Whitehorse Daily Star

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Dr. Brendan Hanley

Opioid overdose plan is ongoing work

After experiencing more than a dozen related deaths in the territory over the last two years,

By Palak Mangat on November 14, 2018

After experiencing more than a dozen related deaths in the territory over the last two years, the Yukon government formally released its opioid action plan Tuesday.

The $500,000 strategy details some of the activities of the government over the last two years and those that will carry the Yukon into 2020.

Broken down into four categories of public awareness, surveillance, harm reduction and improved addictions and pain management, it makes reference to a fentanyl awareness campaign, take-home naloxone kit program and fentanyl drug checking services that have already been in the works.

Speaking generally about the strategy this morning, the territory’s chief medical officer of health explained it was reflective of a work.

“It’s responding to an acute situation on top of a chronic situation,” said Dr. Brendan Hanley, adding that may make it difficult to put hard figures around future efforts.

There are, of course, priority areas that can be refined in the short term and those that are part of the larger overall picture.

It was difficult, for example, to predict the supply needed for the demand of take-home naloxone kits, Hanley said.

“Probably destinations that we didn’t necessarily anticipate in the beginning” have shown an interest in them, like rural areas, “as the word gets out there and we get requests.”

Health and Social Services (HSS) Minister Pauline Frost has been questioned frequently in the legislature and committee by both the Yukon Party and Yukon NDP this sitting about what exactly the details of the strategy would include.

Some of those related questions came as recently as last week, with the minister explaining in committee discussions the $500,000 came from Ottawa.

NDP MLA Kate White also questioned on Nov. 8 what exactly the expansion of a drug testing program, as proposed in the released strategy, meant.

“We need to look at those hours, because I’m sure drugs are consumed throughout the 24-hour span,” White said last week. She suggested more testing services be offered closer to the evening than in the morning, or even serve outside of the 8:30 a.m. to 4:30 p.m. workday hours.

“I recognize and appreciate the Monday to Friday doesn’t work for everyone,” Frost said in response. “But it’s the first time this has been offered in the Yukon.”

White wondered if the government would consider offering it through the Many Rivers outreach van, something that Hanley explained today might be a consideration to expand services.

“We don’t have people lining up to get drugs tested – just the establishment was itself an achievement,” he added.

That may be because the site of the drug-checking services at the Blood Ties Four Direction Centre (which launched a pilot program earlier this year) required an exemption from Health Canada.

Even though the most demand is in the Whitehorse area, Hanley said it still has a “relatively low intake.

“We were breaking down some barriers to establish a service in the first place, now we’re going to look at what are the possibilities of how we could make that more accessible as a rural service.

“And that’s not an easy thing to do.”

The van option is still being mulled over, though, he added, noting a mobile site would need to be also be ran by Health Canada before proceeding.

As for short-term actions, Hanley sees much of them as already being implemented, though the government could improve their public awareness to focus on those that may be missed.

“People are still getting overdosed; there are ongoing deaths from fentanyl,” he said in reference to the 16 opioid-related deaths since 2016. “So clearly we’re not doing enough in public awareness.”

As for the strategy itself, it notes that public awareness and education campaigns, in particular around recognizing mental health and addiction as a chronic disease, is of special importance going forward.

This can help reduce stigma of a “moral failure of the individual” for drug users, along with educating students in grade 10 to 12 by sharing “party safe” cards. The latter is something that has already been done, with the territory sharing 1,250 phone and wallet cards to that age group.

Focusing on harm reduction, the document notes there have been 1,900 kits shared across the Yukon (without a prescription) and the position of an opioid overdose prevention coordinator created.

That person works out of the Sarah Steele Building and oversees the inventory, database and offers training to the public on how to use the naloxone kits.

In the coming years, the government hopes to expand the fentanyl drug check service and kit programs, while reducing barriers for those needing them.

To address the surveillance of opioids, the document references the Public Health Agency of Canada as providing a public health officer from late 2017 to March of next year to help surveil the plan for the territory.

That will be paired with with the Drug Information System (DIS) at HSS, that will help track which pharmacies are dispensing opioids in Yukon communities. The system acts as repository of all drugs and the government says it will ensure that health professionals have the most up to date medication profile for each Yukoner.

That’s because the profile will feature a list of allergies, conditions, adverse reactions and other medications the individual has been subject to.

