Naloxone and the Inner City Youth Experience (NICYE): a community-based participatory research study examining young people's perceptions of the BC take home naloxone program.

BACKGROUND: Take home naloxone (THN) programs reduce mortality by training bystanders to respond to opioid overdoses. Clinical observation by the health care team at the Inner City Youth (ICY) program indicated that young adults appeared to enthusiastically participate in the THN program and developed improved relationships with staff after THN training. However, we found a dearth of literature exploring the experiences of young adults with THN programs. This study set out to address this gap and identify suggestions from the young adults for program improvement. The primary research question was "How do street-involved young people experience the THN Program in Vancouver, BC?" METHODS: The study was undertaken at the ICY Program. Two peer researchers with lived experience of THN were recruited from ICY and were involved in all phases of the study. The peer researchers and a graduate student facilitated two focus groups and five individual interviews with ICY program participants using a semi-structured interview guide. Audio recordings were transcribed verbatim. The cut-up-and-put-in-folders approach was used to identify emerging themes. RESULTS: The themes that emerged were perceptions of risk, altruism, strengthening relationship with staff, access to training, empowerment, and confidence in ability to respond, and suggestions for youth-friendly training. These themes were then situated within the framework of the health belief model to provide additional context. Participants viewed themselves as vulnerable to overdose and spoke of the importance of expanding access to THN training. Following training, participants reported an increase in internal locus of control, an improved sense of safety among the community of people who use drugs, improved self-esteem, and strengthened relationships with ICY staff. Overall, participants found THN training engaging, which appeared to enhance participation in other ICY programming. CONCLUSIONS: Young people perceived THN training as a positive experience that improved relationships with staff. Participant recommendations for quality improvement were implemented within the provincial program.

Involuntary stabilization care of youth who overdose: a call for evidence- and ethics-informed substance use policy.

As is the case across Canada, the province of British Columbia is in the midst of an opioid overdose crisis. In response to the devastating impacts of this crisis on youth (under 19 years of age), the provincial government is considering amending the Mental Health Act to allow for involuntary, hospital-based stabilization care of youth following an overdose. This policy change represents one concrete action that the provincial government is exploring in response to public advocacy for enhanced supports for youth who overdose. At this juncture, however, we are concerned that stabilization care requires further interrogation in the context of key, interrelated public health and ethical dimensions pertaining to this legislation. In this commentary, we describe three key areas for public health deliberation: (1) the evidence underpinning stabilization care, (2) ethical considerations, and (3) the potential for unintended and unevenly distributed consequences. We then offer ways forward to guide and provide opportunities for a more equitable public health response to the overdose crisis and its impacts on youth. In doing so, we emphasize the need for meaningful engagement of youth as key stakeholders in the development of evidence- and ethics-informed substance use care and policy interventions.

RéSUMé: Comme le reste du Canada, la province de la Colombie-Britannique est en pleine crise de surdoses d'opioïdes. En réponse aux effets dévastateurs de cette crise sur les jeunes (moins de 19 ans), le gouvernement provincial songe à modifier la loi sur la santé mentale de la province pour permettre les soins de stabilisation forcés des jeunes à l'hôpital après une surdose. Ce changement d'orientation représente une mesure concrète envisagée en réaction aux campagnes de sensibilisation qui préconisent des mesures de soutien améliorées aux jeunes qui font des surdoses. À ce stade toutefois, nous pensons que les soins de stabilisation nécessitent une interrogation plus poussée sur les aspects sanitaires et éthiques essentiels et interdépendants afférents à cette loi. Dans notre commentaire, nous décrivons trois aspects clés des délibérations de la santé publique : 1) les données probantes qui sous-tendent les soins de stabilisation, 2) les considérations éthiques et 3) les effets pervers et inégalement répartis qui pourraient en découler. Nous proposons ensuite une marche à suivre pour guider et créer les possibilités d'une riposte plus équitable de la santé publique à la crise des surdoses et à ses répercussions sur les jeunes. Ce faisant, nous insistons sur la nécessité de faire participer concrètement les jeunes, en tant qu'acteurs privilégiés, à l'élaboration d'interventions de soins et de politiques sur la consommation de substances éclairées par les données probantes et par l'éthique.

Case report: Successful induction of buprenorphine/naloxone using a microdosing schedule and assertive outreach.

BACKGROUND: The requirement for moderate withdrawal prior to initiation can be a barrier to buprenorphine/naloxone induction. CASE PRESENTATION: We aimed to use a microdosing regimen to initiate regular dosing of buprenorphine/naloxone in a high-risk patient with a history of failed initiations due, in part, to withdrawal symptoms. Using an assertive outreach model and a buprenorphine/naloxone microdosing schedule, we initiated treatment of an individual's opioid use disorder. There was a successful buprenorphine/naloxone microdosing induction as the team reached a therapeutic dose of buprenorphine/naloxone. Including the induction period, the medication was used consistently for 4 weeks. CONCLUSIONS: A microdosing schedule can be used to induce a patient onto buprenorphine/naloxone with no apparent withdrawal; gradually reducing illicit substance use. This case report builds on previous literature, highlighting ways to minimize barriers to induction of buprenorphine/naloxone, using a microdosing schedule and assertive outreach. Given the safety profile of buprenorphine and its potential to be a lifesaving intervention, a larger study of microdosing is indicated.