About

The Best-Practice in Oral Opioid agoniSt Therapy (BOOST) Collaborative is a Quality Improvement initiative launched by Vancouver Coastal Health (VCH) in partnership with the the BC Centre for Excellence in HIV/AIDS (BC-CfE). The purpose of the BOOST Collaborative is to improve the quality, effectiveness, and reach of oral opioid agonist therapy (oOAT) and support services in the Vancouver community to improve outcomes for people living with opioid use disorder (OUD).

The BOOST Collaborative will be piloted within the VCH Vancouver Community region and teams from primary care, mental health, substance use, withdrawal management, and outreach services will be invited to participate. OUD programs need to establish an effective, high-quality cascade of services from diagnosis and referral to care, to engagement and retention in treatment in order to improve care for people living with OUD. Establishing an OUD cascade of care will allow identification of gaps in the continuum of care that are preventing people from fully benefitting from oOAT treatment.

Why are we focusing on oOAT?

  • QI requires focus: to create system change we must focus on specific aspects of care along the continuum of care for people with OUD.
  • QI does not generate new knowledge: QI brings existing knowledge into practice and oOAT is where we have the best evidence and data that will help us drive change.
  • QI is a journey of small steps: we know not everybody benefits from oOAT but optimizing care for those who will benefit, will allow us to identify those who need other types of interventions.

Please visit our Tools and Resources page for more details.

Background

Opioid use disorder (OUD) can be characterized as a chronic relapsing illness which, though associated with elevated rates of morbidity and mortality, has the potential to be in sustained, long-term remission with appropriate treatment. OUD may involve the use of illicitly manufactured opioids such as heroin or street fentanyl, or pharmaceutical opioid medications obtained illicitly or used non-medically. While current Canadian estimates are lacking, OUD is estimated to affect approximately 2.1% of Americans.

In 2016, the British Columbia (BC) Provincial Medical Health Officer, Perry Kendall, declared a public health emergency in response to the dramatic increase in opioid-related overdose deaths. In 2016, there were 922 confirmed overdose deaths in BC, of which 215 occurred in Vancouver. BC is the epicentre of the crisis within Canada, with Vancouver’s downtown eastside (DTES) reporting the highest overdose rates. To address the urgent need for intervention a spectrum of services were launched in late 2016 and early 2017. Despite the public health emergency declaration and new services, the number of opioid-related overdose deaths continues to be far above historical averages.

Evidence demonstrates that a significant proportion of individuals with OUD will respond to appropriate doses of Methadone or Suboxone, defined as reduced illicit opioid use (urinalysis) and retention in treatment1. Other predictors of treatment success include shorter time to treatment from diagnosis2, and longer duration of treatment (≥3 years)3. Current data shows that of approximately 9000 VCH Vancouver clients only 3500 are on a therapeutic dose of Methadone or Suboxone, and approximately 4000 are not currently receiving oral opioid agonist therapy (oOAT). The use of slow release oral morphine (SROM) is indicated for roughly 5% of people with OUD and only approximately 0.5% of people are receiving this treatment.
Care for people living with OUD is a complex process requiring collaboration among multiple care providers and services. This is complicated further as providers face numerous obstacles in delivering optimal OUD care due to a variety of social, economic, cultural and medical challenges. Healthcare providers require effective systems to improve access and adherence to OUD treatment among vulnerable individuals.

Increasingly, the healthcare community is employing quality improvement (QI) frameworks to promote system change and address gaps in care. In particular, the Breakthrough Series Collaborative Methodology, developed by the Institute for Healthcare Improvement (IHI), has been successfully applied in the BC context to improve care for people living with diabetes, congestive heart failure, and HIV/AIDS. We will now apply this framework with a goal of improving care for people with OUD.

Structured Learning Collaborative Methodology

Key Collaborative Stakeholders

Name Role and Affiliation Role
Laura Case Chief Operating Officer, VCH Community VCH Executive Sponsor
Dr. Rolando Barrios Senior Medical Director, VCH Community VCH and BC-CfE Executive Sponsor
Andrew Day Operations Director, VCH Community VCH Project Sponsor
Dr. Ron Joe Associate Medical Director, Addiction Services, VCH VCH Project Sponsor
Yogeeta Dosanjh Manager, PSP Quality Improvement Advisor
Jano Klimas Postdoctoral Fellow, BCCSU Faculty

BOOST Collaborative Teams

  • Raven Song Primary Care
  • Three Bridges Primary Outreach Services
  • Pender Community Health Centre
  • Downtown Community Health Centre
  • Sheway
  • DTES Connections
  • Rapid Access and Assessment Centre
  • Substance Use Treatment and Response Team (START)
  • Vancouver Detox
  • Strathcona Mental Health
  • Reach Community Health Centre
  • Evergreen Substance Use/Addictions
  • South Substance Use/Addictions
  • Three Bridges Substance Use/Addictions
  • West End Mental Health
  • Raven Song Substance Use/Addictions
  • Raven Song Mental Health
  • John Ruedy Clinic
  • Overdose Outreach Team

If you would like more information, contact us at: boostcollaborative@cfenet.ubc.ca.