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    10 Key Actions

    The 2nd annual meeting generated ideas to reduce overdose deaths.

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BC Overdose Action Exchange II

On June 16, 2017, over 130 people and 54 organizations gathered for the second annual meeting. They identified 10 key actions to reduce the unprecedented rise in overdose deaths over the past two years.


While there has been an incredible amount of work and resources put into the overdose response over the last year, we still face a serious health emergency that shows no signs of slowing. The overdose crisis continues to marginalize people who rely on an unregulated drug market to deal with their addiction, pain, trauma, mental illness and social isolation.

These deaths are preventable and there is no one that can’t be helped. Stigma. Decriminalization. Connection. Rebuilding lives.”
- meeting attendee

The purpose of the Overdose Action Exchange meeting was to generate ideas that challenge the status quo and lead to a new set of innovative strategies. These ideas and actions are representative of feedback from people with lived experience, policy makers, community organizations, public health leaders, government, academia, emergency health services, law enforcement, researchers and medical experts.

We have summarized the 10 Key Actions below or you can read the 2017 report in full. You can also read the 2016 report and primer.

More than just a drug problem

"The impact of the overdose crisis to families, friends, and communities has been massive and the scars will be with us for many years to come. The urgency for real change expressed so eloquently by the people who are experiencing the losses firsthand needs to be heard and acted upon." - Dr. Mark Tyndall, Executive Medical Director, BCCDC

10 Key Actions

1. Engage

1. Engage

peers in program development and leadership

2. Address

2. Address

contamination of the drug supply

3. Support

3. Support

appropriate pain management therapies

4. Build

4. Build

on the success of Overdose Prevention Sites

5. Expand

5. Expand

and improve treatment for addiction.

6. Align

6. Align

law enforcement with public health

7. Reform

7. Reform

drug laws

8. Address

8. Address

structural barriers and upstream factors

9. Counter

9. Counter

stigma against people who use drugs

10. Implement

10. Implement

targeted research, surveillance and evaluation initiatives

  Next >>

1. Engage peers in program development and leadership

Promising Practice

Provincial health initiatives working to meaningfully involve people who use drugs

  << previous Next >>

2. Address contamination of the drug supply

    "We need immediate access to safe drugs."
    - Karen Ward, VANDU

  • Increase access to prescription drugs as an alternative to the contaminated drug supply
      • Pilot low-barrier, rapidly scalable models of distributing a regulated supply of pharmaceutical opioids to those at risk of opioid overdose due to illegal drug supply contamination.
      • These may involve accessing opioids through pharmacies, mobile programs, dedicated storefronts and/or supportive housing facilities
      • Allowing consumption off-site (i.e. not witnessed) will lower barriers to participation
      • Pilot and evaluate the impact of stimulant substitution on the overdose crisis
      • Open additional clinics based on the Crosstown model (on-site injection with intensive engagement) to provide access to supervised opioid injection
      • Expand physician capacity and confidence to prescribe opiates including oral hydromorphone, long acting slow release oral morphine and injectable opioids
      • Increase the number of physicians and nurse practitioners with specialty training in addiction medicine
  • Expand the ability of people who use drugs to test their own drugs
      • Develop models of drug testing feasible in rural areas
      • Develop bring-home/mail-in testing programs
      • Expand drug testing beyond qualitative to quantitative results on potency
      • Expand drug testing to additional sites – Supervised Consumption Sites, Overdose Prevention Sites, mobile sites, health authority sites (e.g. Community Health Centres, STI clinics), and bars, nightclubs, and music festivals
  • Conduct outreach to improve processing, bulking and access to testing of of illegal drugs
      • Encourage drug dealers to use drug testing programs
      • Improve access of drug producers to professional-grade mixing equipment and educate them about techniques to improve homogeneity of the product
  • Explore medical opium as a source of uncontaminated opioids
      • Grower’s clubs, production on a model similar to medical marijuana, personal cultivation
  • Addressing contamination of the drug supply must involve drug law reform.

