of 19 and 59 in trade industries, Fraser Health is engaging with groups outside the health care sector, such as employers, technical schools, and sports associations, which may be able to assist in identifying and supporting individuals who are struggling with substance use.
Fraser Health Hackathon: In January 2017, Fraser Heath hosted a hackathon where students and local developers competed to find technology-driven solutions to health care challenges facing the region. Four of 16 teams presented on solutions related to the overdose crisis.
Safe prescribing practices: To support safe prescribing practices Fraser Health has approved and trialled the Opioid Withdrawal Protocol, developed and implemented clinical policy for security requirements in the storage of narcotic medication at all acute care sites, and has the Health Authority Medical Advisory Committee Chair undertaking a review of safe prescribing practices across our acute sites/services.
Surveillance
We enhanced our data collection pertaining to overdoses involving a known or suspected opioid-containing substance to help inform our regional response.
- This enhanced data, when coupled with additional information provided by the BC Coroners Service, helps us target our efforts to focus on the populations and communities that are the most impacted.
- We know that 70 per cent of overdoses in our region are occurring in private residences. The majority are men between the ages of 19 and 59 with many working in trade industries.
To connect with this population, we are enhancing our data collection and analysis to better understand their needs, and are working on communications and outreach strategies to better reach them. - Based on the information from our analysis, we are engaging with groups outside the health care sector, such as employers, technical schools, and sports associations, which may be able to assist in identifying and supporting individuals who are struggling with substance use.
Education, Training and Public Awareness Campaigns
Naloxone training: Designed and delivered Naloxone training to community agencies and others throughout the region. Participants include representatives from the RCMP, Ministry of Children and Family Development, provincial correctional centres, housing providers, treatment centres, non-profit community groups, and unregulated recovery houses. Additionally, all Aboriginal Friendship Centres have been trained to distribute Take Home Naloxone kits.
Peer engagement for naloxone distribution: A bi-weekly drop-in engagement group provides youth and young adults who may not otherwise engage with services with increased access to naloxone kits via peer-to-peer distribution. This program is currently operating in Burnaby, with active recruitment taking place in Surrey, Langley, Burnaby and Abbotsford for start this fall.
Public Awareness Campaigns:
- Poster and social media campaign: In summer 2016, Fraser Health launched a poster ad campaign to raise awareness of the overdose crisis in the province. The posters were displayed in various community locations including transit stops, Skytrains, bars and restaurants. The posters were accompanied by a social media awareness campaign and an online overdose information hub at fraserhealth.ca/overdose.
- Video – How to talk to your kids on drugs: In February 2017, Fraser Health produced a video and developed accompanying resources for parents on how to talk to teens about substance use.
- Anti-stigma campaign: In spring 2017, Fraser Health launched an anti-stigma campaign titled Compassion Matters featuring testimonials from a range of people touched by the overdose crisis.
- Webinar series for professional development: A series of webinars available to all Fraser Health staff has been presented on topics including stigma, community response, supervised consumption services, opioid agonist services and surveillance.
Harm Reduction
Supervised consumption services: In June 2017, opened two supervised consumption sites in Surrey located at SafePoint (135A Street) and Quibble Creek Sobering and Assessment Centre (94A Avenue). Both sites were previously overdose prevention sites. As of September 17, 2017, SafePoint has supported 9,745 visits and there have been no overdose deaths. Assessments regarding need for additional sites are being conducted.
Overdose prevention sites: In December 2016, Fraser Health opened overdose prevention sites in Surrey, Langley, Abbotsford and Maple Ridge. These sites ensure a health care professional is nearby to administer naloxone if a person consumes substances and overdoses. When a person is receptive, the sites also play an important role in connecting them to treatment, as well as other health care and community supports. In addition to these sites, overdose prevention strategies are implemented in some of the high risk settings such as low barrier housing and shelters.
Take Home Naloxone kits: Between January 2016 and May 2017, 9,389 Take Home Naloxone kits were dispensed through acute care settings, community offices and agencies, partners and services in all Fraser Health communities. Take Home Naloxone kits are also available in First Nation communities by health care staff.
Safe sharps disposal and recovery: Safe sharps disposal and/or recovery is provided in each community throughout the region.
Surge outreach: Monthly, on weeks when social assistance cheques are issued and during periodic surges in overdose volumes, public health nurses and Mental Health and Substance Use clinicians conduct outreach to areas with high volume of overdoses to distribute Take Home Naloxone, intervene in overdoses, assess and refer people to treatment.
