Communicating Drug Alerts

Improving the Effectiveness of Drug Alerting to

Reduce Harms Among People Who Use Illicit

Drugs

BC Centre for Disease ControlProvincial Health Services Authority (PHSA)Diagnostic and treatment servicesAnalytical and policy support to all health

authorities and levels of government (1)

Harm Reduction

(2)

(1)

Significant Milestones in Harm Reduction1964

1984

1986

1989

1990

2003

Methadone Treatment Program (Canada)

Needle exchange (Netherlands)

Legalized injection site (Switzerland)

Needle exchange (British Columbia)

International Conference (United Kingdom)

Supervised Injection site (North America) (3)

Common Adulterants Drug Adulterant Licit Use Potential

Reasons for Presence

Public Health Risks

Health Consequences

Heroin Acetaminophen Pain relief(highly accessible, inexpensive)

Analgesic effect & bitter taste

Minimal at low doses

Toxicity at high doses

Liver damageGastro-intestinal effectsAdverse effects (Alcohol)

Cocaine Phenacetin Analgesic properties

Disguise poor quality cocaine

Banned in several countries(Suspected carcinogenicity and linked to renal failure)

Kidney cancerBladder cancerHaemolytic anaemiaAnalgesic nephropathy

Adapted Table (4)

Study Design

• Focus groups & interviews

• Third party transcription and coding –NVivo 8

• Interpretive Descriptive

• Qualitative

Study Design

Study Approach

Study Methods

Data Analysis

Participants 32 Focus Group Participants (Regular illicit drug

user)

Age Range: 23 to 70 years of age

23 participants were between ages 40 to 60

17 Male/15 Female

5 VCH Key Informants (Semi-structured interviews)

Primary contact with illicit drug users

3 Male/2 Female

Primary Outreach Services, Primary care & Insite/Onsite

Socio-economic Status

Single Room Occupancy Hotel (SRO)

Rented Unit No Fixed Ad-dress (NFA)

Sample Total

44 25 31

Male 22 6 25

Female 22 19 6

2.5

17.5

32.5

47.5

Housing Status

Focu

s G

rou

p P

art

icip

an

ts

(%)

Drug Use Patterns

Frequency of Use/Week

Years of Use

Current/Past Injection Drug Use

Poly-substance Abuse

Quit Injection Drug Use

Years of Abstinence from Injection Drug Use

27Participants

Daily Use

Range: 4 to 48 years

Median: 29

21Participants

31Participants

7 Participants

Range: 5 to 39

Median: 8.5

Primary Objectives

Current Quality Assurances Practices

Communication Pathway

Recommendations to Improve

Drug Alerts

A narrative literature review was conducted

Inform focus group questions and interview guide

Quality Assurance

“…I see the ones that have a reputation of being a good dealer down here will always have somebody recommend them” (Focus group 4 participant)

“My dealer, he cares about repeat business.” (Focus group

1 participant)

“By just the way it looks” (Focus group 2 participant)

Communication Pathways“Yeah, I’d share it with all my friends and anybody I run into”. (Focus group 2 participant)

“We’ve got the fastest way”. (Focus group 3 participant)

“friends look after friends”. (Focus group 2 participant)

Recommendations Clear Terminology

A ‘potent’ drug is perceived differently by HSP & PWUD

“that means it’s strong it works”. (Focus group 2 participant)

Preferred Mode of Communication

“Fliers”. “Web news”. “Facebook”. (Focus group 1 & 4 participants)

Visibility, Accessibility & Relevance of Postings

“As long as they are kept to date” (focus group 1 participant)

Implications for Public Health

Policy & PracticeCurrent lack of Provincial, evidence-based guidelines for communicating drug alerts

CDA can Reduce risk of mortality and morbidity associated with illicit drug use

Guidelines should be informed and evaluated by the target population to increase effectiveness

There is limited literature and research evaluating feedback from peers in Canada

Findings will be compiled into a research report and submitted for publication

Questions?

References

(1) BC Centre for Disease Control. (2014). About BCCDC. Retrieved on April 7, 2014 from http://www.bccdc.ca/util/about/default.htm.

(2) Provincial Services Health Authority. (2014). About PHSA. Retrieved on April 7, 2014 from http://www.phsa.ca/AboutPHSA/default.htm

(3) BC Harm Reduction Strategies and Services. (2013). The History of Harm Reduction in British Columbia. Retrieved on April 12, 2014 from http://www.bccdc.ca/NR/rdonlyres/7B9F63E8-7D50-4985-9BC2-38D78C4E77AD/0/UpdatedBCHarmReductionDocumentAug2012JAB_final.pdf.

(4) Cole, C., Jones, L, McVeigh, J., Kicman, A., Qutub, S & Bellis, M.A. (April, 2010). CUT: A Guide to Adulterants. Retrieved on April 24, f http://www.cph.org.uk/wp-content/uploads/2012/08/cut-a-guide-to-the-adulterants-bulking-agents-and-other-contaminants-found-in-illicit-drugs.pdf.