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Stevens A, Keemink JR, Shirley-Beavan S, Khadjesari Z, Artenie A, Vickerman P, Southwell M, Shorter GW. Overdose prevention centres as spaces of safety, trust and inclusion: A causal pathway based on a realist review. Drug Alcohol Rev 2024. [PMID: 39104059 DOI: 10.1111/dar.13908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/07/2024]
Abstract
ISSUES Overdose prevention centres (OPC) are non-residential spaces where people can use illicit drugs (that they have obtained elsewhere) in the presence of staff who can intervene to prevent and manage any overdoses that occur. Many reviews of OPCs exist but they do not explain how OPCs work. APPROACH We carried out a realist review, using the RAMESES reporting standards. We systematically searched for and then thematically analysed 391 documents that provide information on the contexts, mechanisms and outcomes of OPCs. KEY FINDINGS Our retroductive analysis identified a causal pathway that highlights the feeling of safety - and the immediate outcome of not dying - as conditions of possibility for the people who use OPCs to build trust and experience social inclusion. The combination of safety, trust and social inclusion that is triggered by OPCs can - depending on the contexts in which they operate - generate other positive outcomes, which may include less risky drug use practices, reductions in blood borne viruses and injection-related infections and wounds, and access to housing. These outcomes are contingent on relevant contexts, including political and legal environments, which differ for women and people from racialised minorities. CONCLUSIONS OPCs can enable people who live with structural violence and vulnerability to develop feelings of safety and trust that help them stay alive and to build longer term trajectories of social inclusion, with potential to improve other aspects of their health and living conditions.
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Affiliation(s)
- Alex Stevens
- Social Policy, Sociology and Social Research, University of Kent, Medway, UK
| | - Jolie R Keemink
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Sam Shirley-Beavan
- Social Policy, Sociology and Social Research, University of Kent, Medway, UK
| | | | | | | | | | - Gillian W Shorter
- Drug and Alcohol Research Network, Queen's University Belfast, Belfast, UK
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Robinson T, Farrokhyar F, Fischer B. The associations of supervised consumption services with the rates of opioid-related mortality and morbidity outcomes at the public health unit level in Ontario (Canada): A controlled interrupted time-series analysis. Drug Alcohol Rev 2024. [PMID: 39104058 DOI: 10.1111/dar.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 07/04/2024] [Accepted: 07/19/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION This study aimed to assess the impact of the implementation of legally sanctioned supervised consumption sites (SCS) in the Canadian province of Ontario on opioid-related deaths, emergency department (ED) visits and hospitalisations at the public health unit (PHU) level. METHODS Monthly rates per 100,000 population of opioid-related deaths, ED visits and hospitalisations for PHUs in Ontario between December 2013 and March 2022 were collected. Aggregated and individual analyses of PHUs with one or more SCS were conducted, with PHUs that instituted an SCS being matched to control units that did not. Autoregressive integrated moving average models were used to estimate the impact of SCS implementation on opioid-related deaths, ED visits and hospitalisations. RESULTS Twenty-one legally sanctioned SCS were implemented across nine PHUs in Ontario during the study period. Interrupted time series analyses showed no statistically significant changes in opioid-related death rates in aggregated analyses of intervention PHUs (increase of 0.02 deaths/100,000 population/month; p = 0.27). Control PHUs saw a significant increase of 0.38 deaths/100,000 population/month; p < 0.001. No statistically significant changes were observed in the rates of opioid-related ED visits in intervention PHUs (decrease of 0.61 visits/100,000 population/month; p = 0.39) or controls (increase of 0.403 visits; p = 0.76). No statistically significant changes to the rates of opioid-related hospitalisations were observed in intervention PHUs (0 hospitalisations/100,000 population/month; p = 0.98) or controls (decrease of 0.05 hospitalisations; p = 0.95). DISCUSSION AND CONCLUSIONS This study did not find significant mortality or morbidity effects associated with SCS availability at the population level in Ontario. In the context of a highly toxic drug supply, additional interventions will be required to reduce opioid-related harms.
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Affiliation(s)
- Tessa Robinson
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Surgery, McMaster University, Hamilton, Canada
| | - Benedikt Fischer
- Research and Graduate Studies, University of the Fraser Valley, Abbotsford, Canada
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Federal University of Sao Paulo, São Paulo, Brazil
- School of Population Health, University of Auckland, Auckland, New Zealand
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Markoulidakis A, Hickman M, McAuley A, Barnsdale LR, Welton NJ, Glancy M, Shivaji T, Collins C, Lang J, de Wit F, Hunt G, Wilkinson L, Fraser R, Yeung A, Horsburgh K, Priyadarshi S, Hutchinson SJ, Jones HE. Prevalence of opioid dependence in Scotland 2015-2020: A multi-parameter estimation of prevalence (MPEP) study. Addiction 2024; 119:1410-1420. [PMID: 38631671 DOI: 10.1111/add.16500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIMS Drug-related deaths in Scotland more than doubled between 2011 and 2020. To inform policymakers and understand drivers of this increase, we estimated the number of people with opioid dependence aged 15-64 from 2014/15 to 2019/20. DESIGN We fitted a Bayesian multi-parameter estimation of prevalence (MPEP) model, using adverse event rates to estimate prevalence of opioid dependence jointly from Opioid Agonist Therapy (OAT), opioid-related mortality and hospital admissions data. Estimates are stratified by age group, sex and year. SETTING Scotland, 2014/15 to 2019/20. PARTICIPANTS People with opioid dependence and potential to benefit from OAT, whether ever treated or not. Using data from the Scottish Public Health Drug Linkage Programme, we identified a baseline cohort of individuals who had received OAT within the last 5 years, and all opioid-related deaths and hospital admissions (whether among or outside of this cohort). MEASUREMENTS Rates of each adverse event type and (unobserved) prevalence were jointly modelled. FINDINGS The estimated number and prevalence of people with opioid dependence in Scotland in 2019/20 was 47 100 (95% Credible Interval [CrI] 45 700 to 48 600) and 1.32% (95% CrI 1.28% to 1.37%). Of these, 61% received OAT during 2019/20. Prevalence in Greater Glasgow and Clyde was estimated as 1.77% (95% CrI 1.69% to 1.85%). There was weak evidence that overall prevalence fell slightly from 2014/15 (change -0.07%, 95% CrI -0.14% to 0.00%). The population of people with opioid dependence is ageing, with the estimated number of people aged 15-34 reducing by 5100 (95% CrI 3800 to 6400) and number aged 50-64 increasing by 2800 (95% CrI 2100 to 3500) between 2014/15 and 2019/20. CONCLUSIONS The prevalence of opioid dependence in Scotland remained high but was relatively stable, with only weak evidence of a small reduction, between 2014/15 and 2019/20. Increased numbers of opioid-related deaths can be attributed to increased risk among people with opioid dependence, rather than increasing prevalence.
