Patients who visit St. Paul’s after an opioid overdose will now leave the hospital’s emergency department with a supply of addiction-treatment pills.
Providence Health Care and Vancouver Coastal Health have launched a pilot program at the downtown hospital that gives these patients bottles containing three days worth of Suboxone, provided by a specially trained addiction nurse. They will form a plan for follow-up care and get clear instructions about when to take the pills.
A nurse will direct the patients toward follow-up treatment and community resources, including the St. Paul’s Rapid Access Addiction Clinic. The free clinic provides people with immediate short-term addictions treatment and transfers them to a community care provider for longer-term rehabilitation.
Dr. Andrew Kestler, an emergency department physician at St. Paul’s and the project’s co-lead, said the program will save lives.
“People who get started on opioid agonist therapy — that could be Suboxone or methadone — live longer,” Kestler said. “We know that it reduces deaths in people who have opioid-use disorder, and we know that it reduces the need for emergency department visits.”
The B.C. Centre on Substance Use will evaluate whether the pilot program leads to a decrease in overdoses, hospital visits and deaths, and to improved engagement in care.
Patients must be in a sufficient state of withdrawal to start Suboxone, which can lead to six- to 12-hour visits to the emergency department. By letting patients take the pills with them, a common barrier to treatment is reduced for the many people uncomfortable with hospital stays, Kestler said.
Those with opioid-use disorder who visit the hospital but haven’t overdosed are also eligible for the take-home Suboxone, Kestler said.
Subxone, which contains buprenorphine and naloxone, is a medicine which can stop cravings and withdrawal symptoms, and prevent death. It is considered safer than methadone, another leading treatment for opioid addiction, mostly because buprenorphine has a ceiling effect which makes it hard to overdose, Kestler said.
Typically about five or six overdose patients visit St. Paul’s emergency department each day, Kestler said. The hospital sees 10 times more overdose patients than any other hospital in the Vancouver Coastal Health region, according to Providence.
In the first 11 months of 2018, Vancouver Coastal had the highest rate of illicit-drug death of any health region in B.C., at 37 per 100,000 people, according to the B.C. Coroners Service. Of the 1,380 people who died during that period, 408 were in Vancouver Coastal.
Kestler believes the program will prove successful and could be adopted by other emergency departments.
“We’re already sharing some of our ideas and protocols with people around the province but we really hope, with this getting off the ground and having some success, that we can pave the way for broader implementation across the province,” he said.
“I think there’s obviously interest elsewhere in Canada and North America.”