Side Event: UNODC-WHO Community Management of Opioid Overdose – initial results from the S.O.S study (Stop Overdose Safely)

Organized by Australia, Kyrgyzstan and the United States of America, and UNODC Prevention, Treatment and Rehabilitation Section, Vienna NGO Committee on Drugs and World Health Organization

Gilberto Gerra, Chief, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime (UNODC)

Vladimir Poznyak, Unit Head, Alcohol, Drugs and Addictive Behaviours, Department of Mental Health and Substance Abuse, World Health Organization (WHO)

Paul Dietze, Program Director, Behaviours and Health Risks Burnet Institute, Australia

SOS 90-90-90 Model Explained:

  • 90% of relevant audience trained on risk of overdose and behaviour
  • 90% of those receiving naloxone should always have it with them
  • 90% of those with naloxone should use it

Creates a “cascade of care”.

Current status of implementation: 160 national trainers, 15,000 trained on ID and management, 38,000 naloxone ampules distributed, 1600 people enrolled in the cohort study, baseline data collected, follow-up data collection is ongoing. Quality checkups of data enter into RedCap.

Participants: Majority were PWUD. 43% of PWUD participants didn’t have enough money for food in the past 6 months and 37% had had an overdose previously. 93% of PWUD participants had seen an overdose, but only 22 participants had called an ambulance. Perspectives of PWUD are vital to implementing training. After the training, there was an increase in safe use of drugs amongst participants.

Tajikistan and Kyrgyzstan Results of first 6 months: High rates of people carrying naloxone and told others they were doing so. 90% of trainees who witnessed overdoses used naloxone. 96% of overdose victims in these instances survived. Results exceeded expectations.

Mara Barr Director of Multilateral Relations at the Office of Global Affairs US Dept of Health and Human Services

US proud to support SOS Study and supports the aim of providing naloxone to community members witnessing overdoses.

HHS has a 5 point strategy:

  1. Better addiction prevention, treatment and recovery services
  2. Better data
  3. Better pain management
  4. Better targeting of overdose reversing drugs
  5. Better research

US attempting to promote community management of opioid overdoses. US HHS supporting pharmacy-based naloxone dispensing, emergency service naloxone provision and increasing presence of naloxone in emergency rooms. Prescriptions not required for naloxone in the US. HHS assistant sec for health made recommendations to doctors to prescribe naloxone to people prescribed high doses of naloxone. Since launching strategy there was a 4.4% decline in opioid overdose deaths. Supporting prevention and intervention. HHS recommends that patient out of pocket costs for naloxone be reduced by health insurance providers.

Timur Isakov, Permanent Kyrgyzstan Permanent Mission

In Kyrgyzstan, there are up to 25,000 people using intraveneous drugs, meaning high risk of overdose deaths. Kyrgyzstan partnered with NGOs and state instruments. Goal was to save lives and increase community involvement in overdose prevention. Number of overdoses in Kyrgyzstan has decreased but specific data is not yet publicly available. Speaker restated broad goals of SOS and explained the 90/90/90 model.

Allison Jones Australian Department of Health

In the last 2 years there has been a decrease in opioid deaths in Australia, but every day at least 3 people die and 150 people are hospitalised due to opioid overdoses and related health complications. Direct to consumer advertising is totally prohibited for prescription medicine. Strong regulation of advertising to doctors and prescribers as well. This, combined with training of appropriate prescribing by RACGP has helped to reduce opioid deaths.

Opioid deaths accounted for 2/3 of Australian drug deaths over the last 20 years. Prescription opioids found in 60% of overdose deaths. Regional populations are more at risk of overdose than urban populations. Majority of deaths were opioid overdoses of prescription opioids in middle-aged men usually with substance mixing.

Take Home Naloxone Pilot: Notes the key contribution of civil society to launching the program. Pilot started in three states in December 2019 and will run through to February 2021. Naloxone will be available free to people who are either likely to either experience or witness an opioid overdose. No prescription will be required. Each state will identify where naloxone will be available within their state. Sites may include: Community and hospital-based pharmacies, Needle exchange programs, Other community-based organisations

Real-time prescription monitoring (RTPM): Levels of overdose and accidental death from controlled medication in Australia have been rising. Technology can help reduce misuse and make sure that patients who genuinely need these medicines can still get them. RTPM provides information to prescribers and pharmacists about a patients use of controlled medicines. Also allows the tracking of health professionals who may be over-prescribing opioids. It will produce real-time alerts and information for health professionals and state and territory regulators. 70% of pharmacists and GPs are already using it. There has been a decline in the rate of opioid prescription since the measure was brought in.

Penny Hill, Harm Reduction Australia

Thank UNODC, WHO and government co-sponsors for inviting a civil society representative to speak in this side event: working with civil society is the key component necessary to reduce the prevalence and harms associated with opioid overdose in affected communities.

