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Development and Implementation of an Opioid Overdose Prevention and Response Program in Toronto, Ontario

  • Public Health Intervention
  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

Objectives

We describe the development of the first community-based opioid overdose prevention and response program with naloxone distribution offered by a public health unit in Canada (Prevent Overdose in Toronto, POINT).

Participants

The target population is people who use opioids by any route, throughout the City of Toronto.

Setting

The POINT program is operated by the needle exchange program at Toronto Public Health (The Works) and offered at over 40 partner agency sites throughout Toronto.

Intervention

POINT is a comprehensive program of overdose prevention and response training, including naloxone dispensing. Clients are instructed by public health staff on overdose risk factors, recognizing signs and symptoms of overdose, calling 911, naloxone administration, stimulation and chest compressions, and post-overdose care. Training is offered to clients one-on-one or in small groups. Clients receive a naloxone kit including two 1 mL ampoules of naloxone hydrochloride (0.4 mg/mL) and are advised to return to The Works for a refill and debriefing if the naloxone kit is used.

Outcomes

In the first 8 months of the program, 209 clients were trained. Clients have reported 17 administrations of naloxone, and all overdose victims have reportedly survived. Client demand for POINT training has been high, and Toronto Public Health has expanded its capacity to provide training. Overall, reception to the program has been overwhelmingly positive.

Conclusion

We are encouraged by the initial development and implementation experience with the naloxone program and its potential to save lives in Toronto. We have planned short-, intermediate-, and long-term process and outcome evaluations.

Résumé

Objectifs

Nous décrivons l’élaboration du premier programme communautaire de prévention et de lutte contre les surdoses d’opioïdes par la distribution de naloxone offert dans un bureau de santé publique au Canada (Prevent Overdose in Toronto, POINT).

Participants

La population cible est constituée des personnes consommant des opioïdes, par n’importe quelle voie, dans la ville de Toronto.

Lieu

Prevent Overdose in Toronto est exécuté par le programme d’échange de seringues du Service de santé publique de Toronto (The Works) et offert sur plus de 40 sites d’organismes partenaires à Toronto.

Intervention

POINT est un programme complet de formation à la prévention et à la lutte contre les surdoses incluant la distribution de naloxone. Le personnel de santé publique explique aux clients les facteurs de risque de surdose, les signes et les symptômes de surdose, quand composer le 911, le mode d’administration de la naloxone, la stimulation cardiaque et les compressions thoraciques, ainsi que les soins après une surdose. La formation est offerte aux clients individuellement ou en petits groupes. Les clients reçoivent une trousse de naloxone avec deux ampoules de chlorhydrate de naloxone de 1 mL (0,4 mg/mL); s’ils ont utilisé la naloxone, on leur demande de retourner à The Works pour renouveler leur trousse et faire un bilan.

Résultats

Au cours des huit premiers mois du programme, 209 clients ont été formés. Les clients ont fait état de 17 administrations de naloxone; toutes les victimes de surdoses auraient survécu. La demande des clients pour la formation POINT étant élevée, le Service de santé publique de Toronto a renforcé ses capacités d’offrir cette formation. Globalement, l’accueil réservé au programme est extrêmement positif.

Conclusion

Nous sommes encouragés par l’expérience d’élaboration et de mise en oeuvre initiale du programme de naloxone et par les vies qu’il pourrait sauver à Toronto. Nous planifions des évaluations à court, moyen et long terme du processus et des résultats.

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Author information

Authors and Affiliations

  1. Public Health and Preventive Medicine Residency Program, University of Toronto, Toronto, ON, Canada

    Pamela N. Leece MD, MSc, CCFP & Aaron Orkin MD, MSc, CCFP

  2. Toronto Public Health - The Works, 277 Victoria Street, Toronto, ON, M5B 1W2, Canada

    Shaun Hopkins BSW, Chantel Marshall BScN, RN, Margaret A. Gassanov PhD & Rita M. Shahin MD, MHSc, FRCPC

  3. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Aaron Orkin MD, MSc, CCFP & Rita M. Shahin MD, MHSc, FRCPC

Authors
  1. Pamela N. Leece MD, MSc, CCFP
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  2. Shaun Hopkins BSW
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  3. Chantel Marshall BScN, RN
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  4. Aaron Orkin MD, MSc, CCFP
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  5. Margaret A. Gassanov PhD
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  6. Rita M. Shahin MD, MHSc, FRCPC
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Corresponding author

Correspondence to Shaun Hopkins BSW.

Additional information

Acknowledgements: The authors are grateful to Laurie Morrison, Clinician Scientist and Director of Rescu, a resuscitation research program, Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital and Brian Goldig, Manager, Physician Advisory Services at the College of Physicians and Surgeons of Ontario for their advice during the development of the POINT program.

Conflict of Interest: None to declare.

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Leece, P.N., Hopkins, S., Marshall, C. et al. Development and Implementation of an Opioid Overdose Prevention and Response Program in Toronto, Ontario. Can J Public Health 104, e200–e204 (2013). https://doi.org/10.17269/cjph.104.3788

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  • DOI: https://doi.org/10.17269/cjph.104.3788

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