Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study

BMC Public Health, Journal Year: 2022, Volume and Issue: 22(1)

Published: Nov. 15, 2022

Abstract Background Stimulant use has been rising among people with opioid disorder in recent years North America, alongside a parallel rise illicit drug toxicity (overdose) deaths. This study aimed to examine the association between stimulant and overdose mortality. Methods Data from universal health insurance client roster were used identify 20% random general population sample (aged ≥12) British Columbia, Canada ( N = 1,089,682). Provincial records who opioids and/or stimulants. Fatal observed during follow-up (January 1 2015-December 31 2018) was retrieved Vital Statistics Death Registry BC Coroners Service Data. Potential confounders including age, sex, region, comorbidities prescribed medications provincial records. Results We identified 7460 stimulants or opioids. During there 272 fatal events. People both had more than twice hazard of (HR: 2.02, 95% CI: 1.47-2.78, p < 0.001) compared only. The death increased over time Conclusions There is an urgent need prioritize service needs reduce mortality Columbia. Findings have relevance broadly other American settings, where similar trends polysubstance observed.

Language: Английский

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The increase in benzodiazepine-laced drugs and related risks in Canada: The urgent need for effective and sustainable solutions

International Journal of Drug Policy, Journal Year: 2022, Volume and Issue: 111, P. 103933 - 103933

Published: Dec. 16, 2022

The overdose crisis in Canada has continuously evolved and is increasingly challenging to contain, while efforts from governments policymakers address it have often fallen short resulted unintended consequences. One of the main repercussions been an unprecedented rise adulterants illegal drug supply, including a wide array pharmacological psychoactive compounds chemicals, which progressively toxic supply. Most recently, there stark increase synthetic benzodiazepine-laced opioids (i.e., 'benzodope') some Canadian jurisdictions. This unique combination carries distinct amplified risks for people who use drugs fatal non-fatal overdoses, increased dependence withdrawal symptoms, places them extremely vulnerable positions. emergence benzodiazepines within illicit supply substantially contributed drug-related morbidity mortality Canada, further complicated current public health initiatives prevention efforts. reality underscores need effective sustainable policy solutions evolving epidemic knowledge education on specific harms opioid benzodiazepine co-use (especially regards complexity opioid/benzodiazepine overdoses), scaling-up harm reduction measures, eliminating altogether.

Language: Английский

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Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis

International Journal of Drug Policy, Journal Year: 2023, Volume and Issue: 120, P. 104157 - 104157

Published: Aug. 11, 2023

Canada is experiencing an unprecedented drug toxicity crisis driven by a highly toxic unregulated supply contaminated with fentanyl, benzodiazepine, and other drugs. Safer pilot programs provide prescribed doses of pharmaceutical alternatives to individuals accessing the have been implemented prevent overdose reduce related harms. Given recent emergence these paucity data on implementation challenges, we sought document challenges in their initial phase.We obtained organizational progress reports from Health Canada, submitted between 2020 2022 11 located British Columbia, Ontario, New Brunswick. We analyzed using deductive inductive approaches via thematic analysis. Analyses were informed consolidated framework for research.We 45 programs. Six centres based four one Four overarching themes identified regarding faced during establishment programs: i) Organizational features (e.g., physical space constraints, staff shortages); ii) Outer contexts limited operational funds resources, structural inequities access, public perceptions); iii) Intervention characteristics clients' unmet medication needs); iv) Implementation process pandemic-related overly medicalized high-barrier safer models).Safer face multiple inner outer challenges. potential role addressing possibility future scale-up, services should be well-supported phases. Refining service provision within feedback experiences clients program administrators warranted, along efforts ensure that appropriate medications are available meet needs.