  << previous Next >>

3. Support appropriate pain management strategies

    "People cut off their pain medications have to go to the 'street' to get their relief. In the midst of the fentanyl crises this is forcing people with real pain issues to play Russian roulette with street drugs."
    - Dean Wilson

  • Improve access to and evaluate the affordability & effectiveness of non-opioid strategies
      • Consider a multidisciplinary approach including counselling and physical therapy
      • Decrease wait times for referral services to pain clinics
      • Develop a new PharmaCare plan to enable access to non-opioid pain therapies, including allied health modalities
      • Enhance and evaluate access to integrated therapeutic models
  • Expand initiatives that promote patient-centered care (including addictions and chronic pain)
      • Develop incentives and expand alternative billing models to allow physicians more time to engage and manage complex patients appropriately
      • Promote comprehensive pain management within the Patient Medical Home initiative of Doctors of BC
      • Provide access to culturally appropriate treatments and Indigenous healing services
  • Provide timely and easily accessible practice support to physicians
      • Develop clinical guidelines on the treatment of chronic pain in people who have substance use disorders
      • Improve PharmaNet usability to support clinical decision-making and a prescription drug monitoring program (PDMP); introduce reporting to physicians that compares their prescribing practices to the average to encourage self-reflection and behavior change (similar to reporting on antibiotic use) and evaluate any PDMP for unintended consequences
  • Develop advocacy strategies related to unintended consequences of restricting access to prescription opioids
  • Improve education curriculum in medical schools, residency programs, and nursing schools

      including opioids, harm reduction, mental health, substance use and trauma-informed care

  << previous Next >>

4. Build on the success of Overdose Prevention Sites

    "The opposite of addiction is connection and connections are being built at opioid sites. This sense of community can flourish here.”
    - meeting attendee

  • Continue providing support to overdose prevention sites (OPS) throughout BC

      Continue financial and human resources support to community-based OPS

      Continue to support peer engagement at OPS
      • Ensure adequate funds are available to pay peers for their participation in a variety of roles, including program development/consultation, outreach and front-line work
      • Develop site-specific guidelines addressing how to support peers in frontline OPS roles
  • Reframe as “overdose prevention services” to better capture the range of possible initiatives
      • Integrate primary care and mental health services
      • Offer scheduled primary care and mental health services at community-based OPS; scale up if successful
      • Embed OPS within health authority sites
      • Increase geographic scope of OPS
      • Explore support for supervised inhalation in outdoor spaces
      • Increase staffing on income assistance cheque days
  • Develop and pilot new technologies for OPS
      Pilot new technologies for overdose prevention to better serve people who cannot attend a site
      • Build upon the existing BC telemedicine infrastructure
      • Use online and smartphone video communication applications (e.g. Facetime)
      • Use link smartphone actigraphy (technology which measures movement during sleep) with OPS respond where feasible (e.g. in supportive housing)

      Develop a communication platform between OPS to facilitate exchange of best practices

  • Conduct a robust evaluation of OPS to inform longer-term decision making
  • Develop an outreach-based model and create welcoming spaces

      Develop an outreach based OPS model that can be used in rural and remote areas

      Create welcoming social spaces for people to use drugs together both related to and distinct from OPS

  << previous Next >>

5. Expand and improve addiction treatment

    "Being able to heal together is really important."
    - meeting attendee

  • Increase supports & access to treatment
      Expand access to the first line treatment for opioid use disorder (buprenorphine/naloxone)

      while providing the option to attend specialized clinics (offering comprehensive services, including counseling and pharmacist support) to access additional treatment. Lower barriers to access by:

      • Using telehealth infrastructure to improve access in rural areas
      • Improving access to medical therapy during evenings and weekends
      • Expanding physician capacity for outreach and house calls

      Implement legislation and policies that encourage parents to seek treatment without fear of child apprehension

      Provide treatment free of charge

      Increase supports to families, including counselling, education and resources

      Increase supports while accessing and transitioning from treatment while using family-centered approaches

      Increase access to treatment options for youth

      including integrated service hubs, outreach, and Indigenous healing and cultural connection services

  • Work with Indigenous service providers and communities

      to ensure provision of culturally safe, relevant and effective addiction treatment services

      • Promote increased access to training and recruitment of Indigenous physicians
      • Promote access to culture as treatment practices and indigenous healing services
  • Review evidence for approaches used in residential addiction treatment and recovery homes
      • Implement minimum standards under which they must operate and ensure oversight and accountability
  • Improve physician training and resources

      Increase the number of physicians with addiction medicine training through fellowships and Continuing Medical Education (CME)

      • Develop incentives to encourage physicians, particularly family doctors and walk-in clinic doctors, to attend CME addictions training

      Encourage uptake of existing training materials for physicians and develop new resources to fill identified gaps (e.g. people who use substances recreationally, people who use stimulants, treatment of concurrent disorders).

