Associations with experience of non-fatal opioid overdose in British Columbia, Canada: a repeated cross sectional survey study.
Fentanyl
Harm reduction
Opioid overdose
Unregulated drug poisoning emergency
Journal
Harm reduction journal
ISSN: 1477-7517
Titre abrégé: Harm Reduct J
Pays: England
ID NLM: 101153624
Informations de publication
Date de publication:
13 Dec 2023
13 Dec 2023
Historique:
received:
15
10
2023
accepted:
01
12
2023
medline:
14
12
2023
pubmed:
14
12
2023
entrez:
14
12
2023
Statut:
epublish
Résumé
Lives lost in North America due to the unregulated drug poisoning emergency are preventable and those who survive an opioid overdose may suffer long-term disability. Rates of opioid overdose more than doubled following the onset of the COVID-19 pandemic in British Columbia, Canada. Our analytical sample was comprised of 1447 participants from the 2018, 2019, and 2021 Harm Reduction Client Survey who responded yes or no to having experienced an opioid overdose in the past 6 months. Participants were recruited from harm reduction sites from across British Columbia. We used logistic regression to explore associations of experiencing an opioid overdose. Overall, 21.8% of participants reported experiencing an opioid overdose in the last six months (18.2% in 2019 and 26.6% in 2021). The following factors were positively associated with increased adjusted odds of experiencing a non-fatal opioid overdose: cis men relative to cis women (AOR 1.49, 95% CI 1.10-2.02), unstably housed compared to people with stable housing (AOR 1.87, 95% CI 1.40-2.50), and participants from 2021 compared to those from 2019 (AOR 3.06, 95% CI 1.57-5.97). The effects of both previous experience of a stimulant overdose and having witnessed an opioid overdose depended on the year of study, with both effects decreasing over subsequent years. Overdoses have increased over time; in 2021 more than one in four participants experienced an overdose. There is an urgent need for policy and program development to meaningfully address the unregulated drug poisoning emergency through acceptable life-saving interventions and services to prevent overdoses and support overdose survivors.
Identifiants
pubmed: 38093272
doi: 10.1186/s12954-023-00912-9
pii: 10.1186/s12954-023-00912-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
178Subventions
Organisme : Health Canada
ID : 1819-HQ-000054
Informations de copyright
© 2023. The Author(s).
Références
Krausz RM, Westenberg JN, Ziafat K. The opioid overdose crisis as a global health challenge. Curr Opin Psychiatry. 2021;34:405–12. https://doi.org/10.1097/YCO.0000000000000712 .
doi: 10.1097/YCO.0000000000000712
pubmed: 33901060
British Columbia Coroners Service. Unregulated drug deaths in B.C. (to Sep. 30, 2023) posted Nov 1, 2023. Available at https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports accessed Nov 20, 2023
British Columbia Coroners Service. Illicit drug toxicity type of drug data, Data to Dec 31, 2022. Posted January 31, 2023. Available at https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports accessed Jul 30, 2023
Larnder A, Saatchi A, Borden SA, Moa B, Gill CG, Wallace B, Hore D. Variability in the unregulated opioid market in the context of extreme rates of overdose. Drug Alcohol Depend. 2022;235: 109427. https://doi.org/10.1016/j.drugalcdep.2022.109427 .
doi: 10.1016/j.drugalcdep.2022.109427
pubmed: 35405459
Palis H, Bélair M, Hu K, Tu A, Buxton J, Slaunwhite A. Overdose deaths and the COVID-19 pandemic in British Columbia, Canada. Drug Alcohol Rev. 2022;41:912–7. https://doi.org/10.1111/dar.13424 .
doi: 10.1111/dar.13424
pubmed: 34908203
Ali F, Russell C, Nafeh F, Rehm J, LeBlanc S, Elton-Marshall T. Changes in substance supply and use characteristics among people who use drugs (PWUD) during the COVID-19 global pandemic: a national qualitative assessment in Canada. Int J Drug Policy. 2021;93: 103237. https://doi.org/10.1016/j.drugpo.2021.103237 .
