Case 4 : Combatting the Opioid Crisis: Expanding Naloxone Kit Distribution to Niagara Health Emergency Departments

A regional hospital system is exploring the possibility of making naloxone kits accessible to patients in the emergency department of its hospital sites. The current hospital staff are reluctant to distribute these kits. The organization is trying to determine the best approach to guaranteeing program participation. The expansion of hospital access to naloxone kits is a direct response to the ongoing opioid crisis across Canada. Opioid-related deaths have spiked in recent years and various national and provincial initiatives are underway to reduce these deaths. Staff reluctance to distributing lifesaving naloxone kits in emergency departments stems from their lack of understanding and knowledge about the value and benefits of introducing these types of harm-reduction strategies. Unfortunately, many frontline health workers at the hospitals view the distribution of naloxone kits as “enabling drug users”. This stigmatization of patients who have opioid addictions is a complication that is making it much more challenging for Jessica Corso and the Quality, Patient Safety, and Risk Department to introduce this initiative. The problem they face is how to ensure that health workers understand the social constraints that exacerbate addictions and the value of naloxone kit distribution in combatting them. This fictional case focuses on the social determinants of health and health equity, and how best to educate hospital staff so that they gain an understanding of inequities as they relate to health care

Chromosome Xq23 is associated with lower atherogenic lipid concentrations and favorable cardiometabolic indices

Abstract Autosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10−72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10−4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10−5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids