Reducing Harms: Seed and Pilot Funding for BCCDC Researchers
From 2014 to 2019, the BCCDC Foundation for Public Health ran a pilot funding program called the Open Awards Program (OAP). The purpose of the OAP was to strengthen the research enterprise at the BC Centre for Disease Control (BCCDC) by providing small pilot grants and seed funding to support research, knowledge translation, and convening activities that would enable researchers to secure larger funding awards. Spread over two competitions per year, we awarded up to $100,000 per annum to faculty members at the BCCDC, many of whom went on to secure grants from larger funding sources. Over 53 awards were provided, totalling $436,323 for various activities across many key areas, and reflecting our public health priorities.
Here is just a handful of OAPs that reflect our critical focus on reducing harms, we are proud to have funded:
Buprenorphine/naloxone Standard Dosing and Microdosing in the Emergency Department: A feasibility study (2019)
Research Lead: Dr Jessica Moe
Many vulnerable populations, such as First Nations, construction workers, and people who use drugs alone, are at high risk for overdose, and may only seek out healthcare services in Emergency Departments (EDs). Yet, EDs don’t have a good way of identifying those at risk and offering treatments that could prevent future overdoses. By preventing cravings and withdrawal symptoms, Buprenorphine/naloxone (Suboxone) is the recommended treatment for patients with opioid addiction who wish to decrease their harmful opioid use, and studies show that starting people on buprenorphine/naloxone during ED visits helps to connect them with addictions services.
At the same time, many barriers exist that prevent people from accepting this treatment, like experiencing uncomfortable opioid withdrawal symptoms like agitation, nausea, vomiting, and sweats, before starting buprenorphine/naloxone at standard doses, plus, the medication can make patients’ withdrawal symptoms worse if started too early. As a result, microdosing is a new way of starting buprenorphine/naloxone where people take small doses that gradually increase over 6-7 days. People also do not need to be in withdrawal before a microdosing method is started, and the risk of causing worsening withdrawal symptoms during initiation is low. Still, the longer time to reach a target dose is a downside. This innovative study examined the feasibility of starting people on buprenorphine/naloxone from the ED using both standard dosing and microdosing methods, and was the first to address knowledge gaps on the acceptability of these methods, further contributing to the understanding of barriers to induction methods and of how to optimize buprenorphine/naloxone provision for vulnerable ED patients.
Opioid prescribing evaluation and research activities (2016-2018)
Research Lead: Dr Roy Purcell
Deaths due to illicit drug overdoses in BC is on the rise. This dramatic increase in deaths due to illicit drugs is partially due to patients transitioning from prescription opioid use to illicit drug use, which is very common. Many drugs sold illicitly contain fentanyl, an extremely dangerous opioid that is many times more potent than heroin. Patients who transition from taking prescription pain relievers containing opioids to injecting illicit drugs will be a much higher risk of overdose death.
Funding from the BCCDC Foundation allowed researchers to use data from the BC Hepatitis Testers Cohort (BC-HTC), a comprehensive population-based longitudinal cohort consisting of all BC residents who have been tested for HCV or HIV at the BCCDC Public Health Laboratory, to investigate the association between prescribed opioid therapy and objective measures of intravenous drug use (IDU) in a population-based cohort of almost 1.4 million people in Canada. Importantly, this grant was a key component of further funding to complete this research.
CDPC National Knowledge Exchange and Consultation on Supervised Consumption Services (2016)
Research Lead: Dr Naveed Janjua
People who inject drugs face serious potential health risks, including vulnerability to HIV and HCV. As Canada is in the grips of an overdose crisis, many groups are working to establish Supervised Consumption Services (SCSs) as part of a comprehensive response to the overdose situation. Funding from the BCCDC Foundation brought the Canadian Drug Policy Coalition (CDPC) and the Canadian HIV/AIDS Legal Network (Legal Network) together for a two-day facilitated “National Knowledge Exchange and Consultation on Supervised Consumption Services (SCS)” in Vancouver, BC, hosting 100 guests from 20+ localities in Canada considering and/or implementing SCSs.
The event successfully enabled the development of a comprehensive analysis of barriers created by the Respect for Communities Act, and a greater understanding of challenges encountered when operating a supervised consumption site. Additionally, an important network of stakeholders such as community groups, health authorities, harm reduction workers, and people who use drugs, was established to further future knowledge exchange efforts and coordination. The CDPC continues to work at a national level and focuses on including a broader range of participants in its network and activities related to SCSs. With the newly refreshed network of SCS advocates, the CDPC will look at implementing new digital engagement strategies, and may create some task sub-groups to focus on issues of SCS applications, operations, and community advisory processes.
Peer engagement and evaluation project (2015-2016)
Research Lead: Dr Jane Buxton
Harm reduction programs are internationally accepted as effective for reducing health disparities associated with drug use. However, there are large variations in the availability, accessibility, and utilization of these programs across BC. Partnering with people who use drugs, or ‘peers,’ reduces inequities by making services relevant and responsive. The Peer Engagement and Evaluation Project (PEEP) aimed to develop, implement, and evaluate best practice guidelines for peer engagement for harm reduction initiatives using an approach that includes capacity building, empowerment, and engagement of peers, providers, and decision makers.
BCCDC Foundation funding was granted for the purpose of a team meeting, for which one of the main findings was understanding the amount of stigma and discrimination among health providers across the province. As a result, the development of knowledge translation tools, including anti-stigma training with a photo series, were used at presentations across the province, as well as the development of best practice guidelines, which have been directly informed by the validation of their focus group findings at the team meeting.