I’m here representing HRA, which is a national organisation of Australians with a joint commitment to reducing the health, social and economic harms potentially associated with drug use. We take a non-judgmental approach to drug use within society, as all of us should, and recognise the key role people with current and past drug use experience must play in any effective drug policy solutions.

I am an overdose prevention worker and have worked and volunteered across a range of harm reduction services aiming to prevent overdose in Australia and Canada, and I’m also a PhD student investigating the opioid overdose among PWID in Melbourne

Opioid overdose related deaths have risen in Australia over the past 2 decades, but not yet to the extent of the emergency situations that have been declared in Nth America – but we have an urgent need to intervene before the overdose situation in Australia gets any worse

Harm reduction is one of the 3 key pillars of the Australian National Drug Strategy (and has been since 1985), and although historically Australia had a role as a global leader in implementing harm reduction services that were incredibly successful in preventing the spread of HIV among PWID, we feel that recognition and support for existing and innovative harm reduction programs has declined. We urge the Australian government to recognise how integral they have been in Australia’s past response and will be in future responses to various drug situations, and to highlight the importance of these programs at international meetings such as the CND. Peer-led organisations of PWUD are supported and funded by both federal and jurisdictional Australian governments, and have been vital in advancing the health and human rights of PWUD in Australian communities. Partnerships between govt and peer organisations have been incredibly important and must continue to support harm reduction

We are grateful for the recent support of take-home naloxone by the Australian government, including its rescheduling, the listing of an intranasal product, and support to expand its availability in certain jurisdictions. As HRA, we are also extremely grateful for last weeks’ announcement for funding to support family members of people who experience harm, shame and stigma from AOD to an organisation that operates under harm reduction principles.

But, despite these very recent advances, there are still a multitude of barriers facing overdose prevention on the ground. Currently in most jurisdictions, harm reduction workers can train people in how to use naloxone when they meet them on outreach but are not actually able to distribute the product. I have lost count of the amount of people that have proactively asked me for naloxone products in order to protect their loved ones and I’ve had to send them off to find a pharmacy, while knowing they don’t have the means to get there. And, we know that peers are better able to reach more diverse communities of people at risk of overdose, such as younger people, women and our indigenous populations.  Peers and harm reduction workers must be provided with an avenue to distribute naloxone themselves, and in turn empower their communities. They must be recognised as experts in their communities and for the vital contributions they make to society.

Peers can alert you in research and practice of unintended adverse outcomes of implemented programs, and must be listened to. The ongoing implementation of real time prescription monitoring across Australian jurisdictions will result in unintended adverse outcomes if people at risk of opioid overdose are not consulted and their suggestions not incorporated. These programs must be implemented in collaboration with a range of other services, such as: increased availability of OST and OST prescribers, non-discriminatory community awareness education, alternatives to pain medications (including medicinal cannabis), and ending the criminalisation of drug use. Naloxone distribution must also be made available through prisons, treatment programs and emergency health services; which is starting to occur in some jurisdictions, but support must be given to expand access across others. Unique programs such as drug checking services, early warning systems and innovative peer-led overdose prevention sites such as those supported in Canada should be implemented globally.

I am proud to say that Australia is still a global leader in harm reduction research. Many of our major research institutes conduct research funded through the Australian Government, and incorporates peers as researchers and study investigators.

My message to member states: As a member of HRA, the International Drug Policy Consortium and Board Member of the VNGOC,  I encourage you to always involve people who are at risk of opioid overdose (particularly people who inject drugs) in your planning and implementation of all interventions aiming to reduce opioid overdose. Some member states already work with their civil society counterparts, but in the case that you have not already met with them, I am very happy to introduce you to our members working on overdose in your country or region – this is the main reason we all travel to these meetings.

To summarise: death from opioid overdose is entirely preventable. If you work with your local civil society counterparts, particularly people who inject drugs, other people at risk of opioid overdose, community health and harm reduction workers, and effectively within academia – you will play a role in effectively preventing opioid overdose in your local communities. I see this directly on-the-ground in Australia, and we’ve all seen this through the results of the SOS study.

Your work will be most effective if it is implemented through non-discriminatory pathways, following evidence-, human rights-, and public health-based community development principles that recognise the key affected population as experts in their communities. The WHO 90-90-90 targets for overdose, implementation of CND resolutions 55/7 and 62/4, and many components of the UN 2030 Sustainable Development Agenda targets will be met by recognising the unique needs and expert knowledge of people who use drugs and by incorporating this expertise into your national drug strategies. As a member of civil society, I implore you to strive to work with your civil society counterparts to remove opioid overdose as a threat to your communities. Through harm reduction focused community management and peer led programs for opioid overdose prevention, we can all work together to ensure that no one, in particular people who use drugs, are left behind. After all, we are all here for the same reason

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