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.