by Melissa Edwards; photography by Brian Smith
Imagine the equivalent of three passenger planes filled with young people crashing to the earth every year – that’s the picture Dr. Keith Ahamad uses to describe the public health emergency announced this year in response to overdose deaths in British Columbia.
“There’s no escaping it,” he says. “Addiction hits every single patient group and every socioeconomic group. We’re seeing two to three deaths a day from this preventable disease. If you were to compare that with any other health care emergency, the public would mobilize very quickly.”
In 2015 there were more overdose deaths than in any of the previous 20 years, and in 2016 that number has spiked even higher. More than 61 people have died from overdose every month between January and June. Fentanyl, a potent opioid, is involved in over 60 per cent of cases.
Despite the high mortality rate, little is known about what happens to the cardiopulmonary system during an overdose and who might be at increased risk. This desperate lack of knowledge is why Dr. Ahamad and his team at St. Paul’s have launched a new study, called Mobile Opioid Vital-Sign Evaluation (MOVE), that may open the door to better understanding why overdoses happen, and, potentially, how they could be prevented.
The risks of long-term opioid use are only just beginning to be revealed.
In a recent study in the US, patients with non-cancer chronic pain who had been prescribed opioids were shown to not just be at greater risk of unintentional overdose, but also at greater risk of death from all causes – particularly from cardiac events. The goal of MOVE is to create and test a new way of using vital- sign monitoring equipment, setting the groundwork to gather first-of-its-kind data on the cardiopulmonary effects of opioids, both in hospital settings and among those who use injection drugs.
“St. Paul’s has a long history of engaging with populations that other groups haven’t been interested in engaging with,” says Dr. Ahamad proudly. “We look at the data and the science and say: ‘This is what we need to do to improve outcomes.’ And this study is another example of that.”
Because there’s no previous research of its kind, the first phase of MOVE is a feasibility study. To start, Dr. Ahamad has partnered with researchers in the United States, using a mobile vital signs monitoring prototype, called the “Canary I.”
In September, Dr. Ahamad and his team began the study with five participants receiving in-hospital care at St. Paul’s, and 20 on injectable treatment at the Providence Crosstown Clinic in the Downtown Eastside. Patients wear the device, supervised, for two-hour periods after taking opioids during regular visits. Sensors measure heart rate, respiration and participant movements, and transmit the data securely via mobile phone to a server, where it is being held for future analysis to see how opioid use affects these vital signs.
While this initial research is only a first step in determining if patients could tolerate wearing the device, as well as collecting initial data, “the long-term application is really unlimited,” says Dr. Ahamad. Once the device can be adapted for more consistent use and to track further vital signs, such as oxygen saturation and blood pressure, work can begin on recognizing the real physiological effects of long-term opioid use, and how overdose warning signs might manifest in different people.
“This may revolutionize the prescription and safety of these medications, or it may inform us about who we need to be careful with when prescribing them,” says Dr. Ahamad. “And, for patients who use opioids recreationally, it could change the face of harm reduction.”
As the science improves and such a monitor becomes smaller and more responsive, it could be programmed to send out warning messages when the wearer is close to an overdose event. A future device could even be fitted with a naloxone pump that would automatically administer the anti-overdose drug when crisis is imminent.
Dr. Ahamad calls the research “new and leading-edge,” so every step must be invented. “It’s very exciting,” he says. “There is a lot to learn from the data, and we’re laying the framework for some amazing interventions. The potential for saving lives in an innovative, non-stigmatizing way is pretty great.”
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