doi: 10.1016/j.drugpo.2021.103237
pubmed: 33893026
pmcid: 9759688
McAdam E, Hayashi K, Dong H, Cui Z, Sedgemore K, Dietze P, Phillips P, Wilson D, Milloy M-J, DeBeck K. Factors associated with perceived decline in the quality of drugs during the COVID-19 pandemic: evidence from community-recruited cohorts of people who use drugs in Vancouver. Canada Drug Alcohol Depend. 2022;236: 109471. https://doi.org/10.1016/j.drugalcdep.2022.109471 .
doi: 10.1016/j.drugalcdep.2022.109471
pubmed: 35489180
Corrigan JD, Adams RS. The intersection of lifetime history of traumatic brain injury and the opioid epidemic. Addict Behav. 2019;90:143–5. https://doi.org/10.1016/j.addbeh.2018.10.030 .
doi: 10.1016/j.addbeh.2018.10.030
pubmed: 30391775
Hong JS, Moran MT, Eaton LA, Grafton LM. Neurologic, cognitive, and behavioral consequences of opioid overdose: a review. Curr Phys Med Rehabil Rep. 2019;7:305–13. https://doi.org/10.1007/s40141-019-00247-2 .
doi: 10.1007/s40141-019-00247-2
Xavier CG, Kuo M, Desai R, Palis H, Regan G, Zhao B, Moe J, Scheuermeyer FX, Gan WQ, Sabeti S, Meilleur L, Buxton JA, Slaunwhite AK. Association between toxic drug events and encephalopathy in British Columbia, Canada: a cross-sectional analysis. Subst Abuse Treat Prev Polic. 2023;18(1):42. https://doi.org/10.1186/s13011-023-00544-z .
doi: 10.1186/s13011-023-00544-z
Morrow RL, Bassett K, Maclure M, Dormuth CR. Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study. BMJ Open. 2019;9: e025567. https://doi.org/10.1136/bmjopen-2018-025567 .
doi: 10.1136/bmjopen-2018-025567
pubmed: 31061028
pmcid: 6502019
National Institute of Neurological Disorders and Stroke. 2022. Encephalopathy [WWW Document]. https://www.ninds.nih.gov/health-information/disorders/encephalopathy (accessed 9.9.22).
Kuo M, Shamsian A, Tzemis D, Buxton JA. A drug use survey among clients of harm reduction sites across British Columbia, Canada, 2012. Harm Reduct J. 2014;11:13. https://doi.org/10.1186/1477-7517-11-13 .
doi: 10.1186/1477-7517-11-13
pubmed: 24766846
pmcid: 4016659
Papamihali K, Yoon M, Graham B, Karamouzian M, Slaunwhite AK, Tsang V, Young S, Buxton JA. Convenience and comfort: reasons reported for using drugs alone among clients of harm reduction sites in British Columbia, Canada. Harm Reduct J. 2020;17:90. https://doi.org/10.1186/s12954-020-00436-6 .
doi: 10.1186/s12954-020-00436-6
pubmed: 33228676
pmcid: 7682134
Ferguson M, Parmar A, Papamihali K, Weng A, Lock K, Buxton JA. Investigating opioid preference to inform safe supply services: a cross sectional study. Int J Drug Policy. 2022;101:103574. https://doi.org/10.1016/j.drugpo.2021.103574 .
doi: 10.1016/j.drugpo.2021.103574
pubmed: 35007878
Steinberg A, Mehta A, Papamihali K, Lukac CD, Young S, Graham B, Lock K, Fleury M, Buxton JA. Motivations for concurrent use of uppers and downers among people who access harm reduction services in British Columbia, Canada: findings from the 2019 Harm Reduction Client Survey. BMJ Open. 2022;12: e060447. https://doi.org/10.1136/bmjopen-2021-060447 .
doi: 10.1136/bmjopen-2021-060447
pubmed: 35501101
pmcid: 9062822
Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17. https://doi.org/10.1186/1751-0473-3-17 .
doi: 10.1186/1751-0473-3-17
pubmed: 19087314
pmcid: 2633005
The R Project for Statistical Computing. n.d. Collinearity Diagnostics, Model Fit & Variable Contribution [WWW Document]. https://cran.r-project.org/web/packages/olsrr/vignettes/regression_diagnostics.html (accessed 5.14.21).
Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioids and stimulant-related harms in Canada. Ottawa: Public Health Agency of Canada; 2022.
Sorge J, Buxton JA, Amlani A, Ishiguro S. Substance Use Trends in BC: A Survey of Harm Reduction Clients-Overall Results for British Columbia 2014. BC Centre for Disease Control. 2015.
Davis A, Amlani A, Buxton JA. Substance Use Trends in BC: A Survey of Harm Reduction Clients-Overall Results for British Columbia: 2015. BC Centre for Disease Control. 2015.
Kurz M, Min JE, Dale LM, Nosyk B. Assessing the determinants of completing OAT induction and long-term retention: a population-based study in British Columbia, Canada. J Subst Abuse Treat. 2022;133: 108647. https://doi.org/10.1016/j.jsat.2021.108647 .
doi: 10.1016/j.jsat.2021.108647
pubmed: 34740484
Pilarinos A, Fast D, Nosova E, Kwa Y, Joe R, Buxton JA, DeBeck K. Initiation of opioid agonist treatment and subsequent substance use and other patterns among adolescents and young adults in Vancouver, Canada. Drug Alcohol Depend. 2022;235: 109441. https://doi.org/10.1016/j.drugalcdep.2022.109441 .
doi: 10.1016/j.drugalcdep.2022.109441
pubmed: 35427979
pmcid: 9872979
Canadian Association of People who Use Drugs. CAPUD Safe Supply Concept Document. Canadian Association of People who Use Drugs. 2019. https://vancouver.ca/files/cov/capud-safe-supply-concept-document.pdf . Accessed Sept 9 2022
Bohnert ASB, Tracy M, Galea S. Characteristics of drug users who witness many overdoses: implications for overdose prevention. Drug Alcohol Depend. 2012;120:168–73. https://doi.org/10.1016/j.drugalcdep.2011.07.018 .
doi: 10.1016/j.drugalcdep.2011.07.018
pubmed: 21839588
Latkin CA, Edwards C, Davey-Rothwell MA, Yang C, Tobin KE. The relationship between drug use settings, roles in the drug economy, and witnessing a drug overdose in Baltimore, Maryland. Subst Abuse. 2018;39:384–9. https://doi.org/10.1080/08897077.2018.1439801 .
doi: 10.1080/08897077.2018.1439801
Palis H, Xavier C, Dobrer S, Desai R, Sedgemore K, Scow M, Lock K, Gan W, Slaunwhite A. Concurrent use of opioids and stimulants and risk of fatal overdose: a cohort study. BMC Public Health. 2022;22:2084. https://doi.org/10.1186/s12889-022-14506-w .
doi: 10.1186/s12889-022-14506-w
pubmed: 36380298
pmcid: 9664696
Caudarella A, Dong H, Milloy MM, Kerr T, Wood E, Hayashi K. Non-fatal overdose as a risk factor for subsequent fatal overdose among people who inject drugs. Drug Alcohol Depend. 2016;162:51–5.
doi: 10.1016/j.drugalcdep.2016.02.024
pubmed: 26993373
pmcid: 4833586
Irvine MA, Kuo M, Buxton JA, Balshaw R, Otterstatter M, Macdougall L, Milloy M-J, Bharmal A, Henry B, Tyndall M, Coombs D, Gilbert M. Modelling the combined impact of interventions in averting deaths during a synthetic-opioid overdose epidemic. Addiction. 2019;114:1602–13. https://doi.org/10.1111/add.14664 .
doi: 10.1111/add.14664
pubmed: 31166621
pmcid: 6684858
British Columbia Centre for Disease Control. Naloxone is Not Enough: Letter from the Heart of the Crisis [WWW Document]. 2021. https://ohrn.org/wp-content/uploads/2021/08/Naloxone-Is-Not-EnoughLetters-From-The-Heart-Of-The-Crisis.pdf (accessed 9.9.22).