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Affiliation(s)
- Andreas Markoulidakis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Public Health Scotland, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew McAuley
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Megan Glancy
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | | | | | | | | | - Rosalyn Fraser
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Alan Yeung
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Saket Priyadarshi
- Alcohol and Drug Recovery Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sharon J Hutchinson
- Public Health Scotland, UK
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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McLeod KE, Buxton JA, Karim ME, Martin RE, Nosyk B, Kurz M, Scow M, Felicella G, Slaunwhite AK. Receipt of Opioid Agonist Treatment in provincial correctional facilities in British Columbia is associated with a reduced hazard of nonfatal overdose in the month following release. PLoS One 2024; 19:e0306075. [PMID: 38985687 PMCID: PMC11236203 DOI: 10.1371/journal.pone.0306075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND In many jurisdictions, policies restrict access to Opioid Agonist Treatment (OAT) in correctional facilities. Receipt of OAT during incarceration is associated with reduced risk of fatal overdose after release but little is known about the effect on nonfatal overdose. This study aimed to examine the association between OAT use during incarceration and nonfatal overdose in the 30 days following release. METHODS AND FINDINGS Using linked administrative healthcare and corrections data for a random sample of 20% of residents of British Columbia, Canada we examined releases from provincial correctional facilities between January 1, 2015 -December 1, 2018, among adults (aged 18 or older at the time of release) with Opioid Use Disorder. We fit Andersen-Gill models to examine the association between receipt of OAT in custody and the hazard of nonfatal following release. We conducted secondary analyses to examine the association among people continuing treatment initiated prior to their arrest and people who initiated a new episode of OAT in custody separately. We also conducted sex-based subgroup analyses. In this study there were 4,738 releases of 1,535 people with Opioid Use Disorder. In adjusted analysis, receipt of OAT in custody was associated with a reduced hazard of nonfatal overdose (aHR 0.55, 95% CI 0.41, 0.74). This was found for prescriptions continued from community (aHR 0.49, 95%CI 0.36, 0.67) and for episodes of OAT initiated in custody (aHR 0.58, 95%CI 0.41, 0.82). The effect was greater among women than men. CONCLUSIONS OAT receipt during incarceration is associated with a reduced hazard of nonfatal overdose after release. Policies to expand access to OAT in correctional facilities, including initiating treatment, may help reduce harms related to nonfatal overdose in the weeks following release. Differences in the effect seen among women and men indicate a need for gender-responsive policies and programming.
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Affiliation(s)
- Katherine E. McLeod
- Department of Family Medicine, McMaster University, Hamilton, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jane A. Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Ruth Elwood Martin
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Megan Kurz
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Marnie Scow
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Guy Felicella
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Amanda K. Slaunwhite
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Johnson K, Vermeer W, Hills H, Chin-Purcell L, Barnett JT, Burns T, Dean MJ, Hendricks Brown C. Model-driven decision support: A community-based meta-implementation strategy to predict population impact. Ann Epidemiol 2024; 95:12-18. [PMID: 38754571 PMCID: PMC11197148 DOI: 10.1016/j.annepidem.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/11/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Standard tools for public health decision making such as data dashboards, trial repositories, and intervention briefs may be necessary but insufficient for guiding community leaders in optimizing local public health strategy. Predictive modeling decision support tools may be the missing link that allows community level decision makers to confidently direct funding and other resources to interventions and implementation strategies that will improve upon the status quo. METHODS We describe a community-based model-driven decision support (MDDS) approach that requires community engagement, local data, and predictive modeling tools (agent-based modeling in our case studies) to improve decision-making on implementing strategies to address complex public health problems such as overdose deaths. We refer to our approach as a meta-implementation strategy as it provides guidance to a community on what intervention combinations and their required implementation strategies are needed to achieve desired outcomes. We use standard implementation measures including the Stages of Implementation Completion to assess adoption of this meta-implementation approach. RESULTS Using two case studies, we illustrate how MDDS can be used to support decision making related to HIV prevention and reductions in overdose deaths at the city and county level. Even when community acceptance seems high, data acquisition and diffuse responsibility for implementing specific strategies recommended by modeling are barriers to adoption. CONCLUSIONS MDDS has the capacity to improve community decision makers use of scientific knowledge by providing projections of the impact of intervention strategies under various scenarios. Further research is necessary to assess its effectiveness and the best strategies to implement it.
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Affiliation(s)
- Kimberly Johnson
- Department of Mental Health Law and Policy, College of Community and Behavioral Sciences, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL 33612, USA.
| | - Wouter Vermeer
- Center for Prevention Implementation Methodology for Drug Abuse and HIV (Ce-PIM), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA; Center for Connected Learning and Computer-Based Modeling (CCL), School of Education and Social Policy, Northwestern University, Evanston, IL, USA; Northwestern Institute for Complex Systems (NICO), Northwestern University, Evanston, IL, USA
| | - Holly Hills
- Department of Mental Health Law and Policy, College of Community and Behavioral Sciences, University of South Florida, 13301 Bruce B Downs Blvd, Tampa, FL 33612, USA
| | - Lia Chin-Purcell
- Center for Dissemination and Implementation At Stanford (C-DIAS), Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Joshua T Barnett
- Department of Human Services, Pinellas County Government, 440 Court Street, 2nd Floor, Clearwater, FL 33756, USA
| | - Timothy Burns
- Department of Human Services, Pinellas County Government, 440 Court Street, 2nd Floor, Clearwater, FL 33756, USA
| | | | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA; Department of Preventive Medicine, Northwestern University, Chicago, IL, USA; Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Oh S, Cano M, Kim Y. County-level industrial composition of the labor force and drug overdose mortality rates in the United States in 2018-2021. Am J Ind Med 2024; 67:636-645. [PMID: 38770905 PMCID: PMC11168858 DOI: 10.1002/ajim.23612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/25/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Drug mortality risks vary among industries, creating distinctive geographic patterns across US counties. However, less is known about how local labor market structure relates to drug overdose mortality amid the synthetic opioid era in the United States. This study investigates the relationship between industry-specific job composition and drug overdose mortality at the county level while exploring how fentanyl's presence in illicit drug supplies may moderate the relationship. METHODS Data were derived from the National Center for Health Statistics' Multiple Cause of Death files for the rates of drug overdose mortality of any intent, linked with four other sources on industry-specific job shares, drug supply, and county-level sociodemographic characteristics and opioid prescribing rates from the US Census Bureau, the CDC, and the Drug Enforcement Administration. Negative binomial regression models were employed to examine associations between county industry-specific job composition and drug overdose mortality, with tests for moderating effects of state-level fentanyl seizure rates. RESULTS Our models indicate negative associations between job shares of manufacturing, retail trade, and educational services industries and drug overdose mortality. Positive associations were found for arts/entertainment/recreation and public administration. State-level fentanyl seizure rates had moderating effects on administrative/support/waste management/remediation (A/S/WM/R) and educational services. CONCLUSION Counties with a higher concentration of arts/entertainment/recreation and public administration jobs need targeted efforts to mitigate drug-related overdose risks. Additionally, areas with higher concentrations of A/S/WM/R service jobs, particularly where fentanyl seizure rates are higher, may require proactive harm reduction strategies for reducing overdose risks.
