As I was presented, my name is Mr. Guy-Pierre Lévesque. I am the founder of the organization Méta d'Âme, which is a peer-led organization. At our facility we are all peers, people who did or are still using opioids.
We initiated a program, starting in 2013, called PROFAN.
We call it Aller plus loin, or going further. The program focuses on prevention, reducing overdoses, peer training and access to naloxone.
Méta d'Âme is a users' association based on the principles of empowerment. We work to improve the quality of life those who use opioids—such as heroin, morphine and other drugs—through our day centre and our 22 housing units, with community support provided by peers, of course.
PROFAN is a response to a recommendation made by United Nations Commission on Narcotic Drugs in 2011. According to this recommendation, the continuum of care offered to opioid users must include greater access to naloxone and be rounded out with training and education programs. That was resolution 55/7. It referred to
promoting measures to prevent drug overdose, in particular opioid overdose.
PROFAN is a French acronym for prevention, reduction, overdose, training, access and naloxone. So it is really a prevention program.
It is designed to empower users to recognize the signs and symptoms and to differentiate among overdoses of various drugs. Unfortunately, there is an epidemic of opioid overdoses, but there are also stimulant overdoses. We train people to recognize these things.
We also train users to do cardiopulmonary resuscitation or CPR. We also teach them how to react to an overdose so they can call 911. For users, there are several things preventing them from doing this. We train them to react the right way. Reducing the number of overdose deaths is of course our ultimate objective.
As to the community, the objectives are as follows: develop a strategy for one or more physicians to become partners in the initiative and to prescribe naloxone to participants who have completed the training; demonstrate the feasibility and accessibility of the overdose prevention and naloxone access project as part of peer training, which is the unique characteristic of this program; document and evaluate the steps taken in the pilot project and establish a data gathering system, which has already been done; give the community tools to deal with overdoses, that is, first responders, ambulance attendants, police officers, and any other person who can respond to an emergency.
The program consists of two training sessions: a shorter one lasting two and a half hours and a longer one lasting five and half hours. The shorter training does not include CPR. The workshops are divided up as follows. The first one pertains to overdose prevention and education. The second workshop shows how to respond in the event of an overdose, that is, what are the signs and symptoms of an overdose of opioids or other drugs, CPR techniques, and administering naloxone.
All the trainers are peers. We called upon members of our association who are users and took the time to train them properly so they can give the training themselves. They are people who use or have used opioids or other drugs, as well as staff who work for agencies whose services are used by persons who use or have used opioids or other drugs. At the community level, this creates a safety net that is very close to the street, which is an asset.
I would like to highlight an important aspect. Depending on the resources, the staff working in the field may or may not be users or former users of opioids or other drugs. Why? Because drug users are often part of community groups. They work in certain areas and become part of work teams. They are users but they are part of a community group and are employees of that group.
The participants who are trained receive a certificate that enables them to respond to overdoses and to use naloxone appropriately in opioid overdose cases.
In conclusion, PROFAN is a community response to the problem. Peers began developing PROFAN in 2013. Why? Because at the various conferences I have attended, whether in Canada or in Europe, I heard that overdoses are on the rise. This helped me understand that a phenomenon was developing. In the organization's action plan, I included the objective of creating a training program. That is what I have just presented.
The partners who joined the initiative in 2014 were the Centre de recherche et d'aide pour narcomanes, or CRAN, the Douglas Institute, Montreal's public health department, and Quebec's ministry of health and social services.
From the start, peers, community organizations, and network pharmacists have been part of PROFAN. We got all these stakeholders to sit down around a table to evaluate the project and to establish a plan for its first year. We are now planning our third year of operations.
Since the program was established 18 months go, 378 people have been trained and 21 lives have been saved. We are seeing changes in the behaviour of the users who have been trained, but this must still be proven empirically. The researcher, Michel Perreault, who is affiliated with the Douglas Institute, is currently evaluating these changes, so our project is being evaluated.
We are also trying to understand how to retain people who have taken the training, how far peers can go in the training, and their ability to do it.
We found that when peers train people, they saw themselves as lifeguards and felt much more responsible in the community. That is where their behaviour starts to change, and that is very important. These people feel they are playing an important role and it means a lot to them. We had thought that this program would be disparate but it has turned out to be very specific and there is a high level of participation.
We recommend that programs similar to PROFAN be created for drug users wherever possible. Training must also be given to everyone who is in substitution treatment programs and who frequently relapses. These people are the most likely to overdose. They should be trained while they are receiving methadone, for example. These people often associate with other users and they will be able to save someone.
For those receiving pain treatment, it should be recommended that they keep a naloxone kit with them. There are a lot of accidents and non-prescribed drugs that are taken. They can be taken from their mother's or father's medicine cabinet. In our opinion, people with such prescriptions should be given a short awareness training before they receive their kit. That might save lives. If they are trained to prevent overdoses, they will recognize when there is a problem. Drugs that are kept at home must be locked up. Of course, a kit should be on hand should an adolescent, for instance, take pain medication that was prescribed for their father or mother. This has to be done.
Peer outreach workers must be able to train drug users right in the field, giving them brief and specific training. For example, we have outreach workers in downtown Montreal. They come into contact with many opioid users, both sellers or users. These people should be given brief training in the field along with a permit to get naloxone.
There is a legislative void in Quebec because no rules have yet been established surrounding naloxone management. In Montreal, we use a collective prescription for the time being.
That only covers the Montreal area, the users and their entourage. They could be parents, roommates, friends or even community workers who work for an organization such as ours or Cactus. All kinds of non-governmental agencies can play a role.
That is essentially what we do. We drafted the documentation in 2013 and, in 2014, we joined CRAN, as I mentioned before. There was a spike in overdoses in Montreal in spring of 2014, and we were of course encouraged to launch our project.
The use of fentanyl and other contraband drugs made in labs is not as much of a problem right now in Montreal. There was, however, a seizure at a fentanyl lab in the north of Montreal a year and a half ago. Fortunately, we have not yet seen an increase in overdoses, although there are still too many. In our opinion, this problem will eventually spread across the Quebec, so we have to be ready.
Thank you.