The BC Centre on Substance Use (BCCSU) has been at the forefront of care. It has many branches – education and training, research and monitoring, evaluation and quality improvement, and clinical care guidance. Through the work of many it has been able to expand evidence on which much is based, it has improved the access to evident-based care, it has optimized patient outcomes, reduced health care costs, and improved population health. By supporting the collaborative development of evident-based treatment policies, guidelines, and standards the BCCSU will improve the integration of care across the continuum of substance dependence, thereby serving all British Columbians.

 

There have been three distinctive waves in the rise in opioid overdose deaths. Wave 1 in 1999, there was a rise in prescription opioid overdose deaths. Wave 2 in 2010, there was a rise in heroin overdose deaths. Wave 3 in 2013, there was a rise in synthetic opioid overdose deaths. Even though for the last few years covid took over media coverage, overdose deaths far outpace covid deaths.

 

According to the BC Coroner’s report in 2021, in 1995 217 per 100,000 population died from illicit drug toxicity, a steep rise started in 2016 with 993 per 100,000 population died, and by 2021 this increased to 1782 per 100,000.

 

By 2018 1 in 5 people were prescribed opioids on a long-term basis in 2018. High risk (e.g., high dose prescribing) opioid prescribing practices became common. A subsequent steep rise in deaths occurred.

 

Hospitals are considered a major contributor to the overdose epidemic and its related harms. There are over 286 hospitals reported in the US as prescribing for 51% of the 1.14 million non-surgical admissions. Almost one-quarter (23%) of patients received a high daily dose of opioid analgesics (i.e. >100 MME (morphine milligram equivalents)). An Australian tertiary hospital showed that 63% of 334 patients were prescribed an opioid with high-risk prescribing practices. The dosing intervals were not reflective of the drug’s half-life (70%). There were concurrent prescriptions of multiple different opioids PRN (51%).

 

It has been found that hospitals with more frequent opioid use are associated with increased rates of opioid-related adverse drug events, which negatively impact the length of hospital stays and related costs. Inappropriate opioid prescribing practices in acute care settings have also been associated with adverse effects in community post-discharge. E.g., opioid-induced hyperalgesia, addiction, overdose, and mortality.

 

Hospitals have been overlooked as a prime location of potential harm production and an area for intervention. To date, resources to address BC’s opioid crisis have appropriately focused on either harm reduction or improved access to evidence-based care. Systems-level strategies to prevent opioid misuse and addiction have largely been overlooked. Most strategies are focussed in community settings and on medication restriction.

 

Hospitals had developed a successful antimicrobial stewardship program (ASP) which led to the development of the opioid stewardship program (OSP). How it works:

The role of opioid stewardship is to improve prescribing practices and to education patients about opioid use. Thereby reducing adverse effects, length of hospital stays, costs to system.

 

The program is based on multidisciplinary expertise to ensure the approach is thorough. The goal is to improve opioid prescribing practices at St. Paul’s Hospital in order to reduce or prevent adverse opioid-related events (e.g., overdose) and improve or maintain adequate pain control for the patient. It uses an audit feedback approach, continually striving to improve. It started as a pilot project in January 2020, it was so successful it has become a permanent program at St. Paul’s. So far, the responses from patients about OSP, received through surveys, have been overwhelmingly positive.

 

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