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Affiliation(s)
- Sehun Oh
- College of Social Work, The Ohio State University, Columbus, OH, United States
| | - Manuel Cano
- School of Social Work, Arizona State University, Phoenix, AZ, United States
| | - Yeonwoo Kim
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
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7
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Kinoshita AT, Saadat S, Chakravarthy B. Bystanders Saving Lives with Naloxone: A Scoping Review on Methods to Estimate Overdose Reversals. West J Emerg Med 2024; 25:500-506. [PMID: 39028236 PMCID: PMC11254156 DOI: 10.5811/westjem.18037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction People who use drugs in community settings are at risk of a fatal overdose, which can be mitigated by naloxone administered via bystanders. In this study we sought to investigate methods of estimating and tracking opioid overdose reversals by community members with take-home naloxone (THN) to coalesce possible ways of characterizing THN reach with a metric that is useful for guiding both distribution of naloxone and advocacy of its benefits. Methods We conducted a scoping review of published literature on PubMed on August 15, 2022, using PRISMA-ScR protocol, for articles discussing methods to estimate THN reversals in the community. The following search terms were used: naloxone AND ("take home" OR kit OR "community distribution" OR "naloxone distribution"). We used backwards citation searching to potentially find additional studies. Overdose education and naloxone distribution program-based studies that analyzed only single programs were excluded. Results The database search captured 614 studies, of which 14 studies were relevant. Backwards citation searching of 765 references did not reveal additional relevant studies. Of the 14 relevant studies, 11 were mathematical models. Ten used Markov models, and one used a system dynamics model. Of the remaining three articles, one was a meta-analysis, and two used spatial analysis. Studies ranged in year of publication from 2013-2022 with mathematical modeling increasing in use over time. Only spatial analysis was used with a focus on characterizing local naloxone use at the level of a specific city. Conclusion Of existing methods to estimate bystander administration of THN, mathematical models are most common, particularly Markov models. System dynamics modeling, meta-analysis, and spatial analysis have also been used. All methods are heavily dependent upon overdose education and naloxone distribution program data published in the literature or available as ongoing surveillance data. Overall, there is a paucity of literature describing methods of estimation and even fewer with methods applied to a local focus that would allow for more targeted distribution of naloxone.
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Affiliation(s)
| | - Soheil Saadat
- University of California Irvine, School of Medicine, Department of Emergency Medicine, Irvine, California
| | - Bharath Chakravarthy
- University of California Irvine, School of Medicine, Department of Emergency Medicine, Irvine, California
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Howard-Azzeh M, Wasfi R, Kakkar T, Flynn M, Rotondo J, Schleihauf E, Bowes M, Rees EE. Spatiotemporal epidemiology of substance-related accidental acute toxicity deaths in Canada from 2016 to 2017. BMC Public Health 2024; 24:1641. [PMID: 38898445 PMCID: PMC11188508 DOI: 10.1186/s12889-024-18883-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES In Canada, substance-related accidental acute toxicity deaths (AATDs) continue to rise at the national and sub-national levels. However, it is unknown if, where, when, and to what degree AATDs cluster in space, time, and space-time across the country. The objectives of this study were to 1) assess for clusters of AATDs that occurred in Canada during 2016 and 2017 at the national and provincial/territorial (P/T) levels, and 2) examine the substance types detected in AATD cases within each cluster. METHODS Two years of person-level data on AATDs were abstracted from coroner and medical examiner files using a standardized data collection tool, including the decedent's postal code and municipality information on the places of residence, acute toxicity (AT) event, and death, and the substances detected in the death. Data were combined with Canadian census information to create choropleth maps depicting AATD rates by census division. Spatial scan statistics were used to build Poisson models to identify clusters of high rates (p < 0.05) of AATDs at the national and P/T levels in space, time, and space-time over the study period. AATD cases within clusters were further examined for substance types most present in each cluster. RESULTS Eight clusters in five regions of Canada at the national level and 24 clusters in 15 regions at the P/T level were identified, highlighting where AATDs occurred at far higher rates than the rest of the country. The risk ratios of identified clusters ranged from 1.28 to 9.62. Substances detected in clusters varied by region and time, however, opioids, stimulants, and alcohol were typically the most commonly detected substances within clusters. CONCLUSION Our findings are the first in Canada to reveal the geographic disparities in AATDs at national and P/T levels using spatial scan statistics. Rates associated with substance types within each cluster highlight which substance types were most detected in the identified regions. Findings may be used to guide intervention/program planning and provide a picture of the 2016 and 2017 context that can be used for comparisons of the geographic distribution of AATDs and substances with different time periods.
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Affiliation(s)
- Mohammad Howard-Azzeh
- Health Promotion and Chronic Disease Prevention Branch, Substance-Related Harms Division, Public Health Agency of Canada, Ontario, Canada.