  • Develop a post-overdose follow-up and care program
    Pilot an intervention in which social workers attend overdose calls along with first responders

  << previous Next >>

6. Align law enforcement efforts with public health

Promising Practice

Pivot has created a fact sheet about Canada's new Good Samaritan Drug Overdose Act, and what it can protect people from. Support. Don't Punish is a global advocacy campaign calling for drug policies based on health and human rights.

  << previous Next >>

7. Reform drug laws

    "The war on drugs is a war on drug users. And we’re dying."
    - Karen Ward, VANDU

    Strike a provincial coalition to build British Columbia’s vision of drug law reform
  • Focus on an initial goal of decriminalization of illegal drugs for personal use

      while acknowledging that full legalization and regulation is necessary to address contamination of the drug supply.

      • Ask the regulated professions to release joint statements of support for drug law reform
      • Increase re-direction from sentencing to addiction treatment and social support services for minor drug offences
      • Stop court ordered addiction treatment
      • Provide less punitive and more flexible options
  • Reform the Controlled Drugs and Substances Act to allow handling of illegal drugs for the purpose of drug testing without a Section 56 exemption

  << previous Next >>

8. Address structural barriers and upstream factors

    "Linkages to housing are equally important to maintain the work done by linkages to primary care.”
    - meeting attendee

  • Increase support services and strengths-based education for children, youth and parents

      Support services for youth and parents across BC

      • Standardize the connection of public health nurses to parents across the province to provide education, support and counselling
      • Increase access to early screening and support for mental health in school age children

      Increase access to education and programming that supports strengths-based approaches and community connectedness

      • Increase access and engagement for low income children in community recreational activities
      • Develop and implement substance use education for children and youth in schools focused on resiliency and skill building rather than drug harms
  • Align all initiatives with the interests of Indigenous communities
      • Advocate and work to implement recommendations of the Truth and Reconciliation Commission
      • Develop and fund practical tools and programming to support wellness for individuals and families grounded in cultural approaches
  • Increase availability of accessible, confidential supports for people who need help
      • Develop resources for people who do not meet diagnostic criteria for mental illness to support mental health and well-being
  • Implement social policies and advocacy within government

      Implement coordinated social policies across departments with focus on healthy child and family development

      Institute an affordable childcare plan for BC

      Implement BC Poverty Reduction Plan
      • Introduce a minimum guaranteed income
      • Provide housing to those who need it
      Create a cross-governmental advocacy position who can speak to inter-ministerial needs

      for advocacy for people who use drugs (like the Representative for Children and Youth)

      Advocate with the federal government to declare a national public health emergency

  << previous Next >>

9. Counter stigma against people who use drugs

  << previous Next >>

10. Implement targeted research, surveillance & evaluation initiatives

    “I know it’s hard to be positive in such a dire situation, but the innovations in drug policy globally have always emanated from the ground up and started locally.”
    - Donald MacPherson, Canadian Drug Policy Coalition

  • Create targeted research initiatives
      • Focus on people using alone in private residences
      • Explore alternative way of distributing income assistance payments to avoid peaks in overdoses
      • Conduct a feasibility study of how public health leadership might facilitate access to opium on a model similar to medical marijuana
      • Use data from the BC Opioid Overdose Cohort to:
        • Understand the extent to which prescription opioids and recent policy changes have fueled and supported the current overdose crisis
        • Investigate differences in risk factors for overdose, including opioid prescribing, among those with First Nations vs non-First Nations identity
        • Institute a qualitative research program to contextualize results, investigate areas of uncertainty and identify new analytic questions
  • Implement evaluation plans for all new overdose response and prevention initiatives

      including clear timelines and knowledge translation of results.

      • Evaluate unintended consequences of the College of Physicians and Surgeons British Columbia (CPSBC) prescription opioid guidelines and prescription drug monitoring programs
  • Develop surveillance methods
      • Build a centralized database of patients in residential addiction treatment to quantify treatment pathways and outcomes
      • Collect data on possible targeted (deliberate) overdoses towards individuals
      • Improve surveillance of the composition of illegal drugs
  • Implement structure for comprehensive data collection of recommended child and youth indicators

  << previous


The BC Centre for Disease Control respectfully acknowledges that the second annual Overdose Action Exchange meeting was held on the ancestral homelands of the Coast Salish peoples, including the territories of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), Stó:lō and Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) Nations.

We would like to thank all meeting attendees, facilitators and the planning committee for their work in creating the actions for this report.

#CDNOverdoseCrisis • #ODAX2017