BC Overdose Action Exchange II
On June 16, 2017, over 130 people and 54 organizations gathered for the second annual meeting. They identified 10 key actions to reduce the unprecedented rise in overdose deaths over the past two years.
Background
While there has been an incredible amount of work and resources put into the overdose response over the last year, we still face a serious health emergency that shows no signs of slowing. The overdose crisis continues to marginalize people who rely on an unregulated drug market to deal with their addiction, pain, trauma, mental illness and social isolation.
These deaths are preventable and there is no one that can’t be helped. Stigma. Decriminalization. Connection. Rebuilding lives.”
- meeting attendee
The purpose of the Overdose Action Exchange meeting was to generate ideas that challenge the status quo and lead to a new set of innovative strategies. These ideas and actions are representative of feedback from people with lived experience, policy makers, community organizations, public health leaders, government, academia, emergency health services, law enforcement, researchers and medical experts.
We have summarized the 10 Key Actions below or you can read the 2017 report in full. You can also read the 2016 report and primer.
10 Key Actions
- 10 Key Actions
- 1. Engage
- 2. Address
- 3. Support
- 4. Build
- 5. Expand
- 6. Align
- 7. Reform
- 8. Address
- 9. Counter
- 10. Implement

1. Engage
peers in program development and leadership

2. Address
contamination of the drug supply

3. Support
appropriate pain management therapies

4. Build
on the success of Overdose Prevention Sites

5. Expand
and improve treatment for addiction.

6. Align
law enforcement with public health

7. Reform
drug laws

8. Address
structural barriers and upstream factors

9. Counter
stigma against people who use drugs

10. Implement
targeted research, surveillance and evaluation initiatives
1. Engage peers in program development and leadership
-
Increase access to ongoing education and capacity building for peers
- Fund access to community and online training opportunities
- Support the development of an integrated training network
-
Support and fund the development of peer-based organizations
- That act as sites of peer support and knowledge exchange
- That have capacity to consult within their communities and convey the results to policy makers and program developers
- That develop models of supporting peer organizing in rural and remote areas
-
Meaningfully involve people with lived experience in all policy and program development
- Follow best practices for peer employment - pay and employ peers appropriately for their expertise and work
- Follow best practices for peer engagement
- Use Peerology: A guide by and for people who use drugs on how to get involved
- Use Developing Peer Engagement Principles and Best Practices: A Guide for BC Health Authorities and other Providers
- Develop initiatives that facilitate collaborative dialogue and action between peers, service providers and local community organizations

"Most innovation is from the local community of people who use drugs, and activists."
- meeting attendee
2. Address contamination of the drug supply
-
Increase access to prescription drugs as an alternative to the contaminated drug supply
- Pilot low-barrier, rapidly scalable models of distributing a regulated supply of pharmaceutical opioids to those at risk of opioid overdose due to illegal drug supply contamination.
- These may involve accessing opioids through pharmacies, mobile programs, dedicated storefronts and/or supportive housing facilities
- Allowing consumption off-site (i.e. not witnessed) will lower barriers to participation
- Pilot and evaluate the impact of stimulant substitution on the overdose crisis
- Open additional clinics based on the Crosstown model (on-site injection with intensive engagement) to provide access to supervised opioid injection
- Expand physician capacity and confidence to prescribe opiates including oral hydromorphone, long acting slow release oral morphine and injectable opioids
- Increase the number of physicians and nurse practitioners with specialty training in addiction medicine
-
Expand the ability of people who use drugs to test their own drugs
- Develop models of drug testing feasible in rural areas
- Develop bring-home/mail-in testing programs
- Expand drug testing beyond qualitative to quantitative results on potency
- Expand drug testing to additional sites – Supervised Consumption Sites, Overdose Prevention Sites, mobile sites, health authority sites (e.g. Community Health Centres, STI clinics), and bars, nightclubs, and music festivals
-
Conduct outreach to improve processing, bulking and access to testing of of illegal drugs
- Encourage drug dealers to use drug testing programs
- Improve access of drug producers to professional-grade mixing equipment and educate them about techniques to improve homogeneity of the product
-
Explore medical opium as a source of uncontaminated opioids
- Grower’s clubs, production on a model similar to medical marijuana, personal cultivation