The last pillar of opioid pain management is one that relies on a working group that was established in early 2017, which has identified priority areas for the next two years. The priorities include prevention, screening, prescribing, care delivery/service coordination, maintenance/monitoring, managing high risk transitions and effective pain management. The document breaks down the seven areas and some actions over the past years as the following:

• care delivery/service coordination: combined methadone program with other substance user services at Referred Care Clinic Yukon, and provided coverage for Yukoners who don’t have insurance or funding for Suboxone/methadone prescriptions;

• prescribing, maintenance/monitoring and screening: educate care providers (like those at Whitehorse General Hospital) on use of Suboxone;

• managing high-risk transitions: share naloxone kits, train workers at Whitehorse Corrections, hospitals and Mental Wellness Substance Use Services;

• prevention: public awareness of risks of fentanyl, signs of overdose, 11 new workers hired for rural areas focusing on mental wellness and substance use; and

• effective pain management: drafted guiltiness that encourage opioid use as a means of rehabilitation and mobility rather than treatment.

Meanwhile, accessibility for rural areas has been a theme since the beginning of the strategy, Hanley explained.

“You can’t do it unless you have the wraparound supports,” he said, noting the next step would include offering Suboxone to those who want to return to their communities.

As per the funding for the strategy: HSS spokesperson Julie Menard explained this morning that the agreement with the feds was still being finalized and details of it are expected sometime before Christmas. It will be used to support the Referred Care Clinic and other treatment services.

Frost noted in committee discussions on Nov. 8 that the hospital has seen about 14 overdoses from fentanyl ultimately leading to deaths, from 2016 to 2017. As of this year, there have been two more confirmed cases and at least 26 overdose visits.

Meanwhile, a departmental webpage shows that naloxone kits include things like alcohol wipes, two syringes, two vials of naloxone, and a CPR face shield.

Those wishing to get their hands on the kits can pick them up at a number of locations: they include the Walmart, Shoppers Drug Mart and Save-on foods pharmacies, Blood Ties and hospitals (among others).

Documents provided by HSS also lay out some of the signs linked to overdoses: they include slow or no breathing, cold and clammy skin, blue nails and lips and tiny pupils. Those suspecting an overdose are urged to call 911 right away, as naloxone kits are temporarily effective for up to 90 minutes, and the drug itself takes about three to five to kick in to reverse the overdose.

Comments (4)

Up 4 Down 0

Jonah Whale on Nov 17, 2018 at 1:48 pm

This crisis is a case of poisoning.

Up 16 Down 7

north_of_60 on Nov 16, 2018 at 3:38 pm

Despite endless dollars spent on 'education' some people are committed to slow suicide. Let 'em be. When they eventually opt out for good it makes more space in the limited health care queue for people who want to be healed and will make a personal commitment to make it happen.

Up 7 Down 6

PedroFerrero on Nov 16, 2018 at 9:30 am

My partner just received training in overdose identification and treatment, with nolaxone. Just remember folks, if users overdose then THEY and THEY ( and their supplier perhaps ) alone are responsible. Training is available but Injecting into an orange is not the same as injecting into a user experiencing convulsions. First Responders and Community Support Workers are NOT responsible if the antidote or its application fails. Seems an obvious point, but get this fact known.

Up 9 Down 1

Groucho d'North on Nov 15, 2018 at 2:18 pm

Reading this story I got the sense that I had read all of these methods before and frequently enough so that they formed a recognized and predictable way of doing things: Public awareness, surveillance, harm reduction and some kind of management at the final stages, perhaps these tools are used to the point of being a formulaic approach to addressing these social demons. FASD, substance abuse of any kind, bullying, reducing your carbon footprint and a multitude of other campaigns all use the same formula to try and make some positive impacts with their intended audiences.
The success stories are few and far between, there may be some statistical report that doesn’t say very much - they seldom do. Success stories don’t get reported very often so there is little positive news being shared on what worked. Perhaps we could study what works and why before we spend more budgets on the same cycle of repetition. Also roll the dice a bit and open up the discussion for others to propose campaigns for identified social problems. Perhaps some of these non-traditional players would create methods that did promote some measurable successes. How many campaigns are developed by people far removed from the realities of what they are trying to affect? If it looks like a duck, sounds like a duck and it walks like a duck, send a duck to talk with it, the rabbit will not have the same empathy.

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