As the opioid crisis continues to unfold in fast-moving and unexpected ways, CAMH continues to implement a series of enhancements to its Opioid Overdose Prevention Initiative. They include:
- The successful completion of Phase 1, which saw supplemental training provided for over 80 staff in our addiction outpatient services
- An opioid overdose prevention powerform that has been live on ICARE since late August.
- The rollout of Phase 2, where another 40-plus staff from Acute Care Program clinics and services were trained, including clinicians from the Integrated Day Treatment Service, the Mood and Anxiety Ambulatory Service, Adult Gender Identify Clinic, and Borderline Personality Disorder Clinic. Plans for training clinicians within the new Bridging Clinic, Crisis Clinic and the Emergency Department are underway.
- New educational material created for clients and staff on overdose prevention
- Increased pharmacist support for outpatient clients, including easier access to Naloxone kits. Over 330 Naloxone kits have been distributed, most of them to clients and family members who had not previously received one from a pharmacy.
- Medication reviews for complex clients in the Acute Care Program by dedicated Opioid Overdose Prevention Initiative Pharmacist Tianna Costa
“We know that this is absolutely a crisis,” says Stephanie Carter, Clinical Director of the Ambulatory Services Acute Care Program. “We want to make sure we are providing the most up to date information.”
One key reason for the changes is because CAMH clinicians were starting to see a new category of client - those who were overdosing despite seemingly not using opioids at all. At least not knowingly. They would take cocaine or cannabis, only to learn after overdosing that the drugs were laced with Fentanyl. Even anxiety medications like Xanax sold on the street were found with Fentanyl.“The landscape has changed so much so quickly,” says Advance Practice Pharmacist Maria Zhang. “The advent of clandestine synthetic labs that create very potent drugs that seem to come out of nowhere. The competition between dealers to produce the next best thing, puts everyone at risk.”
“Anyone who is not obtaining their substances from the pharmacy is at risk,” says Advance Practice Clinical Nurse Alison Watson.
To mitigate those risks, a key tool in overdose prevention, Naloxone, is being made more widely available and is a central plank in CAMH’s Opioid Overdose Prevention Strategy.
“We want to make Naloxone available to anyone who wants it,” says Zhang. “We want to shift the tide because there are so many people who would benefit from having a Naloxone kit who don’t have one. The idea that Naloxone is just for quote unquote junkies is a message that needs to change.”
The goal is to make Naloxone as stigma-free as an Epipen, and a standard part of every opioid user’s first aid kit, including those taking opioids by prescription as directed by their doctor.
In order to reduce the stigma around Naloxone, a dedicated CAMH pharmacist will distribute Naloxone kits directly to high-risk clients, rather than having clients sent to the pharmacy. Zhang believes that making a pharmacist a core part of the overdose treatment team will improve outcomes.
“Traditionally I don’t think people perceived pharmacists as harm reduction experts, but if you think of the most accessible health care provider in the community, it’s probably the pharmacist.”
Another aspect of the team concept in overdose prevention – the non-judgmental support of family and friends.
“As much as we are focused on our clients, we very much want to reach out to family members and loved ones,” says Watson. “They are the ones who are going to be giving them the Naloxone. Tell someone that you are using. Tell someone where you are going to be. Don’t use alone. This is a relationship-building intervention between our clients, our therapists and the other people in their lives.”