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Ontario, Canada.
| | - Rania Wasfi
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Quebec, Canada
| | - Tanya Kakkar
- Health Promotion and Chronic Disease Prevention Branch, Substance-Related Harms Division, Public Health Agency of Canada, Ontario, Canada
| | - Mallory Flynn
- Department of Statistics, University of British Columbia, British Columbia, Canada
| | - Jenny Rotondo
- Health Promotion and Chronic Disease Prevention Branch, Substance-Related Harms Division, Public Health Agency of Canada, Ontario, Canada
| | - Emily Schleihauf
- Canadian Public Health Service, Public Health Agency of Canada, Ontario, Canada
| | - Matthew Bowes
- Nova Scotia Medical Examiner Service, Department of Justice, Nova Scotia, Canada
| | - Erin E Rees
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Quebec, Canada
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, University of Montreal, Quebec, Canada
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9
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Pauly BB, Kurz M, Dale LM, Macevicius C, Kalicum J, Pérez DG, McCall J, Urbanoski K, Barker B, Slaunwhite A, Lindsay M, Nosyk B. Implementation of pharmaceutical alternatives to a toxic drug supply in British Columbia: A mixed methods study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 161:209341. [PMID: 38490334 DOI: 10.1016/j.josat.2024.209341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/15/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND North America has been in an unrelenting overdose crisis for almost a decade. British Columbia (BC), Canada declared a public health emergency due to overdoses in 2016. Risk Mitigation Guidance (RMG) for prescribing pharmaceutical opioids, stimulants and benzodiazepine alternatives to the toxic drug supply ("safer supply") was implemented in March 2020 in an attempt to reduce harms of COVID-19 and overdose deaths in BC during dual declared public health emergencies. Our objective was to describe early implementation of RMG among prescribers in BC. METHODS We conducted a convergent mixed methods study drawing population-level linked administrative health data and qualitative interviews with 17 prescribers. The Consolidated Framework for Implementation Research (CFIR) informs our work. The study utilized seven linked databases, capturing the characteristics of prescribers for people with substance use disorder to describe the characteristics of those prescribing under the RMG using univariate summary statistics and logistic regression analysis. For the qualitative analysis, we drew on interpretative descriptive methodology to identify barriers and facilitators to implementation. RESULTS Analysis of administrative databases demonstrated limited uptake of the intervention outside large urban centres and a highly specific profile of urban prescribers, with larger and more complex caseloads associated with RMG prescribing. Nurse practitioners were three times more likely to prescribe than general practitioners. Qualitatively, the study identified five themes related to the five CFIR domains: 1) RMG is helpful but controversial; 2) Motivations and challenges to prescribing; 3) New options and opportunities for care but not enough to 'win the arms race'; 4) Lack of implementation support and resources; 5) Limited infrastructure. CONCLUSIONS BC's implementation of RMG was limited in scope, prescriber uptake and geographic scale up. Systemic, organizational and individual barriers and facilitators point to the importance of engaging professional regulatory colleges, implementation planning and organizational infrastructure to ensure effective implementation and adaptation to context.
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Affiliation(s)
- Bernadette Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada; University of Victoria School of Nursing, Box 1700 Stn CSC, Victoria, BC 250, Canada.
| | - Megan Kurz
- Centre for Advancing Health Outcomes, Providence Health Care, 570-1081 Burrard Street, Vancouver, BC V6Z IY6b, Canada.
| | - Laura M Dale
- Centre for Advancing Health Outcomes, Providence Health Care, 570-1081 Burrard Street, Vancouver, BC V6Z IY6b, Canada.
| | - Celeste Macevicius
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada; University of Victoria School of Public Health and Social Policy, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Jeremy Kalicum
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada; University of Victoria School of Public Health and Social Policy, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Daniel Gudiño Pérez
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada; University of Victoria School of Public Health and Social Policy, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Jane McCall
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada; University of Victoria School of Public Health and Social Policy, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Brittany Barker
- School of Public Health and Social Policy, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada; First Nations Health Authority, 501 - 100 Park Royal South, 170-6371 Crescent Road, Coast Salish Territory (West Vancouver), BC V7T 1A2, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, B.C. V5A 1S6, Canada.
| | - Amanda Slaunwhite
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC V5Z 4R4, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada; Centre for Advancing Health Outcomes, 570-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC V6Z1Y6, Canada.
| | - Morgan Lindsay
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada.
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, B.C. V5A 1S6, Canada; Centre for Advancing Health Outcomes, Providence Health Care, 570-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC V6Z1Y6, Canada.
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Tobias S, Buxton JA, Ti L. Local Impact From International Crises: Unregulated Drug Toxicity During the COVID-19 Pandemic in British Columbia, Canada. Am J Public Health 2024; 114:587-589. [PMID: 38718337 PMCID: PMC11079835 DOI: 10.2105/ajph.2024.307673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Samuel Tobias
- Samuel Tobias is with the School of Population and Public Health, University of British Columbia, and the British Columbia Centre on Substance Use, Vancouver, Canada. Jane A. Buxton is with the School of Population and Public Health, University of British Columbia. Lianping Ti is with the Department of Medicine, University of British Columbia, and the British Columbia Centre on Substance Use
| | - Jane A Buxton
- Samuel Tobias is with the School of Population and Public Health, University of British Columbia, and the British Columbia Centre on Substance Use, Vancouver, Canada. Jane A. Buxton is with the School of Population and Public Health, University of British Columbia. Lianping Ti is with the Department of Medicine, University of British Columbia, and the British Columbia Centre on Substance Use
| | - Lianping Ti
- Samuel Tobias is with the School of Population and Public Health, University of British Columbia, and the British Columbia Centre on Substance Use, Vancouver, Canada. Jane A. Buxton is with the School of Population and Public Health, University of British Columbia. Lianping Ti is with the Department of Medicine, University of British Columbia, and the British Columbia Centre on Substance Use
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11
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Irvine MA, Bardwell S, Williams S, Liu L, Ge W, Kinniburgh B, Coombs D, Buxton JA. Estimating the total utilization of take home naloxone during an unregulated drug toxicity crisis: A Bayesian modeling approach. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104454. [PMID: 38788389 DOI: 10.1016/j.drugpo.2024.104454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND British Columbia (BC) Canada has a large take-home naloxone (THN) program, implemented as part of the provincial response to the ongoing toxic unregulated drug supply emergency. Ascertaining the rate of use of THN kits is vital to understanding the full impact of the program. However, this is a challenging problem due to under-reporting of kit distribution. This study aims to estimate the total number of THN kits used based on the number of THN kits shipped, the number of THN kits reported as distributed, and the number of THN kits reported as used. METHODS We used BC THN shipment and distribution records (February 2015 to August 2023) to inform a simple Bayesian model of naloxone kit distribution and use. A logistic regression term by health region and distribution site type was incorporated to account for variable under-reporting, and a convolution term was incorporated to account for kit distribution. RESULTS We find the number of THN kits reported as used, and the number of total THN kits distributed, are largely under-reported. An estimated 1,500 (95 % CrI: 1,430 - 1,590) THN kits per 10,000 BC population were used, of which 288 per 10,000 had been reported as used. Of all the THN kits shipped, the model estimated that 43 % (95 % CrI: 41-45 %) of kits were used. We also found variation in both distribution and use by distribution site type, with kits distributed from overdose prevention sites having the highest rate of use (56 %; 95 % CrI: 53-59 %). CONCLUSION Across all sites, kit use is approximately five times higher than has been reported. Our framework can also be applied to other localities where THN programs operate, in order to better estimate the true reach and impact of take home naloxone distribution.
