Process evaluation of the Prevent Overdose in Toronto (POINT) program

Leece, Pamela; Gassanov, Margaret A.; Hopkins, Shaun; Marshall, Chantel; Millson, Peggy; Shahin, Rita

doi:10.17269/cjph.107.5480

Cited by 4 publications

(6 citation statements)

References 16 publications

(37 reference statements)

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“…The observed growth in naloxone uptake in these populations is encouraging, as it suggests that the ONPP is providing access to individuals who may witness an opioid overdose and be in a position to administer this product. [6, 12] Future work is needed to better characterize this group, their reasons for accessing naloxone, and to compare the facilitators or barriers to naloxone access that exists for different patient populations through the ONPP.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Furthermore, the number of opioid-related deaths in Ontario has increased more than 778% since 1991, and in 2015 represented 1 in 133 deaths among Ontario residents. [3–5] Although several legislative and educational interventions have been undertaken to counter escalating rates of opioid overdose and death,[6, 7] these rates continue to grow. [2] Consequently, enhanced access to harm reduction interventions is increasingly advocated for mitigating the risk of opioid overdose and death.…”

Section: Introductionmentioning

confidence: 99%

“…[8] Because of its efficacy and safety, increased access to take-home naloxone has been endorsed by the World Health Organization. [9] As a result, many jurisdictions and agencies within Canada, the United States and the United Kingdom have introduced take-home naloxone programs as part of their opioid overdose harm reduction strategies,[6, 8] which have been generally well-received by the public and stakeholders. [6, 10, 11] Evaluations of take-home naloxone programs have found that they reduce opioid-related mortality[8] and encourage bystanders to take action.…”

Section: Introductionmentioning

confidence: 99%

“…[9] As a result, many jurisdictions and agencies within Canada, the United States and the United Kingdom have introduced take-home naloxone programs as part of their opioid overdose harm reduction strategies,[6, 8] which have been generally well-received by the public and stakeholders. [6, 10, 11] Evaluations of take-home naloxone programs have found that they reduce opioid-related mortality[8] and encourage bystanders to take action. [12] Importantly, these interventions have also been found to be cost-effective in the context of naloxone provision to people using heroin.…”

Section: Introductionmentioning

confidence: 99%

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The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

et al. 2019

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BackgroundNaloxone is a life-saving antidote for opioid overdoses. In June 2016, the Ontario government implemented the Ontario Naloxone Program for Pharmacies (ONPP) to enhance access to naloxone.ObjectiveWe examined the initial uptake of naloxone through the ONPP and characteristics of the individuals receiving and pharmacies dispensing naloxone kits.MethodsWe conducted a population-based study of all Ontario residents who received a naloxone kit between July 1, 2016 and March 31, 2018. This involved 1) a cross-sectional analysis of monthly rates of kits dispensed; and 2) a descriptive analysis of all individuals and pharmacies who accessed and dispensed naloxone, respectively. We stratified individuals according to their opioid exposure as: prescription opioid agonist therapy (OAT) recipients, prescription opioid recipients, those with past opioid exposure and those with no/unknown opioid exposure. We calculated a Lorenz curve comparing the cumulative percent of naloxone-dispensing pharmacies and cumulative percent of naloxone kits dispensed and the corresponding Gini coefficient.ResultsNaloxone dispensing through the ONPP increased considerably from 1.9 to 54.3 kits per 100,000 residents over the study period. In this time, 2,729 community pharmacies dispensed 91,069 kits to 67,910 unique individuals. Uptake was highest among prescription OAT recipients (40.7% of OAT recipients dispensed at least one kit), compared with 1.6% of prescription opioid recipients, 1.0% of those with past opioid exposure and 0.3% with no/unknown opioid exposure. Naloxone dispensing was highly clustered among pharmacies (Gini = 0.78), with 55.6% of Ontario pharmacies dispensing naloxone, and one-third (33.7%) of kits dispensed by the top 1.0% of naloxone-dispensing pharmacies.ConclusionThe ONPP launch led to a rapid increase in the number of naloxone kits dispensed in Ontario. Although the program successfully engaged people prescribed OAT, efforts to increase uptake among others at risk of opioid overdose appear warranted. Opportunities for expanding pharmacy participation should be identified and pursued.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

et al. 2019

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“…Abbreviated point-of-care OEND training according to the training programme adapted from the Toronto Public Health Prevention Overdose in Toronto (POINT) programme 24 25. The key aspects of this training are:…”

