A leading-edge pilot project in the St. Paul's Hospital Emergency Department (ED) will provide opioid overdose patients with take-away treatment upon leaving the hospital.
The program is a first in Canada in terms of its low-barrier approach, with an emphasis on pre-prepared, to-go packs, easy-to-understand instructions, and a well-defined follow-up care plan. By providing these patients with a take-home supply of Suboxone right out of the emergency department, St. Paul's Hospital addiction physician Dr. Keith Ahamad hopes this innovative approach will ultimately save lives.
With this new practice, patients with opioid use disorder who are being treated for an opioid overdose in the ED will see a doctor, then receive a three-day supply of Suboxone from a specially-trained addiction nurse. Detailed information on follow-up treatment and community resources will be provided as well.
Suboxone is a brand name combination pill of two active ingredients – buprenorphine and naloxone – which can treat opioid addiction by stopping cravings and withdrawal symptoms, and it can also prevent overdose deaths. In addition, the medication has a much better safety profile compared to methadone and is recommended as the preferred first line of treatment by the BC Centre on Substance Use. Suboxone is one type of opioid agonist treatment (OAT).
"Currently, overdose patients are seen in emergency rooms all over the province, resuscitated, and never given a chance to start life-saving treatment," explains Dr. Ahamad. He says it's like a patient after a heart attack not being started on treatment for heart disease. "We want to reduce as many barriers as possible to get these high-risk patients started on treatment, stabilized, and then engaged in follow-up care. We think the emergency room is a natural place to start, same as we do with many other diseases after an acute life-threatening event."
Dr. Andrew Kestler, ED physician at St. Paul's, says many emergency patients already have difficulties filling their prescriptions. "It can be even more difficult for someone who may have a history of substance use and a mental health condition. The take-away doses will maximize access to Suboxone for some of our most vulnerable patients."
St. Paul's Hospital sees the majority of overdoses in Vancouver Coastal Health region, almost 10 times more than other hospitals.
"Many of these patients are not coming to the hospital to seek addiction treatment, necessarily. If we can get them to try treatment, build trust, and understand that we see this as a health issue, that is a huge step forward," says Dr. Ahamad. Previous studies have shown more than two-thirds of those who have died from an overdose had been to an ED in the year prior to their death.
The pilot, which will run for the next two years and then evaluated for results and future use.
For information on overdoses visit www.vch.ca/overdose.