Department of Emergency Medicine, Diamond Health Care Centre, University of British Columbia, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
BC Centre for Disease Control, 655 West 12 Avenue, Vancouver, BC, V5Z 4R4, Canada.
Harm Reduct J. 2024 Feb 20;21(1):45. doi: 10.1186/s12954-024-00963-6.
Smoking is the most common mode of unregulated opioid consumption overall and implicated in fatal overdoses in British Columbia (BC). In part, perception of decreased risk (e.g., fewer who smoke carry naloxone kits) and limited smoking-specific harm reduction services contribute to overdose deaths. Overdose prevention services (OPS) offer supervised settings for drug use. Continuous pulse oximetry, common in acute care, allows real-time, remote oxygen monitoring. We evaluated the effectiveness of a novel continuous pulse oximetry protocol aimed at allowing physical distancing (as required by COVID-19, secluded spaces, and to avoid staff exposure to vaporized opioids), its feasibility, and acceptability at OPS for people who smoke opioids.
This was a mixed methods survey study. We developed a continuous pulse oximetry protocol in collaboration with clinical experts and people with lived/living experience of substance use. We implemented our protocol from March to August 2021 at four OPS in BC permitting smoking. We included adults (≥ 18 years) presenting to OPS to smoke opioids. Peer researchers collected demographic, health, and substance use information, and conducted structured observations. OPS clients participating in our study, OPS staff, and peer researchers completed post-monitoring surveys. We analyzed responses using a thematic inductive approach and validated themes with peer researchers.
We included 599 smoking events. OPS clients participating in our study had a mean age of 38.5 years; 73% were male. Most (98%) reported using "down", heroin, or fentanyl; 48% concurrently used other substances (32% of whom reported stimulants); 76% reported smoking alone in the last 3 days; and 36% reported an overdose while smoking. Respondents reported that the protocol facilitated physical distancing, was easy to use, high satisfaction, improved confidence, improved sense of safety, and that they would use it again.
Continuous pulse oximetry allowed safe physical distancing, was feasible, and acceptable in monitoring people who smoke opioids at OPS.
吸烟是全球最常见的非监管阿片类药物消费方式，也是不列颠哥伦比亚省（BC）致命药物过量的罪魁祸首之一。部分原因是，人们认为风险降低（例如，吸烟人群携带纳洛酮试剂盒的人数减少），以及吸烟相关的减少伤害服务有限，这导致了药物过量死亡。过量预防服务（OPS）为药物使用提供了监督环境。连续脉搏血氧饱和度监测在急性护理中很常见，可以实时远程监测氧气。我们评估了一种新的连续脉搏血氧饱和度协议的有效性，该协议旨在实现物理距离（如 COVID-19、隔离空间和避免工作人员接触蒸发的阿片类药物所要求的），并评估其在允许吸烟的 OPS 中的可行性和可接受性。
这是一项混合方法调查研究。我们与临床专家和有药物使用经验的人合作制定了连续脉搏血氧饱和度协议。我们于 2021 年 3 月至 8 月在 BC 的四个允许吸烟的 OPS 实施了该协议。我们纳入了到 OPS 吸烟的成年人（≥18 岁）。同行研究人员收集了人口统计学、健康和药物使用信息，并进行了结构化观察。参与我们研究的 OPS 客户、OPS 工作人员和同行研究人员完成了监测后调查。我们使用主题归纳法分析了回复，并与同行研究人员一起验证了主题。
我们共纳入了 599 次吸烟事件。参与我们研究的 OPS 客户的平均年龄为 38.5 岁；73%为男性。大多数（98%）报告使用“downtown”、海洛因或芬太尼；48%同时使用其他物质（其中 32%报告使用兴奋剂）；76%报告在过去 3 天内独自吸烟；36%报告在吸烟时药物过量。受访者报告说，该协议促进了物理距离，使用方便，满意度高，增强了信心，提高了安全感，他们会再次使用。
连续脉搏血氧饱和度监测在 OPS 监测吸烟的阿片类药物使用者时，允许安全的物理距离，具有可行性和可接受性。
