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Evaluating Buprenorphine/Naloxone Microdosing vs. Standard Dosing in Emergency Departments (EMED Study)
This is a multi-centre, open-label, randomized controlled trial (RCT) at four Emergency Departments (EDs) in British Columbia (active) and Alberta (tentative). The current study aims to compare the effectiveness of buprenorphine/naloxone microdosing and standard dosing take-home induction regimens in enabling patients to successfully complete the induction regimen and retaining patients on opioid agonist therapy.
We randomize our enrolled patients to receive take-home microdosing or standard dosing packages of buprenorphine/naloxone. For the microdosing arm, patients immediately start taking low doses that increase to effective levels without requiring them to go into withdrawal.
We hypothesize that ED patients provided with buprenorphine/naloxone microdosing packages will be more likely to successfully complete the induction period compared to patients provided with standard dosing packages. We furthermore hypothesize that those provided microdosing will be more likely to be retained in opioid agonist therapy and experience a lower overdose, mortality, and healthcare utilization subsequent to their ED visit.
We are actively recruiting participants for the EMED study at our Vancouver General Hospital (VGH) and St. Paul’s Hospital (SPH) sites.
Qualified Investigators (QIs):
BC study sites: Dr. Jessica Moe (VGH and UBC Hospital); Dr. Andrew Kestler (SPH)
Alberta study sites:
Edmonton: Dr. Kathryn Dong (Royal Alexandra Hospital); Dr. Robert Wittmeier (Northeast Community Health Centre)
Calgary: Dr. Kathryn Crowder (Foothills Medical Centre); Dr. Kathryn Crowder (South Health Campus)
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EMED Study Email: emed.study@ubc.ca
ClinicalTrials.gov Study Details: https://clinicaltrials.gov/ct2/show/NCT04893525
UBC Department of Emergency Medicine Feature: https://emergency.med.ubc.ca/2021/08/23/buprenorphine-naloxone-microdosing-clinical-trial-launches/
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Observing from Afar: Continuous Pulse Oximetry for People Who Smoke Opioids to Prevent Overdose Deaths (Oximetry Study)
In 2021, 2232 people died of an overdose in British Columbia (BC), the highest annual death toll on record.* Smoking opioids has become the most common way to consume opioids, and the proportion of overdose deaths from smoking unregulated drugs increased from 31% to 56% between 2016 and 2020.**
Given the rise in smoking-related deaths during the coronavirus disease (COVID-19) pandemic, our project responded to an urgent need to develop a remote monitoring system that maintains physical distancing and is effective and feasible for staff to implement at overdose prevention services (OPS) when monitoring and responding to people who smoke drugs. Continuous pulse oximetry enables real-time, remote oxygen level monitoring for patients in healthcare settings. Introducing this technology at OPS for individuals smoking drugs may promote service use and improve staff safety by allowing monitoring from a safe distance.
This project implemented a novel continuous pulse oximetry monitoring protocol using a participatory research approach to improve services at OPS for people who smoke opioids. The four partnering OPS from Victoria and Vancouver successfully implemented our protocol. The project improved capacity and comfort levels among peer researchers, participants, and OPS staff in the use of continuous pulse oximetry.
Our study offers crucial lessons about engaging people with lived experience in participatory research on people who smoke opioids. We engaged people with lived experience in every aspect of the study.
Toward The Heart Project Summary: https://towardtheheart.com/research-projects
*British Columbia Coroners Service. Illicit Drug Toxicity Deaths in BC January 1, 2011 –December 31, 2021.
**BC Coroners Services Illicit Drug Toxicity Deaths in BC Knowledge Update: Mode of Consumption (Feb 2022)
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Analyzing Patient Outcomes Post-overdose Using the BC Centre for Disease Control Provincial Overdose Cohort (Overdose Cohort Study)
Visits to the emergency department are critical opportunities to engage individuals after an overdose. We analyzed data from the BC Centre for Disease Control’s Provincial Overdose Cohort to estimate and compare the 12-month mortality between persons with visits to the emergency department related to opioid overdose and those with non-overdose-related visits. We found that among persons who were discharged, the 12-month mortality hazard was 3.5 (95% CI 3.0–4.2) times higher among those with overdose-related visits than those with non-overdose-related visits. For persons who left against medical advice, the mortality hazard was 7.1 (95% CI 4.0–12.5) times higher among those with opioid overdose.
Peer Navigator Project
The Peer Navigator Project is a research study identifying care/service gaps and challenges to inform the design of a non-stigmatizing, person-centred ED peer navigator program. Integrating peers with lived/living experience of opioid use into EDs could improve patients’ sense of safety, comfort, and positive experiences based on their shared experience and potentially increase engagement in life-saving care.