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Alberta’s provincial take-home naloxone program: A multi-sectoral and multi-jurisdictional response to overdose

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Abstract

SETTING: Alberta is a prairie province located in western Canada, with a population of approximately 4.3 million. In 2016, 363 Albertans died from apparent drug overdoses related to fentanyl, an opioid 50–100 times more toxic than morphine. This surpassed the number of deaths from motor vehicle collisions and homicides combined.

INTERVENTION: Naloxone is a safe, effective, opioid antagonist that may quickly reverse an opioid overdose. In July 2015, a committee of community- based harm reduction programs in Alberta implemented a geographically restricted take-home naloxone (THN) program. The successes and limitations of this program demonstrated the need for an expanded, multi-sectoral, multi-jurisdictional response. The provincial health authority, Alberta Health Services (AHS), used previously established incident command system processes to coordinate implementation of a provincial THN program.

OUTCOMES: Alberta’s provincial THN program was implemented on December 23, 2015. This collaborative program resulted in a coordinated response across jurisdictional levels with wide geographical reach. Between December 2015 and December 2016, 953 locations, including many community pharmacies, registered to dispense THN kits, 9572 kits were distributed, and 472 reversals were reported. The provincial supply of THN kits more than tripled from 3000 to 10 000.

IMPLICATIONS: Alberta was uniquely poised to deliver a large, province-wide, multi-sectoral and multi-jurisdictional THN program as part of a comprehensive response to increasing opioid-related morbidity and mortality. The speed at which AHS was able to roll out the program was made possible by work done previously and the willingness of multiple jurisdictions to work together to build on and expand the program.

Résumé

LIEU : L’Alberta, une province des Prairies de l’Ouest canadien, a une population d’environ 4,3 millions d’habitants. En 2016, 363 Albertains sont décédés de surdoses apparentes de fentanyl, un opioïde 50 à 100 fois plus toxique que la morphine. Ce chiffre a dépassé le nombre de décès par collision entre véhicules automobiles et de décès par homicide combinés.

INTERVENTION : La naloxone est un antagoniste opioïde sûr et efficace qui peut rapidement neutraliser une surdose d’opioïdes. En juillet 2015, un comité d’intervenants de programmes communautaires de réduction des méfaits de l’Alberta a mis en œuvre dans une zone géographiquement restreinte un programme de « trousses maison de naloxone » (TMN). Les réussites et les contraintes de ce programme ont démontré le besoin d’une intervention élargie, multisectorielle et intergouvemementale. L’autorité sanitaire provinciale, Alberta Health Services (AHS), s’est servie des processus établis du système de commandement en cas d’incident pour coordonner la mise en œuvre d’un programme de TMN provincial.

RÉSULTATS : Le programme de TMN provincial de l’Alberta a été mis en œuvre le 23 décembre 2015. Ce programme concerté a coordonné une intervention intergouvernementale de grande portée géographique. Entre décembre 2015 et décembre 2016, 953 établissements, dont de nombreuses pharmacies communautaires, se sont inscrits au registre pour pouvoir dispenser des TMN, 9 572 trousses ont été distribuées, et 472 surdoses neutralisées ont été déclarées. Les approvisionnements provinciaux en TMN ont plus que triplé, passant de 3 000 à 10 000.

CONSÉQUENCES : L’Alberta était singulièrement bien placée pour offrir un vaste programme de TMN multisectoriel et intergouvememental à l’échelle de la province dans le cadre d’une intervention globale face aux hausses de la morbidité et de la mortalité liées aux opioïdes. La vitesse à laquelle AHS a pu déployer le programme s’explique par le travail effectué antérieurement et par la volonté de plusieurs sphères de compétence de travailler ensemble pour renforcer et développer le programme.

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Author information

Authors and Affiliations

  1. Faculty of Medicine and Dentistry, University of Alberta, Canada

    Lisa K. Dr. Freeman MD, FRCPC (Assistant Clinical Professor, Senior Resident)

  2. Alberta Community Council on HIV, Lethbridge, AB, Canada

    Stacey Bourque MEd (Executive Director, ARCHES and Chair)

  3. Medical Officer of Health, Calgary Zone, Calgary, AB, Canada

    Nick Etches MD, FRCPC (Medical Director)

  4. Public Health, Calgary Zone Alberta Health Services, Calgary, AB, Canada

    Nick Etches MD, FRCPC (Medical Director)

  5. Medical Officer of Health, Alberta Health Services, Lethbridge, AB, Canada

    Karin Goodison MD, FRCPC

  6. Safeworks, Calgary Zone Alberta Health Services, Calgary, AB, Canada

    Claire O’Gorman BScN, MPH (Program Coordinator)

  7. Addiction & Mental Health Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada

    Kay Rittenbach PhD (Assistant Scientific Director, Adjunct Assistant Professor)

  8. Medical Officer of Health, Alberta Health Services, Edmonton Zone, Edmonton, AB, Canada

    Christopher A. Sikora MD, FRCPC

  9. Poison and Drug Information Service (PADIS), Calgary, AB, Canada

    Mark Yarema MD, FRCPC (Medical Director, Section Chief, Clinical Associate Professor)

  10. Public Health and Preventive Medicine, Alberta Health Services, Edmonton, AB, Canada

    Lisa K. Dr. Freeman MD, FRCPC (Assistant Clinical Professor, Senior Resident)

  11. Locum Regional Medical Officer of Health, Nova Scotia Health Authority, Canada

    Lisa K. Dr. Freeman MD, FRCPC (Assistant Clinical Professor, Senior Resident)

  12. Department of Psychiatry, University of Alberta, Calgary, AB, Canada

    Kay Rittenbach PhD (Assistant Scientific Director, Adjunct Assistant Professor)

  13. Clinical Pharmacology and Toxicology, Alberta Health Services, Calgary, AB, Canada

    Mark Yarema MD, FRCPC (Medical Director, Section Chief, Clinical Associate Professor)

  14. Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada

    Mark Yarema MD, FRCPC (Medical Director, Section Chief, Clinical Associate Professor)

Authors
  1. Lisa K. Dr. Freeman MD, FRCPC
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  2. Stacey Bourque MEd
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  3. Nick Etches MD, FRCPC
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  4. Karin Goodison MD, FRCPC
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  5. Claire O’Gorman BScN, MPH
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  6. Kay Rittenbach PhD
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  7. Christopher A. Sikora MD, FRCPC
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  8. Mark Yarema MD, FRCPC
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Corresponding author

Correspondence to Lisa K. Dr. Freeman MD, FRCPC.

Additional information

Acknowledgements: Those who provided their input by interview: Alberta Community Council on HIV: Marliss Taylor; Alberta Health: Michelle Craig, Keely McBride; Alberta Health Services: Dianne Dyer, Alexis Mageau, Domhnall Odochartaigh, Amy Woroniuk; First Nations and Inuit Health Branch, Health Canada: Chris Sarin. Numerous other people within AH, AHS, ACCH and other organizations were instrumental in the roll-out and continued operation of the THN Program.

Conflict of Interest: None to declare.

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Dr. Freeman, L.K., Bourque, S., Etches, N. et al. Alberta’s provincial take-home naloxone program: A multi-sectoral and multi-jurisdictional response to overdose. Can J Public Health 108, 398–402 (2017). https://doi.org/10.17269/CJPH.108.5989

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  • DOI: https://doi.org/10.17269/CJPH.108.5989

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