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Affiliation(s)
- Michael A Irvine
- BC Centre for Disease Control, Vancouver, BC, Canada; Department of Statistics, University of British Columbia, Vancouver, BC, Canada.
| | - Samantha Bardwell
- Mathematics Department, University of British Columbia, Vancouver, BC, Canada
| | | | - Lisa Liu
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Wenxue Ge
- BC Centre for Disease Control, Vancouver, BC, Canada
| | | | - Daniel Coombs
- Mathematics Department, University of British Columbia, Vancouver, BC, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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12
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Zahan R, Osgood ND, Plouffe R, Orpana H. A Dynamic Model of Opioid Overdose Deaths in Canada during the Co-Occurring Opioid Overdose Crisis and COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:442. [PMID: 38673354 PMCID: PMC11050073 DOI: 10.3390/ijerph21040442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/23/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
With over 40,000 opioid-related overdose deaths between January 2016 and June 2023, the opioid-overdose crisis is a significant public health concern for Canada. The opioid crisis arose from a complex system involving prescription opioid use, the use of prescription opioids not as prescribed, and non-medical opioid use. The increasing presence of fentanyl and its analogues in the illegal drugs supply has been an important driver of the crisis. In response to the overdose crisis, governments at the municipal, provincial/territorial, and federal levels have increased actions to address opioid-related harms. At the onset of the COVID-19 pandemic, concerns emerged over how the pandemic context may impact the opioid overdose crisis. Using evidence from a number of sources, we developed a dynamic mathematical model of opioid overdose death to simulate possible trajectories of overdose deaths during the COVID-19 pandemic. This model incorporates information on prescription opioid use, opioid use not as prescribed, non-medical opioid use, the level of fentanyl in the drug supply, and a measure of the proportion deaths preventable by new interventions. The simulated scenarios provided decision makers with insight into possible trajectories of the opioid crisis in Canada during the COVID-19 pandemic, highlighting the potential of the crisis to take a turn for the worse under certain assumptions, and thus, informing planning during a period when surveillance data were not yet available. This model provides a starting point for future models, and through its development, we have identified important data and evidence gaps that need to be filled in order to inform future action.
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Affiliation(s)
- Rifat Zahan
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada; (R.Z.); (N.D.O.)
| | - Nathaniel D. Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada; (R.Z.); (N.D.O.)
| | - Rebecca Plouffe
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada;
| | - Heather Orpana
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada;
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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13
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Khorassani F, Espejo G. Evaluation of the Impact of Pharmacist-Driven Physician Naloxone Training on an Inpatient Psychiatric Unit. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:148-152. [PMID: 38279070 DOI: 10.1007/s40596-024-01934-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/02/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of pharmacist-driven naloxone training of resident physicians as part of discharge prescribing from an inpatient psychiatric unit. METHODS This is a prospective pilot study in which psychiatric resident physicians (N = 21) were educated on naloxone administration, prescribing, and counseling. A ten-question survey was designed and delivered immediately pre- and post-training to assess resident knowledge of and comfort with naloxone prescribing. Respondents were asked to rate ten statements on a scale from 1 to 5, with 1 corresponding to "strongly disagree" and 5 corresponding to "strongly agree." The primary objective was to evaluate the impact of training on prescriber knowledge and attitudes using the designed questionnaire. The secondary objective was to assess the difference in naloxone prescribing pre- and post-training implementation. Descriptive statistics and paired t-tests were conducted to assess statistical significance. RESULTS Prior to training, 11 resident physicians (approximately 50%) agreed or strongly agreed that they felt knowledgeable about naloxone and approximately 70% (n = 15) felt confident identifying patients who would benefit from naloxone at discharge. Only 10% of resident physicians (n = 2) felt comfortable counseling patients on and administering naloxone during an overdose pre-training compared to 100% after training. Thirty-seven patients were discharged and counseled on naloxone use during the study period. CONCLUSION Pharmacist-driven naloxone training significantly increased physician knowledge and comfort prescribing naloxone and resulted in an increase in naloxone prescriptions upon discharge from an inpatient psychiatric unit.
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Affiliation(s)
- Farah Khorassani
- University of California Irvine School of Pharmacy and Pharmaceutical Sciences, Irvine, CA, USA.
| | - Gemma Espejo
- University of California Irvine School of Medicine, Irvine, CA, USA
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14
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Taha S, King S, Atif S, Bate E. Changes in harm reduction service providers professional quality of life during dual public health emergencies in Canada. Harm Reduct J 2024; 21:48. [PMID: 38388932 PMCID: PMC10882723 DOI: 10.1186/s12954-024-00966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/20/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Harm reduction (HR) is a critical response to the pronounced toxicity deaths being experienced in Canada. HR providers report many benefits of their jobs, but also encounter chronic stress from structural inequities and exposure to trauma and death. This research study sought to quantify the emotional toll the toxicity emergency placed on HR providers (Cycle One; 2019). Study objectives were later expanded to determine the impact of the ongoing toxicity as well as the pandemic's impact on well-being (Cycle Two; 2021). METHODS Standardized measures of job satisfaction, burnout, secondary traumatic stress, and vulnerability to grief were used in an online national survey. Open-ended questions addressed resources and supports. HR partners across Canada validated the findings and contributed to alternative interpretations and implications. RESULTS 651 respondents in Cycle One and 1,360 in Cycle Two reported moderately high levels of job satisfaction; they reported finding great meaning in their work. Yet, mean levels of burnout and secondary traumatic stress were moderate, with the latter significantly increasing in Cycle Two. Reported vulnerability to grief was moderate but increased significantly during COVID. When available, supports lacked the quality necessary to respond to the complexities of HR workers' experiences, or an insufficient number of sessions were covered through benefits. Respondents shared that their professional quality of life was affected more by policy failures and gaps in the healthcare system than it was by the demands of their jobs. CONCLUSION Both the benefits and the strain of providing harm reduction services cannot be underestimated. For HR providers, these impacts are compounded by the drug toxicity emergency, making the service gaps experienced by them all the more critical to address. Implications highlight the need for integration of HR into the healthcare system, sustainable and reliable funding, sufficient counselling supports, and equitable staffing models. Support for this essential workforce is critical to ensuring the well-being of themselves, the individuals they serve, and the health of the broader healthcare system.