Treatment
Opioid Agonist Treatment clinics: Improved access to first line treatment for opioid addiction (medications like Suboxone and methadone) with clinics currently located in Surrey and Maple Ridge and new clinics coming to Chilliwack, Burnaby, Abbotsford, Mission, and Langley.
Outpatient substance use programs: Outpatient substance use programs include school-based prevention services, individual and group counselling, family support, psycho-education and opioid agonist treatment.
- Two Fraser Health owned/operated outpatient programs provide services for children through school-based services, as well as youth, adults and older adults. While located in Burnaby and Surrey, these services can be accessed by anyone within the region.
- Twenty contracted agencies covering all Fraser Health communities provide outpatient services including three specific to youth, one specific to culturally diverse populations and one to Indigneous populations.
Substance use treatment beds: Increased access to treatment by opening 147 new substance use treatment beds throughout the region, for a total of 465. In addition to these 465 beds, Fraser Health has access to 32 beds at Burnaby Centre for Mental Health and Addictions and 5 at the Heartwood Centre for Women in Vancouver. The 465 beds are a combination of sobering centre mats, withdrawal management, short-term access to recovery, stabilization and transitional living residence and intensive residential treatment beds. These services include specialized support for Indigenous men and women, young men and women ages 19 to 24, and women (including pregnant women). The 465 beds include:
- Intensive Residential Treatment beds: 165 intensive residential treatment beds for adults (including 4 for youth and 22 for young adults 19-24 years old) in five owned and operated/contracted programs. Intensive residential treatmentservices and supports offer an intensive program experience for people 19 years and older with serious substance use issues within a residential setting, supported by qualified and trained health care providers. Programs include group-based and individual educational and counselling sessions, meals, recreational, social and life-skills building opportunities. Programs are usually 35-70 days. While accessible by anyone in the region, these beds are located in Maple Ridge, Abbotsford, Chilliwack and Keremos.
- Stabilization and Transitional Living Residences: 219 beds, including 4 for youth, for individuals post-detox that require additional support. While available to support anyone living within the Fraser Health region, these beds are located in Burnaby, Maple Ridge, New Westminster, TriCities, Surrey, Abbotsford and Agassiz.
- Short-term Transitional Access to Recovery (STAR): 26 STAR recovery beds for people 19 years and older who are homeless, or at risk of homelessness due to substance misuse. STAR programs offer a safe, structured short-stay to help improve individuals’ access to and engagement with services, following a withdrawal management program. While located in Surrey, Abbotsford and Agassiz, these beds are accessible to anyone within the region.
- Creekside Withdrawal Management Service: Located in Surrey, Creekside provides regional access to 24 adult detox and 6 youth detox beds to support people as they detox from alcohol and drugs.
- Quibble Creek Sobering and Assessment Centre and Opioid Agonist Treatment Clinic: Quibble Creek provides medical and substance use care and treatment with 25 mats to Surrey residents.
- Second stage housing units: 26 units for substance use clients post treatment.
DEWY (Day, Evening, Weekend Youth): Two DEWY intensive day treatment programs for youth located in Coquitlam (serving Fraser North including Surrey/Delta) and Langley (serving Fraser South including Maple Ridge/Pitt Meadows). Four additional mobile DEWY cycles will be provided on a one-time basis prior to the end of 2017/28. Each cycle supports 12 youth through a five week program.
Day, Evening Weekend (DEW) Substance Use Treatment Program: an intensive, group-based support program for individuals.
Emergency department Opioid Agonist Treatment: Currently being piloted in Burnaby Hospital emergency department, this new program supports patients to begin treatment with Suboxone while at hospital and be linked to community substance use service for follow-up.
Emergency department follow-up: Within two to three days of visiting an emergency department for an overdose, patients are being supported to access community substance use services. We also provide additional information on harm reduction and treatment options during these interactions. The program is currently being piloted at Surrey Memorial Hospital and will be expanded throughout the region.
Intensive Case Management: Partnering with BC Housing, Fraser Health has implemented an intensive case management team in Maple Ridge to support people with a severe substance use disorder who face complex challenges related to health, housing, and poverty, and face barriers in accessing existing health or social services. A new team will be implemented in Langley this fall.
Outreach teams: Fraser Health has outreach teams in communities, such as Chilliwack and Abbotsford, that provide services to people with serious mental health or substances use concerns that require intensive outreach. In collaboration with existing non-clinical outreach and social services, these services support people in moving towards recovery and link them to housing and treatment.