Communicating Illicit Drug HarmsTo warn or not to warn; that is the question

PHPC CPD symposium May 24, 2015

Jane BuxtonDrug Overdose and Alert Partnership

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None to declare• I have no relationship with any pharmaceutical

company or communications firm

Conflict of interest

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• Lessons learned• Communicating Drug Alerts• Sharing information (DOAP)• Mass media campaign (fentanyl)• Do no harm- unintended consequences

Overview

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Coroners warning - heroin potency

Lessons learned re messaging

Didn’t identify where issue was - people assumed was Vancouver DTES

Language – ‘at least twice as potent’; encouraged people to seek out ‘potent’ drugs

Need to engage service providers & people who use drugs (PWUD) to develop appropriate messaging

Recommend use INSITE but often at full capacity and only one in Vancouver DTES

Media message doesn’t reach PWUD who needed to know urgently

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Goal: Develop evidence-based guidelines to effectively communicate drug alerts to service providers and people who use drugs (peers).

• What are the perceptions and beliefs of peers regarding adulterated drugs?

• How do peers suggest drug alerts can be better communicated to meet their needs?

CDA: Research questions

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Literature Review 4 focus groups with peers (n=22)

Age 19+ years (23-70yrs; mean 48yrs)>50% identified as AboriginalUsed illicit drugs in the past 7 days (various drugs)UBC ethics - informed consent

5 interviews with 5 frontline health staff

Methods

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Theme Sub-theme

Drug Quality Assurance Practices

• Relationships esp. dealer• Quality assurance tests

Communication Pathways PWUD know first

Improving communications •Timeliness• Mode of communication• Language•Content of posters

Findings

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Timeliness: “Don’t wait for the third person to die. If somebody OD’s off of it, find out why and which type of dope it was and then report it. Don’t wait for those one or two more to go” – FG 4, Female Participant

Mode: Use every possible means• Local organizations• Health or other service providers• Word on the street• Online sources• Free newspapers

Improving Communication:

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Brief, simple & clear messages Use words that imply harm (toxic, dangerous, lethal)

Date posters and remove Say what to look for & what to do

“… when somebody does come out with the ‘potent’ stuff, the word spreads real quick on who has it” – FG 2, Male Participant

Language & content messages

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Example

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Drug Overdose and Alert Partnership

DOAP

Law Enforcement

Labs

Health

Ambulance

Coroners

Drug & Poison Info

Centre

Researchers (CARBC, CfE)

Peers

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Goal: to coordinate stakeholder communication and action to enable timely alerting and appropriate responses to illicit drug use issues.

Inter-sectoral collaboration

• Collect, collate and share data• Password protected website• Face to face meetings (4x/year + PRN)

• Develop trust between partners• Partners share perspectives to inform and interpret• Identify who and how to contact in urgent situation

• Pharmacy break-in• Sudden increase ODs at Insite

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WEEKLY UPDATES• VCH ODs – ER & Insite• DPIC exposure calls• Ambulance calls for ingestion

poisonings

BC CORONERS• Monthly Illicit Drug OD Deaths• Specific reports PRN

• Fentanyl-detected• Prescription opioids

BC AMBULANCE• Naloxone administration

Surveillance Data

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Inter-sectoral collaboration

• Collect, collate and share data• Password protected website• Face to face meetings (4x/year + PRN)

• Develop trust between partners• Partners share perspectives to inform and interpret• Identify who and how to contact in urgent situation

• Pharmacy break-in protocol• Sudden increase ODs at Insite

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April to June 2012

July to September

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October to December

2012

January to March 2013

April to June 2013

July to September

2013

October to December

2013

January to March 2014

April to June 2014

July to September

2014

October to December

2014

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5%

10%

15%

20%

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30%

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45%

Fentanyl-Detected Deaths in Apparent Drug Circumstances Non-Fentanyl-Detected Deaths in Apparent Drug Circumstances

Proportion of Fentanyl-Related Deaths Linear (Proportion of Fentanyl-Related Deaths)

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PHO alert Coroners alertCoroners data: 2012-2014

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Patches only ex. pharmacy break-in

Powdered fentanyl mixed with/sold as heroin

Fake oxy; green monsters/jellies

Enforcement:• March 2014 - 300 pills seized/tested• Analysis flaps Thanksgiving Insite OD • Fentanyl powder thought imported

and pressed into pills locally

Coroners data• Fentanyl-detected deaths, provisional

data 2014 o young adults, o 2/3 did not inject, o <1/4 in Vancouver in DTES

Photo from CCENDU alert

Fentanyl

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Multi-stakeholder working group

Target audience PWUD:• Inexperienced/infrequent users• Recreational setting• 18-40yrs

Feedback from:• DOAP agencies• MHSU & outreach workers• Youth who use drugs

Facebook ads:• 18-40yrs, 25 mile radius major cities• Mar 2-16: had 213,748 views

PSA campaign

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• Participants (PWUD)• DOAP members• Harm reduction team

at BCCDC • Stream of wonderful

residents, medical and MPH students

• CCENDU funding for CDA project

Acknowledgements

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Take home messages:• Unregulated market -don’t know what you’re taking• PWUD trust their dealer• Alerts – wording (toxic, lethal); timely, multi-modes, facts

• Standard opioid harm reduction messages apply:Don’t use alone Taste (inject) small amount drug

first

Have a plan Don’t mix drugs or drugs/alcohol

Carry naloxone Get help if OD occurs

Discussion:Do no harm - unintended consequences

PMMA in ecstasy; Levamisole in cocaine

Kerr et al 2013; Duty to warn;

Who is the audience?

Paternalistic choose what to inform