"We need immediate access to safe drugs."
- Karen Ward, VANDU
3. Support appropriate pain management strategies
-
Improve access to and evaluate the affordability & effectiveness of non-opioid strategies
- Consider a multidisciplinary approach including counselling and physical therapy
- Decrease wait times for referral services to pain clinics
- Develop a new PharmaCare plan to enable access to non-opioid pain therapies, including allied health modalities
- Enhance and evaluate access to integrated therapeutic models
-
Expand initiatives that promote patient-centered care (including addictions and chronic pain)
- Develop incentives and expand alternative billing models to allow physicians more time to engage and manage complex patients appropriately
- Promote comprehensive pain management within the Patient Medical Home initiative of Doctors of BC
- Provide access to culturally appropriate treatments and Indigenous healing services
-
Provide timely and easily accessible practice support to physicians
- Develop clinical guidelines on the treatment of chronic pain in people who have substance use disorders
- Improve PharmaNet usability to support clinical decision-making and a prescription drug monitoring program (PDMP); introduce reporting to physicians that compares their prescribing practices to the average to encourage self-reflection and behavior change (similar to reporting on antibiotic use) and evaluate any PDMP for unintended consequences
-
Improve education curriculum in medical schools, residency programs, and nursing schools
including opioids, harm reduction, mental health, substance use and trauma-informed care

"People cut off their pain medications have to go to the 'street' to get their relief. In the midst of the fentanyl crises this is forcing people with real pain issues to play Russian roulette with street drugs."
- Dean Wilson
4. Build on the success of Overdose Prevention Sites
-
Continue providing support to overdose prevention sites (OPS) throughout BC
- Ensure adequate funds are available to pay peers for their participation in a variety of roles, including program development/consultation, outreach and front-line work
- Develop site-specific guidelines addressing how to support peers in frontline OPS roles
Continue financial and human resources support to community-based OPS
Continue to support peer engagement at OPS
-
Reframe as “overdose prevention services” to better capture the range of possible initiatives
- Integrate primary care and mental health services
- Offer scheduled primary care and mental health services at community-based OPS; scale up if successful
- Embed OPS within health authority sites
- Increase geographic scope of OPS
- Explore support for supervised inhalation in outdoor spaces
- Increase staffing on income assistance cheque days
-
Develop and pilot new technologies for OPS
- Build upon the existing BC telemedicine infrastructure
- Use online and smartphone video communication applications (e.g. Facetime)
- Use link smartphone actigraphy (technology which measures movement during sleep) with OPS respond where feasible (e.g. in supportive housing)
Pilot new technologies for overdose prevention to better serve people who cannot attend a site
Develop a communication platform between OPS to facilitate exchange of best practices
-
Develop an outreach-based model and create welcoming spaces
Develop an outreach based OPS model that can be used in rural and remote areas
Create welcoming social spaces for people to use drugs together both related to and distinct from OPS

"The opposite of addiction is connection and connections are being built at opioid sites. This sense of community can flourish here.”
- meeting attendee
5. Expand and improve addiction treatment
-
Increase supports & access to treatment
- Using telehealth infrastructure to improve access in rural areas
- Improving access to medical therapy during evenings and weekends
- Expanding physician capacity for outreach and house calls
Expand access to the first line treatment for opioid use disorder (buprenorphine/naloxone)
while providing the option to attend specialized clinics (offering comprehensive services, including counseling and pharmacist support) to access additional treatment. Lower barriers to access by:
Implement legislation and policies that encourage parents to seek treatment without fear of child apprehension
Provide treatment free of charge
Increase supports to families, including counselling, education and resources
Increase supports while accessing and transitioning from treatment while using family-centered approaches
Increase access to treatment options for youth
including integrated service hubs, outreach, and Indigenous healing and cultural connection services
-
Work with Indigenous service providers and communities
- Promote increased access to training and recruitment of Indigenous physicians
- Promote access to culture as treatment practices and indigenous healing services
to ensure provision of culturally safe, relevant and effective addiction treatment services
-
Review evidence for approaches used in residential addiction treatment and recovery homes
- Implement minimum standards under which they must operate and ensure oversight and accountability
-
Improve physician training and resources
- Develop incentives to encourage physicians, particularly family doctors and walk-in clinic doctors, to attend CME addictions training
Increase the number of physicians with addiction medicine training through fellowships and Continuing Medical Education (CME)
Encourage uptake of existing training materials for physicians and develop new resources to fill identified gaps (e.g. people who use substances recreationally, people who use stimulants, treatment of concurrent disorders).

"Being able to heal together is really important."
- meeting attendee
6. Align law enforcement efforts with public health
-
Include law enforcement in public health planning and policy development
- Include representatives from multiple levels of law enforcement
- Ensure consistency of action and alignment with a public health approach to the crisis
-
Build connections between law enforcement agencies with those seeking guidance
Agencies engaging well with public health actions, such as Vancouver Police Department.
-
Expand training for those in the criminal justice system
- Include peers in development of this training
- Deliver this training regularly as a mandatory standard
- Build mandatory case plans for people with histories of addiction, including social services, mental health services, employment and housing
that addresses trauma informed care, harm reduction, substance use disorders, mental illness, cultural competency and stigma.
-
Raise awareness of the Good Samaritan Drug Overdose Act
through public campaigns in targeted areas.
-
Improve access to harm reduction supplies & services inside and out of correctional facilities
Develop a provincial policy ending parole conditions that prevent visiting harm reduction sites (“red zones”) or carrying harm reduction supplies
Deliver evidence-based harm reduction supplies, including needle and syringe programs, inside correctional facilities
Allow people leaving corrections to carry harm reduction supplies without repercussions from parole officers and law enforcement on release
Improve treatment options and continuity for people exiting correctional facilities including pre-release planning, connection to local services and coordinated service delivery