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Affiliation(s)
- Sheena Taha
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada.
| | - Samantha King
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada
| | - Sara Atif
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada
| | - Eliza Bate
- Canadian Centre on Substance Use and Addiction, 75 Albert St, Ottawa, ON, K1P 5E7, Canada
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15
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Moe J, Chavez T, Marr C, Cameron F, Feldman-Kiss D, Wang YE, Xavier JC, Mamdani Z, Purssell RA, Salmon A, Buxton JA. Feeling safer: effectiveness, feasibility, and acceptability of continuous pulse oximetry for people who smoke opioids at overdose prevention services in British Columbia, Canada. Harm Reduct J 2024; 21:45. [PMID: 38378610 PMCID: PMC10877878 DOI: 10.1186/s12954-024-00963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Smoking is the most common mode of unregulated opioid consumption overall and implicated in fatal overdoses in British Columbia (BC). In part, perception of decreased risk (e.g., fewer who smoke carry naloxone kits) and limited smoking-specific harm reduction services contribute to overdose deaths. Overdose prevention services (OPS) offer supervised settings for drug use. Continuous pulse oximetry, common in acute care, allows real-time, remote oxygen monitoring. We evaluated the effectiveness of a novel continuous pulse oximetry protocol aimed at allowing physical distancing (as required by COVID-19, secluded spaces, and to avoid staff exposure to vaporized opioids), its feasibility, and acceptability at OPS for people who smoke opioids. METHODS This was a mixed methods survey study. We developed a continuous pulse oximetry protocol in collaboration with clinical experts and people with lived/living experience of substance use. We implemented our protocol from March to August 2021 at four OPS in BC permitting smoking. We included adults (≥ 18 years) presenting to OPS to smoke opioids. Peer researchers collected demographic, health, and substance use information, and conducted structured observations. OPS clients participating in our study, OPS staff, and peer researchers completed post-monitoring surveys. We analyzed responses using a thematic inductive approach and validated themes with peer researchers. RESULTS We included 599 smoking events. OPS clients participating in our study had a mean age of 38.5 years; 73% were male. Most (98%) reported using "down", heroin, or fentanyl; 48% concurrently used other substances (32% of whom reported stimulants); 76% reported smoking alone in the last 3 days; and 36% reported an overdose while smoking. Respondents reported that the protocol facilitated physical distancing, was easy to use, high satisfaction, improved confidence, improved sense of safety, and that they would use it again. CONCLUSIONS Continuous pulse oximetry allowed safe physical distancing, was feasible, and acceptable in monitoring people who smoke opioids at OPS.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, Diamond Health Care Centre, University of British Columbia, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- BC Centre for Disease Control, 655 West 12 Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Tamara Chavez
- CoVaRR-Net's Indigenous Engagement, Development, and Research Pillar 7, University of British Columbia, 103-1690 Nelson Street, Vancouver, BC, V6G 1M5, Canada
| | - Charotte Marr
- Portland Hotel Society, 9 East Hastings Street, Vancouver, BC, V6A 1M9, Canada
| | - Fred Cameron
- SOLID Outreach Society, 1056 North Park Street, Victoria, BC, V8T 1C6, Canada
| | - Damian Feldman-Kiss
- Department of Emergency Medicine, Diamond Health Care Centre, University of British Columbia, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Yueqiao Elle Wang
- Department of Emergency Medicine, Diamond Health Care Centre, University of British Columbia, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jessica C Xavier
- BC Centre for Disease Control, 655 West 12 Avenue, Vancouver, BC, V5Z 4R4, Canada
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Zahra Mamdani
- BC Children's and Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Roy A Purssell
- Department of Emergency Medicine, Diamond Health Care Centre, University of British Columbia, 11 Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- BC Centre for Disease Control, 655 West 12 Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Amy Salmon
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- School of Population of Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z8, Canada
| | - Jane A Buxton
- BC Centre for Disease Control, 655 West 12 Avenue, Vancouver, BC, V5Z 4R4, Canada
- School of Population of Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z8, Canada
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16
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Fleming T, Boyd J, Chayama KL, Knight KR, McNeil R. Using alone at home: What's missing in housing-based responses to the overdose crisis? Harm Reduct J 2024; 21:24. [PMID: 38281992 PMCID: PMC10823649 DOI: 10.1186/s12954-024-00933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Against the backdrop of North America's overdose crisis, most overdose deaths are occurring in housing environments, largely due to individuals using drugs alone. Overdose deaths in cities remain concentrated in marginal housing environments (e.g., single-room occupancy housing, shelters), which are often the only forms of housing available to urban poor and drug-using communities. This commentary aims to highlight current housing-based overdose prevention interventions and to situate them within the broader environmental contexts of marginal housing. In doing so, we call attention to the need to better understand marginal housing as sites of overdose vulnerability and public health intervention to optimize responses to the overdose crisis. HARM REDUCTION AND OVERDOSE PREVENTION IN HOUSING In response to high overdose rates in marginal housing environments several interventions (e.g., housing-based supervised consumption rooms, peer-witnessed injection) have recently been implemented in select jurisdictions. However, even with the growing recognition of marginal housing as a key intervention site, housing-based interventions have yet to be scaled up in a meaningful way. Further, there have been persistent challenges to tailoring these approaches to address dynamics within housing environments. Thus, while it is critical to expand coverage of housing-based interventions across marginal housing environments, these interventions must also attend to the contextual drivers of risks in these settings to best foster enabling environments for harm reduction and maximize impacts. CONCLUSION Emerging housing-focused interventions are designed to address key drivers of overdose risk (e.g., using alone, toxic drug supply). Yet, broader contextual factors (e.g., drug criminalization, housing quality, gender) are equally critical factors that shape how structurally vulnerable people who use drugs navigate and engage with harm reduction interventions. A more comprehensive understanding of these contextual factors within housing environments is needed to inform policy and programmatic interventions that are responsive to the needs of people who use drugs in these settings.
