With BC in the midst of two public health emergencies, one for COVID-19 and one for drug overdose deaths, the BC Centre for Excellence in HIV/AIDS (BC-CfE) has just launched a new Quality Improvement Network for its BOOST Collaborative (Best-Practices in Oral Opioid agoniSt Therapy).

Led by Dr. Rolando Barrios, the BC-CfE’s Senior Medical Director, the Vancouver and Provincial BOOST Collaboratives brought together more than 40 teams to deliver services through mental health and substance use programs, and stabilization and primary care clinics, both in health authority and private practice settings. The new Quality Improvement (QI) Network, launched on June 25th, will build on this work and continue with the common purpose of improving care for clients living with opioid use disorder (OUD) by systematically implementing, measuring and sharing best practices in Opioid Agonist Therapy (OAT).

The arrival of the new BOOST QI Network comes at a crucial time for this province as last month was the deadliest in BC history for illicit drug overdoses. In May 170 people died, with first responders attending to close to 2,300 overdose calls. Since the declaration of the public health emergency in early 2016, there have been more than 5,000 confirmed opioid-related overdose deaths in BC alone.

Hon. Judy Darcy, BC Minister of Mental Health and Addictions, summed up the lead-up to the tragic month by saying, “Before COVID-19, there was so much more to do, but we were heading in the right direction. The overdose death rate was coming down in BC, and the evidence told us that our collective efforts were making a difference. The rapid scale up and distribution of naloxone and increased access to overdose prevention services (OPS) and treatment showed, through the BC Centre for Disease Control, that we had averted more than 6,000 deaths since the crisis began.

Indeed, since the global COVID-19 pandemic began, BOOST Collaborative partners have seen first-hand its early effects and impacts on the ongoing opioid crisis. With our borders closed, the usual illegal drug supply chains are disrupted leading to an increasingly toxic drug supply on the streets. COVID-19 has also increased unemployment, social isolation, and has exacerbated mental health and addiction issues.

The BOOST QI Network, however, has partners and leaders who have the benefit of experience and accomplishments from working within the BC-CfE’s Treatment as Prevention mandate.

Dr. Barrios says, “The QI Network is rooted in the experiences and accomplishments of the Treatment as Prevention and the STOP HIV/AIDS Collaboratives.”

BOOST collaborators stress the importance of using established improvement tools and methods to implement system changes. Doing so is critical in ensuring the maintenance of the gains made over the last couple of years in improving overall care for clients living with OUD.

Evidence shows that a significant proportion of individuals with OUD will reduce illicit opioid use and remain in treatment longer with appropriate doses of opioid agonist therapy such as methadone, buprenorphine/naloxone or slow release oral morphine.

Furthermore, the BOOST QI Network aims to provide equitable access to integrated, evidence-based care to help clients with OUD. The Collaborative’s goals are to see 95% of clients with an active OAT prescription, 95% of those clients with an active OAT prescription retained on therapy for greater than 3 months, and 100% of teams with a process to monitor and incorporate the patient voice in their quality improvement work.

QI teams will be supported in their mission to achieve these goals by continued quality improvement coaching, educational webinars, quarterly feedback reports, access to expert faculty, and half-day Learning Sessions.

Another invaluable resource for the BOOST QI Network and its clients is the BC-CfE’s Hope to Health Research & Innovation Centre in the heart of Vancouver’s Downtown Eastside.

The Research & Innovation Centre provides integrated and accessible healthcare to clients in the inner city with complex healthcare needs. Many of these clients have multiple conditions that can include HIV, hepatitis C, and mental health issues. Staffed by an interdisciplinary team of physicians, nurses, counsellors, and peer navigators, the Research & Innovation Centre provide ‘wrap-around’ healthcare to clients, ensuring they receive the full continuum of care under one roof.

The BOOST QI Network project team say the early effects of COVID-19, and its impact on the ongoing opioid crisis, demonstrates the importance of using established improvement tools and methods to implement system changes. Doing so is critical in ensuring the maintenance of the gains made over the last couple of years in improving overall care for clients living with OUD.