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Booth RG, Shariff SZ, Carter B, Hwang SW, Orkin AM, Forchuk C, Gomes T. Opioid-related overdose deaths among people experiencing homelessness, 2017 to 2021: A population-based analysis using coroner and health administrative data from Ontario, Canada. Addiction 2024; 119:334-344. [PMID: 37845790 DOI: 10.1111/add.16357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/28/2023] [Indexed: 10/18/2023]
Abstract
AIMS To measure the change in proportion of opioid-related overdose deaths attributed to people experiencing homelessness and to compare the opioid-related fatalities between individuals experiencing homelessness and not experiencing homelessness at time of death. DESIGN, SETTING AND PARTICIPANTS Population-based, time-trend analysis using coroner and health administrative databases from Ontario, Canada from 1 July 2017 and 30 June 2021. MEASUREMENTS Quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness. We also obtained socio-demographic and health characteristics of decedents, health-care encounters preceding death, substances directly contributing to death and circumstances surrounding deaths. FINDINGS A total of 6644 individuals (median age = 40 years, interquartile range = 31-51; 74.1% male) experienced an accidental opioid-related overdose death, among whom 884 (13.3%) were identified as experiencing homelessness at the time of death. The quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness increased from 7.2% (26/359) in July-September 2017 to 16.8% (97/578) by April-June 2021 (trend test P < 0.01). Compared with housed decedents, those experiencing homelessness were younger (61.3 versus 53.1% aged 25-44), had higher prevalence of mental health or substance use disorders (77.1 versus 67.1%) and more often visited hospitals (32.1 versus 24.5%) and emergency departments (82.6 versus 68.5%) in the year prior to death. Fentanyl and its analogues more often directly contributed to death among people experiencing homelessness (94.0 versus 81.4%), as did stimulants (67.4 versus 51.6%); in contrast, methadone was less often present (7.8 versus 12.4%). Individuals experiencing homelessness were more often in the presence of a bystander during the acute toxicity event that led to death (55.8 versus 49.7%); and where another individual was present, more often had a resuscitation attempted (61.7 versus 55.1%) or naloxone administered (41.2 versus 28.9%). CONCLUSIONS People experiencing homelessness account for an increasing proportion of fatal opioid-related overdoses in Ontario, Canada, reaching nearly one in six such deaths in 2021.
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Affiliation(s)
- Richard G Booth
- Arthur Labatt Family School of Nursing, Western University, London, Canada
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- London Health Sciences Centre, Lawson Health Research Institute, London, Canada
| | - Salimah Z Shariff
- Arthur Labatt Family School of Nursing, Western University, London, Canada
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- London Health Sciences Centre, Lawson Health Research Institute, London, Canada
| | - Brooke Carter
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- London Health Sciences Centre, Lawson Health Research Institute, London, Canada
| | - Stephen W Hwang
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
| | - Aaron M Orkin
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Emergency Medicine, St Joseph's Health Centre, Toronto, Canada
| | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, Canada
- London Health Sciences Centre, Lawson Health Research Institute, London, Canada
| | - Tara Gomes
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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