Addressing the opioid crisis: engagement in multidisciplinary care

Background: The past few years have seen an epidemic of drug-related overdoses across Canada. Since 2016, there have been over 8,000 opioid-related deaths including 3,859 in our province of British Columbia. There were 120 overdose-related deaths in Nov/18, representing an increase in 13% over last year. In the context of addressing the opioid epidemic, there is critical need for engagement of people who use drugs (PWUD) in multidisciplinary care in which addiction-related needs can be addressed and treated.

Methods: A retrospective cohort evaluation was conducted among active/remote PWUD patients engaged at our centre, some of whom experienced opioid-related deaths. All were enrolled in a multidisciplinary program of care to address medical, social, psychological and addiction-related needs. In this analysis, we compare baseline PWUD population demographics, drug use to those who experienced an opioid-related death.

Results: A total of 730 active/remote PWUD were included in this analysis. Mean age 53 (22-78) years, 21% female, 29% opiate use, 31% cocaine, 22% amphetamines, 40% on opiate substitution therapy (OST), 34% current alcohol use, 16% currently homeless, and 50% with a diagnosed psychological condition. Based on the estimated 1,108 opioid-related deaths since 2015 and the estimated 12,900 PWID in Vancouver, the expected observed opioid-related deaths at our centre would have been 63. In median follow up of 3.6 years (0.17-16 years), there have been only 4 overdose-related deaths (0.18 per 100-person years) among PWUD at our centre. The age of PWUD who experienced an overdose-related death were 26, 38 ,54, 55 years, all were male, 50% opiate use, 50% hydromorphone, 25 % OST, 25% alcohol use, 50% homeless, and 75% diagnosed psychological condition.

Conclusion: In light of the current opioid crisis, our clinic population has demonstrated a lower than expected number of opioid-related deaths, despite engaging in high risk behaviours. We feel this is at least partially linked to the program we offer. In addition to addiction care, patients receive multidisciplinary care to address their physical, mental, and social needs. This probably leads to a reduction in risky opioid use. This approach should be integrated into the response to the opioid epidemic. Given proper engagement in multidisciplinary care, risk of fatal opioid-related events can be mitigated. Our data provide further support for future programs aimed at engaging and treating active and remote PWUD.