Justin Koh

Biography

Justin Jek-Kahn Koh is an Addiction Medicine Fellow with the British Columbia Centre on Substance Use and a Royal College Emergency Medicine resident at the University of Saskatchewan. He studied medicine at McMaster University and recently completed a Master of Public Health at Johns Hopkins University. He is passionate about improving addiction care and harm reduction services in the emergency department setting.

Node Funded Project (April 2018)

Title: Naloxone in Saskatoon Emergency Departments

Principal Investigator: Justin Koh, University of Saskatchewan

Co-investigators/collaborators:

Dr. Luke Terrett, Dr. Peter Butt, Dr. Colleen Dell (University of Saskatchewan)

Description

This project will implement and evaluate a pilot take-home naloxone (THN) program in the emergency department (ED) of St. Paul’s Hospital, Saskatoon, SK. More research is needed to demonstrate the feasibility of implementing ED-THN, particularly within the geopolitical context of the Prairie provinces. Healthcare provider (HCP) challenges, behaviours and attitudes towards drug users need to be further explored. It is unclear what additional challenges may arise after ED-THN program implementation. This project has the support of the Saskatchewan Health Authority, and will implement the first ED-THN program in the province.

Results

Overdose education and naloxone distribution (OEND) in the emergency department (ED) is an important strategy for preventing opioid overdose deaths. However, implementation barriers in
the ED limit the effectiveness of OEND programs. This project evaluated the implementation of an OEND program in a single ED in Saskatoon, Canada, and utilized a theory-informed approach to develop organizational-level strategies for implementation refinement.

Semi-structured interviews were conducted with ED providers between January and May 2019, six months after initial OEND program launch. Four key themes were identified: 1) Providers do not agree on the need for OEND in the ED; 2) Providers remain resistant toward OEND after ED program launch; 3) Providers find it challenging to provide OEND in the ED; and 4) Providers want appropriate follow-up for ED patients who receive OEND. Evidence-based implementation refinement strategies were proposed for each key theme, including forming patient advisory councils, sharing program outcome data, task-shifting, using innovative technologies, and establishing rapid-access to addiction medicine pathways for follow-up.

More resources are needed to sustain OEND programs beyond their initial launch in the ED to maintain effectiveness and to ensure that harm reduction is fully integrated into standard ED
practice. Health care administrators should consider targeting modifiable organizational and social contexts for implementation. This capstone project proposes four implementation
refinement strategies that can be considered for adoption by other ED-based OEND programs that have similar implementation contexts.

Publications:

Koh J, Paterson QS, Ong M, Martin LJ, Woods RA, Dong K. (2019). Addressing the opioid crisis in the era of competency-based medical education: recommendations for emergency department interventions. Canadian Journal of Emergency Medicine. 21(4): 452-454.