Language: Английский

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Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada

Harm Reduction Journal, Journal Year: 2023, Volume and Issue: 20(1)

Published: June 28, 2023

Abstract Objectives Fentanyl has contributed to a sharp rise in the toxicity of unregulated drug supply and fatal overdoses Canada. It also changed injection practices. Injection frequency increased as result so equipment sharing health-related risks. The aim this analysis was explore impact safer programs on practices from perspective clients providers Ontario, Methods data set included qualitative interviews with 52 21 that were conducted between February October 2021 across four programs. Interview excerpts discussing extracted, screened, coded then grouped into themes. Results We identified three themes, each theme corresponding change first decrease amount fentanyl used frequency. second involved switching injecting hydromorphone tablets instead fentanyl. Finally, third stopping altogether taking medications orally. Conclusion Safer can contribute reducing injection-related health risks addition overdose More specifically, they have potential address disease prevention promotion gaps stand-alone downstream harm reduction interventions cannot address, by working upstream providing alternative

Language: Английский

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Mapping a moral panic: News media narratives and medical expertise in public debates on safer supply, diversion, and youth drug use in Canada

International Journal of Drug Policy, Journal Year: 2024, Volume and Issue: 127, P. 104423 - 104423

Published: April 19, 2024

The ongoing overdose and drug toxicity crisis in North America has contributed momentum to the emergence of safer supply prescribing programs Canada as a means providing an alternative highly volatile unregulated supply. implementation scale-up have been met with vocal reaction on part news media commentators, conservative politicians, recovery industry representatives, some prominent addiction medicine physicians. This largely converged around several narratives, based unsubstantiated claims anecdotal evidence, alleging that are generating "new opioid epidemic", reflecting emerging alignment among key institutional political actors. Employing situational analysis method, drawing policy studies social science scholarship moral panics, this essay examines coverage from January July 2023, bringing into dialogue other existing empirical sources (e.g. Coroner's reports, program evaluations, debates experts medical journals). We employ eight previously established criteria delineating panics critically appraise public regarding supply, diverted medication, increased youth initiation use overdose. In detailing panic we trace historic continuities earlier scares Canadian history mobilized tools racialized poverty governance, well previous backlashes towards healthcare interventions for people who drugs (PWUD). assesses entrepreneurs against current landscape use, diversion, youth, notes role played by expertise identifies what convergence these narratives materialize PWUD access, broader responses such activate.

Language: Английский

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British Columbia’s Safer Opioid Supply Policy and Opioid Outcomes

JAMA Internal Medicine, Journal Year: 2024, Volume and Issue: 184(3), P. 256 - 256

Published: Jan. 16, 2024

In March 2020, British Columbia, Canada, became the first jurisdiction globally to launch a large-scale provincewide safer supply policy. The policy allowed individuals with opioid use disorder at high risk of overdose or poisoning receive pharmaceutical-grade opioids prescribed by physician nurse practitioner, but date, opioid-related outcomes after implementation have not been explored.

Language: Английский

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Law Enforcement Drug Seizures and Opioid-Involved Overdose Mortality

JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(3), P. e251158 - e251158

Published: March 19, 2025

Importance Opioid-involved overdose mortality has been on the rise for 2 decades in US, exacerbated by an unregulated drug supply that is unpredictable and increasingly contained highly potent fentanyl analogs starting a decade ago. Objective To determine whether there geospatial association between law enforcement seizures opioid-involved San Francisco. Design, Setting, Participants This cross-sectional study used location- time-stamped data from Office of Chief Medical Examiner publicly available crime Francisco Police Department 2020 2023 to assess location time were associated with subsequent mortality. Data analyzed January September 2023. Exposures Time-stamped locations involving distribution charge. Main Outcomes Measures The primary outcomes (1) any opioid (2) or analog. relative risk (RR) 95% CIs endemic epidemic factors calculated. Results There 2653 seizure events involved charge 1833 deaths tested positive synthetic opioid, including heroin analogs. Within surrounding 100 meters, increase fatal overdoses day following event (RR, 1.74; CI, 1.06-2.83; P = .03) elevated persisted 7 days (2 days: RR, 1.55; 1.09-2.21; .02; 3 1.45; 1.08-1.93; .01; 1.27; 1.11-1.46; .001). Similar statistically significant spatiotemporal patterns observed 250- 500-meter spatial bandwidths. each space-time kernel, strength association, all which significant, dissipated further away distance event. Conclusions Relevance findings this suggest laws public safety residents may be having unintended negative consequence increasing reduce mortality, it better focus evidence-based health policies interventions.

