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The POINT Program
OHRDP 2014 Conference presentation Shaun Hopkins
Acknowledgements
The clients of the POINT Program
The staff of The Works
Toronto Public Health
Overview of Session POINT – how did we get started and
why
Lessons learned
Statistics so far
Evaluation
Lesson # 1 – this took a really long time
Challenges
Not a huge number of overdoses in Toronto Lack of current overdose data Fear of developing a new harm reduction service in a
politically unfriendly environment (also a positive – we had to be prepared)
No new funding
How did we do it?
An idea
2005 Policy framework
(Toronto Drug Strategy)
Existing problem -overdose
Internal interest in exploring the
possibility
2007 Study Willingness of target
population to use intervention
Support from regulatory bodies Program development
August 2011 Implementation
Consultation
Response – very supportive
City Legal -Dispensing to a 3rd party, liability issues, who should be authorized under the medical directive?
CNO – within the scope of practice for nurses CPSO – 3rd party dispensing, emergency intervention,
precedent Drug Users Union – empowerment College of Pharmacists – supportive but no role
Lesson # 2 – at some point, just do it
Program launch date August 31st, 2011 International Overdose Awareness day
Our roll out plan Phase I Nurses at our fixed site Phase II Nurses at our partner agencies Phase III Counsellors at our fixed site Phase IV Our methadone support worker at our fixed
site Phase V All trained and certified staff on our van Phase VI Staff with peers at community agencies
The Naloxone Kit Syringes -Safety
engineered 2 ampoules of
Naloxone(.4mg/1cc/am) Alcohol swabs (assist
with breaking ampoule) Prescription identifier
Card Overdose Response steps
pamphlet
Naloxone Training:
•Locations: The Works, Outreach, Mobile •Length: 10-40 minutes •Content:
•Overdose prevention and risks • Drug classifications • Naloxone how it works • 5 Steps in responding to an opioid overdose • Interfacing with police/EMS • Debrief/Support after overdose • Evaluation/follow-up refill.
Current Statistics Number of people dispensed to 900 Number of agencies we have dispensed at 34
Number of reported administrations 120
Program Evaluation In the first eight months of the program, 209
individuals (60% male; mean age 39.1 years) were trained.
Clients typically used oxycodone and heroin (both reported by approximately 40% of clients), and frequently reported regular use of cocaine, crack, benzodiazepines, and alcohol.
Most reported witnessing an opioid overdose, and about one-third reported experiencing one themselves.
Program Evaluation
Clients reported 17 administrations of naloxone
• 1/2 of these occurred within 36 days of training • Most often, it was used for a friend who had
overdosed in a private residence • All victims reportedly survived • Other interventions (chest compressions, calling
EMS) were not used in the majority of incidents
Program Evaluation
• feel the program reaches the target population and that training is appropriate for clients’ needs.
Staff and partner
agencies
• consider trainers nonjudgmental and want to see POINT training offered more widely.
Clients
How to get started Get overdose statistics Talk to your clients about their interest Try to develop a policy framework – local drug
strategy? Develop a mechanism for prescribing – can you do it?
Do you have a doctor/nurse working for you? In the community?
Develop the process – ask for help - get our protocols, medical directives, etc.