Background | Ramp

Historical Responses to the Opioid Overdose Crisis

2012

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) [1] identified 16 factors of non-fatal and fatal overdoses, separated into 4 major domains:

characteristics of the individual who injects drugs
circumstances in which the overdose occurred
treatment interventions;
organizational response in the aftermath of an overdose.

Managing individual, situational, and organizational risk factors can reduce the likelihood of a fatal overdose [2].

2005-2015

Among the 2,494 people who inject drugs surveyed between 2005 and 2015, 65% reported barriers to accessing care [3]. In BC, 88% of illicit drug overdose deaths occur inside, where 58% occur in private residences and 30% in other residences including social and supportive housing, Single Room Occupancy Hotels, shelters, and hotels [4]. As overdoses occur in “private” settings, interventions to prevent overdoses become more difficult. In addition, Indigenous communities are disproportionately affected by overdose, where 14% of all overdose events in BC occurred among Indigenous individuals even though they comprise only 3.4% of the population [5].

Therefore, interventions that can reach out to all groups of people are greatly needed to improve access to care and mitigate inequity for those who face significant barriers. Overall, the healthcare system in Canada is currently overwhelmed with this crisis and the following system issues need to be addressed:

The incoherence and disintegration of services, especially the disconnect of mental health and substance use components which makes it difficult for patients to understand and navigate the risk management resources [6]
The high thresholds for accessing appropriate resources and lack of transparency in the 8 system [7].
Limiting the overdose response to crisis management instead of crisis prevention and risk management [8]

[5]

2016

To address these issues, the Federal Government of Canada issued a Joint Statement of Action on November 2016 [9]. To ensure the alignment with these national strategic goals, the RAMP project will contribute to the prevention, treatment, and harm reduction pillars of the Canadian Drugs and Substances Strategy. In addition, it will enforce all the collaborative, compassionate, comprehensive, and evidence-based Health Portfolio’s actions emphasized under the Joint Statement of Action [10]. From implementation elements in Federal Actions on Opioids, RAMP will particularly contribute to:

Better informing Canadians about the risks of opioids
Supporting better treatment options for patients
Improving the evidence base upon which policy decisions are made [10,11].

2016-2018

In 2017, there were 4,034 opioid-related deaths in Canada and 3,286 from January to September 2018 [12]. BC is the epicenter of this crisis; there are an estimated 3.4 deaths from illicit drug overdoses each day in BC [4].

Comparing across different provinces, BC had fatal overdose cases of 1,155, Ontario 1,031, Alberta 613, and Quebec 300 from January to September 2018 [12]. The number of overdose incidents and deaths have continued to rise at an accelerated rate [12] despite most of them being avoidable [1]. As complex health conditions and chronic illness are based on modifiable and non-modifiable risk factors as well as individual resilience, the understanding of risk factors and potential protection mechanisms is important to influence the course of disease and prevent serious adverse events or fatal outcomes [14,15][16].