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Affiliation(s)
- Taylor Fleming
- British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Jade Boyd
- British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Koharu Loulou Chayama
- British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Kelly R Knight
- Department of Humanities and Social Sciences, School of Medicine, University of California San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA, 94143-0850, USA
| | - Ryan McNeil
- British Columbia Centre On Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, 10001, USA.
- Program in Addiction Medicine, Yale School of Medicine, 367 Cedar Street, New Haven, CT, 10001, USA.
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17
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Kennedy MC, Dong H, Tobias S, Buxton JA, Lysyshyn M, Tupper KW, Ti L. Fentanyl Concentration in Drug Checking Samples and Risk of Overdose Death in Vancouver, Canada. Am J Prev Med 2024; 66:10-17. [PMID: 37633426 DOI: 10.1016/j.amepre.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION The proliferation of fentanyl and its analogs in illegal, unregulated drug markets remains a major driver of the overdose crisis in North America. Drug checking services have been implemented as a harm reduction strategy to address the crisis. However, little is known about their potential utility as a mechanism for monitoring population-level risk of overdose stemming from changing fentanyl concentration in unregulated drugs over time. Therefore, this study assessed the relationship between median fentanyl concentration in expected opioid drug checking samples and the death rate due to illicit drug toxicity over time in Vancouver, Canada. METHODS Monthly population-based rates of death due to illicit drug toxicity were drawn from provincial coroner records. Monthly median percent fentanyl concentration was calculated using a validated quantification model from point-of-care Fourier-transform infrared spectra among expected opioid samples that tested positive for fentanyl at community drug checking services. A time-series analysis using generalized additive modeling was conducted to examine the association between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, controlling for calendar month. Analyses were conducted in 2021-2022. RESULTS Between January 2019 and October 2020, 577 deaths due to illicit drug toxicity occurred in Vancouver, and the observed monthly rate ranged from 1.75 to 7.65 deaths per 100,000 population. A significant, positive association was observed between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, adjusting for calendar month (chi-square=52.21, p<0.001). CONCLUSIONS Findings suggest a role for point-of-care drug checking as a tool for monitoring evolving overdose risk at the population level.
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Affiliation(s)
- Mary Clare Kennedy
- School of Social Work, Faculty of Health and Social Development, The University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada; British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
| | - Huiru Dong
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel Tobias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane A Buxton
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Lysyshyn
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Kenneth W Tupper
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; School of Child and Youth Care, Faculty of Human and Social Development, University of Victoria, Victoria, British Columbia, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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18
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Ferguson M, Choisil P, Lamb J, Burmeister C, Newman C, Lock K, Tobias S, Liu L, Buxton JA. Associations with experience of non-fatal opioid overdose in British Columbia, Canada: a repeated cross sectional survey study. Harm Reduct J 2023; 20:178. [PMID: 38093272 PMCID: PMC10717189 DOI: 10.1186/s12954-023-00912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Max Ferguson
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Paul Choisil
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jessica Lamb
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | | | - Cheri Newman
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Kurt Lock
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Samuel Tobias
- British Centre on Substance Use, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lisa Liu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jane A Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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Salvalaggio G, Brooks H, Caine V, Gagnon M, Godley J, Houston S, Kennedy MC, Kosteniuk B, Livingston J, Saah R, Speed K, Urbanoski K, Werb D, Hyshka E. Flawed reports can harm: the case of supervised consumption services in Alberta. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:928-933. [PMID: 37930628 PMCID: PMC10661131 DOI: 10.17269/s41997-023-00825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
Supervised consumption services have been scaled up within Canada and internationally as an ethical imperative in the context of a public health emergency. A large body of peer-reviewed evidence demonstrates that these services prevent poisoning deaths, reduce infectious disease transmission risk behaviour, and facilitate clients' connections to other health and social services. In 2019, the Alberta government commissioned a review of the socioeconomic impacts of seven supervised consumption services in the province. The report is formatted to appear as an objective, scientifically credible evaluation of these services; however, it is fundamentally methodologically flawed, with a high risk of biases that critically undermine its authors' assessment of the scientific evidence. The report's findings have been used to justify decisions that jeopardize the health and well-being of people who use drugs both in Canada and internationally. Governments must ensure that future assessments of supervised consumption services and other public health measures to address drug poisoning deaths are scientifically sound and methodologically rigorous. Health policy must be based on the best available evidence, protect the right of structurally vulnerable populations to access healthcare, and not be contingent on favourable public opinion or prevailing political ideology.
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Affiliation(s)
- Ginetta Salvalaggio
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Hannah Brooks
- School of Public Health, University of Alberta, Nashville, TN, USA
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Marilou Gagnon
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Jenny Godley
- Department of Sociology, University of Calgary, Calgary, AB, Canada
| | - Stan Houston
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mary Clare Kennedy
- British Columbia Centre On Substance Use, University of British Columbia - Okanagan School of Social Work, Vancouver, BC, Canada
| | - Brynn Kosteniuk
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jamie Livingston
- Department of Criminology, Saint Mary's University, Halifax, NS, Canada
| | - Rebecca Saah
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kelsey Speed
- School of Public Health, University of Alberta, Vancouver, BC, Canada
| | - Karen Urbanoski
- School of Public Health & Social Policy, University of Victoria, Victoria, BC, Canada
| | - Dan Werb
- Centre On Drug Policy Evaluation, MAP Centre On Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Division of Infectious Disease & Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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20
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Knudsen HK, Freeman PR, Oyler DR, Oser CB, Walsh SL. Scaling up overdose education and naloxone distribution in Kentucky: adoption and reach achieved through a "hub with many spokes" model. Addict Sci Clin Pract 2023; 18:72. [PMID: 38031180 PMCID: PMC10688494 DOI: 10.1186/s13722-023-00426-6] [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] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Scaling up overdose education and naloxone distribution (OEND), an evidence-based practice for reducing opioid overdose mortality, in communities remains a challenge. Novel models and intentional implementation strategies are needed. Drawing upon the EPIS model's phases of Exploration, Preparation, Implementation, and Sustainment (Aarons et al. in Adm Policy Ment Health 38:4-23, 2011), this paper describes the development of the University of Kentucky's unique centralized "Naloxone Hub with Many Spokes" approach to implementing OEND as part of the HEALing Communities Study (HCS-KY). METHODS To scale up OEND in eight Kentucky counties, implementation strategies were utilized at two levels: a centralized university-based naloxone dispensing unit ("Naloxone Hub") and adopting organizations ("Many Spokes"). Implementation strategies varied across the EPIS phases, but heavily emphasized implementation facilitation. The Naloxone Hub provided technical assistance, overdose education resources, and no-cost naloxone to partner organizations. Implementation outcomes across the EPIS phases were measured using data from internal study management trackers and naloxone distribution data submitted by partner organizations. RESULTS Of 209 organizations identified as potential partners, 84.7% (n = 177) engaged in the Exploration/Preparation phase by participating in an initial meeting with an Implementation Facilitator about the HCS-KY OEND program. Adoption of the HCS-KY OEND program, defined as receipt of at least one shipment of naloxone, was achieved with 69.4% (n = 145) of all organizations contacted. During the Implementation phase, partner organizations distributed 40,822 units of naloxone, with partner organizations distributing a mean of 281.5 units of naloxone (SD = 806.2). The mean number of units distributed per county was 5102.8 (SD = 3653.3; range = 1057 - 11,053) and the mean county level distribution rate was 8396.5 units per 100,000 residents (SD = 8103.1; range = 1709.5-25,296.3). Of the partner organizations that adopted the HCS-KY OEND program, 87.6% (n = 127) attended a sustainability meeting with an Implementation Facilitator and agreed to transition to the state-funded naloxone program. CONCLUSIONS These data demonstrate the feasibility of this "Hub with Many Spokes" model for scaling up OEND in communities highly affected by the opioid epidemic. Trial registration ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https://clinicaltrials.gov/ct2/show/NCT04111939 .