Lei V, Ferguson M, Geiger R, Williams S, Liu L, Buxton JA. Factors associated with take-home naloxone kit usage in British Columbia: an analysis of administrative data. Subst Abuse Treat Prev Policy. 2022;17:25. https://doi.org/10.1186/s13011-022-00452-8 .
doi: 10.1186/s13011-022-00452-8
pubmed: 35361228
pmcid: 8968772
Mamdani Z, McKenzie S, Pauly B, Cameron F, Conway-Brown J, Edwards D, Howell A, Scott T, Seguin R, Woodrow P, Buxton JA. “Running myself ragged”: stressors faced by peer workers in overdose response settings. Harm Reduct J. 2021;18:18. https://doi.org/10.1186/s12954-020-00449-1 .
doi: 10.1186/s12954-020-00449-1
pubmed: 33573661
pmcid: 7877312
Kenny KS, Kolla G, Firestone M, Bannerman M, Greig S, Flores BF, Dodd Z, Strike C, Bayoumi AM. Frequency of fatal and non-fatal overdoses and response to grief and loss among people who inject drugs: an unexplored dimension of the opioid overdose crisis. Drug Alcohol Depend. 2022;237: 109539. https://doi.org/10.1016/j.drugalcdep.2022.109539 .
doi: 10.1016/j.drugalcdep.2022.109539
pubmed: 35777172
Mamdani Z, McKenzie S, Ackermann E, Voyer R, Cameron F, Scott T, Pauly B, Buxton JA. The cost of caring: compassion fatigue among peer overdose response workers in British Columbia. Subst Use Misuse. 2023;58(1):85–93. https://doi.org/10.1080/10826084.2022.2148481 .
doi: 10.1080/10826084.2022.2148481
pubmed: 36433651
Schneider KE, Tomko C, Nestadt DF, Silberzahn BE, White RH, Sherman SG. Conceptualizing overdose trauma: the relationships between experiencing and witnessing overdoses with PTSD symptoms among street-recruited female sex workers in Baltimore, Maryland. Int J Drug Policy. 2021;92: 102859. https://doi.org/10.1016/j.drugpo.2020.102859 .
doi: 10.1016/j.drugpo.2020.102859
pubmed: 32712164
Laing MK, Ti L, Marmel A, Tobias S, Shapiro AM, Laing R, Lysyshyn M, Socías ME. An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: preliminary results from a community drug checking program using point-of-care and confirmatory methods. Int J Drug Policy. 2021;93: 103169. https://doi.org/10.1016/j.drugpo.2021.103169 .
doi: 10.1016/j.drugpo.2021.103169
pubmed: 33627302
Cho J, Spence MM, Niu F, Hui RL, Gray P, Steinberg S. Risk of overdose with exposure to prescription opioids, benzodiazepines, and non-benzodiazepine sedative-hypnotics in adults: a retrospective cohort study. J Gen Intern Med. 2020;35:696–703. https://doi.org/10.1007/s11606-019-05545-y .
doi: 10.1007/s11606-019-05545-y
pubmed: 31919729
pmcid: 7080944
Tori ME, Larochelle MR, Naimi TS. Alcohol or benzodiazepine co-involvement with opioid overdose deaths in the United States, 1999–2017. JAMA Netw Open. 2020;3: e202361. https://doi.org/10.1001/jamanetworkopen.2020.2361 .
doi: 10.1001/jamanetworkopen.2020.2361
pubmed: 32271389
pmcid: 7146101
Purssell R, Buxton JA, Godwin J, Moe J. Potent sedatives in opioids in BC: Implications for resuscitation, and benzodiazepine and etizolam withdrawal. BC Med J. 2021;63:177–8.