"There’s a difference between being a criminal and being criminalized."
- Erica from Abbotsford
7. Reform drug laws
-
Focus on an initial goal of decriminalization of illegal drugs for personal use
- Ask the regulated professions to release joint statements of support for drug law reform
- Increase re-direction from sentencing to addiction treatment and social support services for minor drug offences
- Stop court ordered addiction treatment
- Provide less punitive and more flexible options
while acknowledging that full legalization and regulation is necessary to address contamination of the drug supply.

"The war on drugs is a war on drug users. And we’re dying."
- Karen Ward, VANDU
8. Address structural barriers and upstream factors
-
Increase support services and strengths-based education for children, youth and parents
- Standardize the connection of public health nurses to parents across the province to provide education, support and counselling
- Increase access to early screening and support for mental health in school age children
- Increase access and engagement for low income children in community recreational activities
- Develop and implement substance use education for children and youth in schools focused on resiliency and skill building rather than drug harms
Support services for youth and parents across BC
Increase access to education and programming that supports strengths-based approaches and community connectedness
-
Align all initiatives with the interests of Indigenous communities
- Advocate and work to implement recommendations of the Truth and Reconciliation Commission
- Develop and fund practical tools and programming to support wellness for individuals and families grounded in cultural approaches
-
Increase availability of accessible, confidential supports for people who need help
- Develop resources for people who do not meet diagnostic criteria for mental illness to support mental health and well-being
-
Implement social policies and advocacy within government
- Introduce a minimum guaranteed income
- Provide housing to those who need it
Implement coordinated social policies across departments with focus on healthy child and family development
Institute an affordable childcare plan for BC
Implement BC Poverty Reduction Plan
Create a cross-governmental advocacy position who can speak to inter-ministerial needs
for advocacy for people who use drugs (like the Representative for Children and Youth)
Advocate with the federal government to declare a national public health emergency

"Linkages to housing are equally important to maintain the work done by linkages to primary care.”
- meeting attendee
9. Counter stigma against people who use drugs
-
Develop and implement a comprehensive provincial stigma reduction plan
- Use lessons learned and resources from decreasing stigma around HIV, tobacco and alcohol, mental health and towards LGBTQ populations
-
Launch educational programming and materials for multiple audiences
- Create non-stigmatizing language and cultural competency guides that build from existing documents
- Work with peers to develop a mandatory online training course for frontline health care providers about cultural competency and the principles of harm reduction and trauma-informed care
- Launch a public anti-stigma awareness campaign using storytelling and photo voice directed by people with lived experience
including media, government, healthcare workers, law enforcement workers, health care students and the public
-
Continue to fund and support initiatives to facilitate collaborative dialogue and action
between peers, service providers and local community organizations such as the Compassion, Inclusion and Engagement initiative

"Stigma and discrimation is ripping apart families."
- meeting attendee
10. Implement targeted research, surveillance & evaluation initiatives
-
Create targeted research initiatives
- Focus on people using alone in private residences
- Explore alternative way of distributing income assistance payments to avoid peaks in overdoses
- Conduct a feasibility study of how public health leadership might facilitate access to opium on a model similar to medical marijuana
- Use data from the BC Opioid Overdose Cohort to:
- Understand the extent to which prescription opioids and recent policy changes have fueled and supported the current overdose crisis
- Investigate differences in risk factors for overdose, including opioid prescribing, among those with First Nations vs non-First Nations identity
- Institute a qualitative research program to contextualize results, investigate areas of uncertainty and identify new analytic questions
-
Implement evaluation plans for all new overdose response and prevention initiatives
- Evaluate unintended consequences of the College of Physicians and Surgeons British Columbia (CPSBC) prescription opioid guidelines and prescription drug monitoring programs
including clear timelines and knowledge translation of results.
-
Develop surveillance methods
- Build a centralized database of patients in residential addiction treatment to quantify treatment pathways and outcomes
- Collect data on possible targeted (deliberate) overdoses towards individuals
- Improve surveillance of the composition of illegal drugs
- Implement structure for comprehensive data collection of recommended child and youth indicators

“I know it’s hard to be positive in such a dire situation, but the innovations in drug policy globally have always emanated from the ground up and started locally.”
- Donald MacPherson, Canadian Drug Policy Coalition
Acknowledgments
The BC Centre for Disease Control respectfully acknowledges that the second annual Overdose Action Exchange meeting was held on the ancestral homelands of the Coast Salish peoples, including the territories of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), Stó:lō and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) Nations.
We would like to thank all meeting attendees, facilitators and the planning committee for their work in creating the actions for this report.