Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Harm Reduction, BC Centre for Disease Control, Vancouver, British Columbia, Canada.
BMJ Open. 2019 Oct 28;9(10):e030046. doi: 10.1136/bmjopen-2019-030046.
This study describes the 2016 expansion of the British Columbia Take Home Naloxone (BCTHN) programme quantitatively and explores the challenges, facilitators and successes during the ramp up from the perspectives of programme stakeholders.
Mixed-methods study.
The BCTHN programme was implemented in 2012 to reduce opioid overdose deaths by providing naloxone kits and overdose recognition and response training in BC, Canada. An increase in the number of overdose deaths in 2016 in BC led to the declaration of a public health emergency and a rapid ramp up of naloxone kit production and distribution. BCTHN distributes naloxone to the five regional health authorities of BC.
Focus groups and key informant interviews were conducted with 18 stakeholders, including BC Centre for Disease Control staff, urban and rural site coordinators, and harm reduction coordinators from the five regional health authorities across BC.
Take Home Naloxone (THN) programme activity, qualitative themes and lessons learnt were identified.
In 2016, BCTHN responded to a 20-fold increase in demand of naloxone kits and added over 300 distribution sites. Weekly numbers of overdose events and overdose deaths were correlated with increases in THN kits ordered the following week, during 2013-2017. Challenges elicited include forecasting demand, operational logistics, financial, manpower and policy constraints. Facilitators included outsourcing kit production, implementing standing orders and policy changes in naloxone scheduling, which allowed for easier hiring of staff, reduced paperwork and expanded client access.
For THN programmes preparing for potential increases in naloxone demand, we recommend creating an online database, implementing standing orders and developing online training resources for standardised knowledge translation to site staff and clients.
本研究从项目利益相关者的角度描述了不列颠哥伦比亚省 2016 年扩大美沙酮丁丙诺啡纳洛酮（BCTHN）计划的数量，并探讨了在增加供应期间所面临的挑战、促进因素和成功经验。
混合方法研究。
BCTHN 计划于 2012 年在加拿大不列颠哥伦比亚省实施，通过提供纳洛酮试剂盒以及阿片类药物过量识别和反应培训，以减少阿片类药物过量死亡。2016 年不列颠哥伦比亚省的阿片类药物过量死亡人数增加，导致宣布公共卫生紧急状态，并迅速增加纳洛酮试剂盒的生产和分发。BCTHN 将纳洛酮分发给不列颠哥伦比亚省的五个地区卫生当局。
对包括不列颠哥伦比亚省疾病控制中心工作人员、城市和农村现场协调员以及来自不列颠哥伦比亚省五个地区卫生当局的减少伤害协调员在内的 18 名利益相关者进行了焦点小组和关键知情人访谈。
确定了美沙酮丁丙诺啡纳洛酮（THN）计划活动、定性主题和经验教训。
2016 年，BCTHN 对纳洛酮试剂盒需求增加 20 倍做出反应，并增加了 300 多个分发点。2013-2017 年期间，每周发生的过量事件和过量死亡人数与随后一周订购的 THN 试剂盒数量增加相关。提出的挑战包括需求预测、运营物流、财务、人力和政策限制。促进因素包括外包试剂盒生产、实施常备订单以及在纳洛酮配药方面的政策变更，这使得更容易招聘员工、减少文书工作并扩大客户获得途径。
对于准备增加纳洛酮需求的 THN 计划，我们建议创建在线数据库、实施常备订单以及为现场工作人员和客户开发标准化知识转化的在线培训资源。