Language: Английский

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Comparing the effects of prescribed safer opioid supply and methadone in Ontario, Canada: a population-based matched cohort study

The Lancet Public Health, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Prescribed safer opioid supply (SOS) programmes are novel harm reduction interventions. We examined health outcomes among people receiving SOS over time and relative to a similar group of methadone. conducted population-based cohort study new methadone recipients in Ontario, Canada, who commenced treatment between Jan 1, 2016 Dec 31, 2021. People were matched (1:1) based on age (within 3 years), sex, location residence (public unit), propensity score 0·2 SDs). Primary hospital-treated opioid-related toxicities, emergency department visits inpatient hospitalisations, incident infections, health-care costs (in CA$, excluding related primary care services medications) 1 year follow-up. Outcome rates calculated the follow-up period, with censoring death, discontinuation or methadone, end (360 days). Within-group changes assessed using interrupted time-series analysis, Prentice-Williams-Peterson regression was used assess between-group differences recurrent events. Of 991 prescribed 25 116 met eligibility criteria, 856 (86·4%) In within-group had significant improvements monthly rate toxicities (step change -1·09 events per 100 individuals [95% CI -2·12 -0·07]; p=0·037), all-cause (-8·85 person-year [-13·5 -4·20]; p=0·0002), hospitalisations (-2·08 [-3·41 -0·75]; p=0·0022), infections (-0·68 [-1·22 -0·14]; p=0·013), non-primary-care-related (-$91 699 [-112 749 -70 650]; p<0·0001). Results consistent for recipients. commencing significantly higher hazards toxicity (hazard ratio 2·83 1·97 4·06]), (1·16 [1·05 1·29]), admissions (1·50 [1·13 1·99]), no difference infection (1·51 [0·87 2·61]), less likely discontinue than those (0·62 [0·55 0·70]). When removed as criterion, we found groups hazard any except (1·65 [1·38 1·97]). associated outcomes, including reduced use, after initiation. The findings suggest play an important, complementary role traditional agonist expanding options available support use drugs. Canadian Institutes Health Research Ontario SPOR Support Unit.

Language: Английский

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Safer opioid supply via a biometric dispensing machine: a qualitative study of barriers, facilitators and associated outcomes

Canadian Medical Association Journal, Journal Year: 2023, Volume and Issue: 195(19), P. E668 - E676

Published: May 14, 2023

The MySafe program provides pharmaceutical-grade opioids to participants with opioid use disorder via a biometric dispensing machine. objectives of this study were examine facilitators and barriers safer supply the associated outcomes.We conducted semistructured interviews who had been enrolled in for at least month 1 3 sites Vancouver. We developed interview guide consultation community advisory board. Interviews focused on context substance overdose risk, enrolment motivations, access functionality, outcomes. integrated case grounded theory methodologies, used both conventional directed content analyses inductive deductive coding processes.We interviewed 46 participants. Characteristics that facilitated included accessibility choice, lack consequences missing doses, nonwitnessed dosing, judgment-free services an ability accumulate doses. Barriers technological issues machine, dosing challenges prescriptions being tied individual machines. Participant-reported outcomes reduced illicit drugs, decreased positive financial impacts improvements health well-being.Participants perceived drug-related harms promoted This service delivery model may be able circumvent exist other programs enable settings where otherwise limited.

Language: Английский

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‘I don't chase drugs as much anymore, and I'm not dead’: Client reported outcomes associated with safer opioid supply programs in Ontario, Canada

Drug and Alcohol Review, Journal Year: 2023, Volume and Issue: 42(7), P. 1825 - 1837

Published: Sept. 18, 2023

Abstract Introduction The ongoing opioid overdose crisis, which has killed over 30,000 people in Canada since 2016, is driven by the volatility of an unregulated drug supply comprised primarily fentanyl. Canadian government recently funded safer (SOS) programs, include off‐label prescriptions pharmaceutical‐grade opioids to high risk individuals with goal reducing deaths. Methods In 2021, we examined implementation and adaption four SOS programs Ontario. These use a primary care model serve communities experiencing marginalisation. We conducted semi‐structured interviews program clients. present results thematic analysis aim describing clients' self‐reported impact these on their health well‐being. Results interviewed 52 clients between June October 2021 (mean age 47 years, 56% men, 17% self‐identified Indigenous, 14% living HIV). Our indicate multifaceted pathways improved well‐being among including changes practices, fewer overdoses, reduced criminalised activity, trust engagement care, increased social stability (e.g., housing). Discussion Conclusion Most reported that intervention saved life because frequency overdoses. Findings suggest outcomes increase opportunities for services. provide insight into mechanisms behind some emergent evidence prescribing.

Language: Английский

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