Section: Methodsmentioning

confidence: 99%

Protocol for a mixed-methods feasibility study for the surviving opioid overdose with naloxone education and resuscitation (SOONER) randomised control trial

et al. 2019

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IntroductionThe surviving opioid overdose with naloxone education and resuscitation (SOONER) project uses co-design and trial methods to develop and evaluate a point-of-care overdose education and naloxone distribution (OEND) tool. We plan to conduct a randomised controlled trial to assess the effectiveness of our OEND tool in comparison with best available standard of care by observing participants’ performance as a responder to a simulated overdose. Recruiting and retaining people at risk of or likely to witness opioid overdose raises scientific, logistical and bioethical challenges. A feasibility study is needed to establish the effectiveness of recruitment and retention strategies and acceptability of study procedures prior to launching the full trial.Methods and analysisStrategies to enhance recruitment include candidate-driven recruitment, verbal informed consent, and attractive, destigmatising materials. Adults at risk of or likely to witness opioid overdose will be recruited through an urban emergency department, inpatient and ambulatory addiction medicine service, and outpatient family practice settings. Participants randomised to the intervention arm will receive our OEND intervention; those in the control arm will be referred to existing OEND programme. Retention procedures include participant reminders, flexible scheduling, cash and comfort compensation, and strategies to maintain a consistent relationship between individual study staff and participants. Within 2 weeks following recruitment, participants will engage as a responder to a manikin-simulated overdose, and complete overdose knowledge and attitudes questionnaires. The primary outcome is recruitment and retention feasibility, defined as the recruitment of 28 participants within 28 days of recruitment and <50% attrition at the overdose simulation. Staff and participant feedback will also be collected and considered.Ethics and disseminationThe study has been reviewed by ethics boards at St. Michael’s Hospital, Toronto Public Health and the University of Toronto. Dissemination will occur through peer-reviewed publication and presentations.Trial registration numberClinicalTrials.gov registry (NCT03821649).

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Knowledge and possession of take-home naloxone kits among street-involved youth in a Canadian setting: a cohort study

Goldman-Hasbun¹,

DeBeck²,

Buxton³

et al. 2017

Harm Reduct J

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BackgroundThe distribution of take-home naloxone (THN) kits has been an important strategy in reducing overdose fatalities among people who use drugs. However, little is known about the use of THN among youth who are street-involved. The present study explores knowledge and possession of THN among street-involved youth in a Canadian setting.MethodsData were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth age 14–28 at enrollment in Vancouver, Canada. Participants completed a standardized questionnaire, which included items related to knowledge and possession of THN, sociodemographic characteristics, and substance use-related factors. Multivariable logistic regression models were used to identify factors independently associated with knowledge and possession of THN.ResultsBetween December 2014 and November 2016, 177 youth were interviewed, including 68 females (38.4%). While 126 (71.2%) participants reported knowledge of THN, only 40 (22.6%) possessed a THN kit. Caucasian/white ethnicity was found to be positively associated with both knowledge and possession of THN (both p < 0.05). Public injection drug use in the last 6 months was found to be positively associated with knowledge of THN, while daily heroin use and daily methamphetamine use were associated with possession of THN (all p < 0.05). Male gender was negatively associated with possession of THN (p < 0.05).ConclusionsThese findings highlight important gaps between knowledge and possession of THN among youth and the need to increase participation in THN programs among specific populations including non-white and male youth. Further research is needed to gain a better understanding of the barriers that may prevent certain youth from acquiring THN kits.

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Process evaluation of the Prevent Overdose in Toronto (POINT) program

Cited by 4 publications

References 16 publications

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

The uptake of the pharmacy-dispensed naloxone kit program in Ontario: A population-based study

Protocol for a mixed-methods feasibility study for the surviving opioid overdose with naloxone education and resuscitation (SOONER) randomised control trial

Knowledge and possession of take-home naloxone kits among street-involved youth in a Canadian setting: a cohort study

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