Modelling the combined impact of interventions in averting deaths during a synthetic-opioid overdose epidemic.
Bayes Theorem
British Columbia
/ epidemiology
Drug Overdose
/ drug therapy
Harm Reduction
Humans
Markov Chains
Models, Theoretical
Naloxone
/ therapeutic use
Narcotic Antagonists
/ therapeutic use
Needle-Exchange Programs
Opiate Substitution Treatment
/ methods
Opioid Epidemic
Opioid-Related Disorders
/ drug therapy
Bayesian modelling
opioid agonist therapy
opioid overdose crisis
overdose prevention sites
public health intervention
take-home naloxone
Journal
Addiction (Abingdon, England)
ISSN: 1360-0443
Titre abrégé: Addiction
Pays: England
ID NLM: 9304118
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
12
10
2018
revised:
18
01
2019
accepted:
10
05
2019
pubmed:
6
6
2019
medline:
21
10
2020
entrez:
6
6
2019
Statut:
ppublish
Résumé
The province of British Columbia (BC) Canada has experienced a rapid increase in illicit drug overdoses and deaths during the last 4 years, with a provincial emergency declared in April 2016. These deaths have been driven primarily by the introduction of synthetic opioids into the illicit opioid supply. This study aimed to measure the combined impact of large-scale opioid overdose interventions implemented in BC between April 2016 and December 2017 on the number of deaths averted. We expanded on the mathematical modelling methodology of our previous study to construct a Bayesian hierarchical latent Markov process model to estimate monthly overdose and overdose-death risk, along with the impact of interventions. Overdose events and overdose-related deaths in BC from January 2012 to December 2017. The interventions considered were take-home naloxone kits, overdose prevention/supervised consumption sites and opioid agonist therapy MEASUREMENTS: Counterfactual simulations were performed with the fitted model to estimate the number of death events averted for each intervention and in combination. Between April 2016 and December 2017, BC observed 2177 overdose deaths (77% fentanyl-detected). During the same period, an estimated 3030 (2900-3240) death events were averted by all interventions combined. In isolation, 1580 (1480-1740) were averted by take-home naloxone, 230 (160-350) by overdose prevention services and 590 (510-720) were averted by opioid agonist therapy. A combined intervention approach has been effective in averting overdose deaths during British Columbia's opioid overdose crisis in the period since declaration of a public health emergency (April 2016-December 2017). However, the absolute numbers of overdose deaths have not changed.
Sections du résumé
BACKGROUND AND AIMS
The province of British Columbia (BC) Canada has experienced a rapid increase in illicit drug overdoses and deaths during the last 4 years, with a provincial emergency declared in April 2016. These deaths have been driven primarily by the introduction of synthetic opioids into the illicit opioid supply. This study aimed to measure the combined impact of large-scale opioid overdose interventions implemented in BC between April 2016 and December 2017 on the number of deaths averted.
DESIGN
We expanded on the mathematical modelling methodology of our previous study to construct a Bayesian hierarchical latent Markov process model to estimate monthly overdose and overdose-death risk, along with the impact of interventions.
SETTING AND CASES
Overdose events and overdose-related deaths in BC from January 2012 to December 2017.
INTERVENTIONS
The interventions considered were take-home naloxone kits, overdose prevention/supervised consumption sites and opioid agonist therapy MEASUREMENTS: Counterfactual simulations were performed with the fitted model to estimate the number of death events averted for each intervention and in combination.
FINDINGS
Between April 2016 and December 2017, BC observed 2177 overdose deaths (77% fentanyl-detected). During the same period, an estimated 3030 (2900-3240) death events were averted by all interventions combined. In isolation, 1580 (1480-1740) were averted by take-home naloxone, 230 (160-350) by overdose prevention services and 590 (510-720) were averted by opioid agonist therapy.
CONCLUSIONS
A combined intervention approach has been effective in averting overdose deaths during British Columbia's opioid overdose crisis in the period since declaration of a public health emergency (April 2016-December 2017). However, the absolute numbers of overdose deaths have not changed.
Identifiants
pubmed: 31166621
doi: 10.1111/add.14664
pmc: PMC6684858
mid: NIHMS1030966
doi:
Substances chimiques
Narcotic Antagonists
0
Naloxone
36B82AMQ7N
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1602-1613Subventions
Organisme : NIDA NIH HHS
ID : U01 DA021525
Pays : United States
Organisme : Natural Science and Engineering Research Council Discovery Grant
ID : RGPIN-2015-04611
Pays : International
Organisme : Natural Sciences and Engineering Research Council of Canada
Pays : International
Organisme : CIHR
Pays : Canada
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 Society for the Study of Addiction.
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