BACKGROUND: In 2016 a public health emergency was declared in British Columbia, Canada due to an increase in overdose deaths. The objective of this project was to use emergency department (ED) overdose surveillance and healthcare utilization data to identify opportunities to improve care for a population of suspected opioid overdose patients in Vancouver Coastal Health (VCH).
METHODS: Patients with severe illicit opioid overdose events detected by the ED surveillance system between January and June, 2016 were included. Descriptive statistics by age, sex, and residence were generated for overdose patients. For 6 months preceding the overdose event, the number of repeat ED visits for overdoses and for other visit reasons were identified. Hospital-based and community-based encounters for the same time period were extracted from patient charts to identify individuals who had previously received care from VCH, points of access with the healthcare system, and time since the most recent VCH healthcare encounter.
RESULTS:  108 illicit opioid overdose patients were identified from the inclusion criteria. The majority of the patients were male (64%) aged 19 to 49 years (range: 18 to 61; mean: 37) and lived in Vancouver’s Downtown Eastside and City Centre neighbourhoods. Of those individuals identified, 95% of the patients had received care from VCH prior to the overdose event and 75% had at least one encounter in the 6 months preceding the overdose. Overall, 27% of the 108 patients had a healthcare encounter within 7 days prior to the overdose event. Community-based programs saw a smaller proportion of patients (48/108; 44%) compared to hospital-based services (72/108; 67%) but had seen patients more recently (median 17 days from last visit to overdose compared to median 34 days for hospital-based services). Among patients seen in hospital settings, 35% had more than 3 encounters and 4% had >10 encounters in the 6 month period. The most common hospital-based encounters were at EDs (179/271; 66%), primarily for visits related to substance abuse (50/179; 28%) or infection-related illness (22%).
CONCLUSIONS: The majority of patients presenting to EDs with overdose events received care from VCH in the 6 months preceding the overdose. Information on access to care was used to inform expansion of the Take Home Naloxone program and to improve patient engagement across a variety of programs and services. Understanding the opioid overdose patient population and their healthcare utilization has been used to improve patient care, within the context of a public health emergency.