The role of networks in evidence-informed policy implementation to address Canada's opioid overdose crisis
Stephanie Glegg, Michelle Olding, Samara Mayer, Jade Boyd, Ryan McNeilBackground: Opioid-related overdose is the leading cause of accidental death in Canada, with one death reported every two hours. An 80% increase in fatal overdoses from 2015 to 2016 prompted British Columbia’s (BC) provincial government to declare a public health emergency that persists today, with BC’s death rate twice the national average. Buprenorphine/naloxone is an evidence-based treatment for reducing opioid-related harms but was largely inaccessible in BC early in the overdose crisis because of funding and prescriber restrictions. This study examined the role of networks in mobilizing buprenorphine/naloxone as a first-line treatment for opioid use disorder within the overdose crisis context. The aims of this mixed-methods social network analysis descriptive case study were to:
(1) Describe the network of actors and organizations involved in evidence-informed policy changes enhancing access to buprenorphine/naloxone for opioid use disorder; and
(2) Identify the network-specific barriers and facilitators of implementation from multiple stakeholder perspectives.
Methods: Key actors in buprenorphine/naloxone research, policy and practice were identified through expert consultation, review of media reports, and snowball sampling. A questionnaire gathered demographic data and participant-reported knowledge translation/implementation ties with organizations and individuals (e.g. collaboration in creating, sharing, implementing, evaluating evidence) specific to the buprenorphine/naloxone policy changes. Semi-structured interviews then explored perceptions of the network, key actors, and barriers and facilitators of implementation.
Relational data entered into an adjacency matrix were imported into UCINet to derive network properties, and to generate network visualizations using Netdraw. Transcribed interviews were analyzed in NVivo, using a directed content analysis approach, whose a priori coding framework targeted network properties, roles in implementation, and barrier/facilitator constructs from the Consolidated Framework for Implementation Research.
Results: The 18 participants represented health professionals, decision-makers, researchers, people with lived experience (PWLE)/allies, the media, lawyers, law enforcement, and pharmaceutical representatives, 56% of whom reported multiple roles/organizations. One subgroup of 74 named organizations (density 10.2%, average degree 7.5) suggested an inter-organizational approach to policy change. Key brokers (via betweenness centrality) included the two Vancouver-based health authorities, the BC Centre on Substance Use (with a research, clinical guidance and educational mandate) and the BC Opioid Task Force, which linked most government, academic, healthcare, community/advocacy and regulatory groups. Perceived network strengths included its connectivity, engagement of the Minister of Health, and a neutral non-regulatory body (the BCCSU) to support physicians and link groups. Key network and communications gaps included a lack of coordinated addictions and mental health care infrastructure, disagreement among groups, confusion regarding network structure and roles; barriers accessing evidence for non-academic groups; late engagement of PWLE/allies; and disconnect between policy and practice.
Conclusions: This first study to describe the network of stakeholders involved in mobilizing drug policy change in BC highlights the interconnectedness of multiple sectors in developing evidence-informed policy. These findings can inform the design of targeted network-driven implementation interventions tailored to the needs, strengths, and roles of stakeholder groups (e.g. PWLE/ally-engaged policy planning; centralized coordination; broader evidence dissemination; illuminating network structure). These strategies may optimize the efficiency and effectiveness of ongoing implementation efforts to address the opioid crisis.