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Affiliation(s)
- Hannah K Knudsen
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA.
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science and Center for the Advancement of Pharmacy Practice, College of Pharmacy, University of Kentucky, Lexington, KY, 40536, USA
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, 40536, USA
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, and Center for Health Equity Transformation, University of Kentucky, Lexington, KY, 40536, USA
| | - Sharon L Walsh
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA
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Morris H, Wild TC, Giovannoni M, Haines-Saah R, Koziel J, Schulz P, Bwala H, Kunyk D, Bubela T, Hyshka E. Canadian newspaper coverage on harm reduction featuring bereaved mothers: A mixed methods analysis. PLoS One 2023; 18:e0294608. [PMID: 38011175 PMCID: PMC10681218 DOI: 10.1371/journal.pone.0294608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
A growing body of evidence suggests that news media which includes a sympathetic portrayal of a mother bereaved by substance use can increase public support for harm reduction initiatives. However, the extent to which such news media coverage occurs in Canada is unknown, and research has not documented how the news media in Canada covers such stories. We undertook a mixed-method secondary analyses of 5681 Canadian newspaper articles on harm reduction (2000-2016). Quantitative analyses described the volume and content of harm reduction reporting featuring a mother whose child's death was related to substance use while qualitative thematic analysis provided in-depth descriptions of the discourses underlying such news reporting. Newspaper articles featuring a mother whose child's death was related to substance use were rarely published (n = 63; 1.1% of total harm reduction media coverage during the study period). Deductive content analysis of these 63 texts revealed that coverage of naloxone distribution (42.9%) and supervised drug consumption services (28.6%) were prioritized over other harm reduction services. Although harm reduction (services or policies) were advocated by the mother in most (77.8%) of these 63 texts, inductive thematic analysis of a subset (n = 52) of those articles revealed that mothers' advocacy was diminished by newspaper reporting that emphasized their experiences of grief, prioritized individual biographies over structural factors contributing to substance use harms, and created rhetorical divisions between different groups of people who use drugs (PWUD). Bereaved mothers' advocacy in support of harm reduction programs and services may be minimized in the process of reporting their stories for newspaper readers. Finding ways to report bereaved mothers' stories in ways that are inclusive of all PWUD while highlighting the role of broad, structural determinants of substance use has the potential to shift public opinion and government support in favour of these life-saving services.
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Affiliation(s)
- Heather Morris
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), University of Alberta, Edmonton, AB, Canada
| | - T. Cameron Wild
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Marina Giovannoni
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rebecca Haines-Saah
- Cummings School of Medicine, University of Calgary, Calgary , Alberta, Canada
| | | | - Petra Schulz
- Moms Stop the Harm, RPO Broadmead, Victoria, BC, Canada
| | - Hauwa Bwala
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Diane Kunyk
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), University of Alberta, Edmonton, AB, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Elaine Hyshka
- School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
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22
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Schmidt RA, Kaminski N, Kryszajtys DT, Rudzinski K, Perri M, Guta A, Benoit AC, Bayoumi AM, Challacombe L, Hales J, Kenny K, Kolla G, O'Reilly E, Sereda A, Rai N, Strike C. '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 Alcohol Rev 2023; 42:1825-1837. [PMID: 37718646 DOI: 10.1111/dar.13745] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023]
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 opioid drug supply comprised primarily of fentanyl. The Canadian government has recently funded safer opioid supply (SOS) programs, which include off-label prescriptions of pharmaceutical-grade opioids to high risk individuals with the goal of reducing overdose deaths. METHODS In 2021, we examined the implementation and adaption of four SOS programs in Ontario. These programs use a primary care model and serve communities experiencing marginalisation. We conducted semi-structured interviews with program clients. We present the results of a thematic analysis with the aim of describing clients' self-reported impact of these programs on their health and well-being. RESULTS We interviewed 52 clients between June and October 2021 (mean age 47 years, 56% men, 17% self-identified Indigenous, 14% living with HIV). Our results indicate multifaceted pathways to improved self-reported health and well-being among clients including changes to drug use practices, fewer overdoses, reduced criminalised activity, improved trust and engagement in health care, and increased social stability (e.g., housing). DISCUSSION AND CONCLUSION Most clients reported that the intervention saved their life because of the reduced frequency of overdoses. Findings suggest that SOS programs improved clients' health outcomes and increase opportunities for engagement in health services. Our results provide insight into the mechanisms behind some of the emergent evidence on the impact of safer supply prescribing.
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Affiliation(s)
- Rose A Schmidt
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Nat Kaminski
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David T Kryszajtys
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- School of Social Work, University of Windsor, Windsor, Canada
| | - Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Canada
| | - Anita C Benoit
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Ahmed M Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | | | - Jessica Hales
- Regent Park Community Health Centre, Toronto, Canada
| | - Kathleen Kenny
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Emmet O'Reilly
- South Riverdale Community Health Centre, Toronto, Canada
| | | | - Nanky Rai
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Parkdale Queen West Community Health Centre, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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23
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Rioux W, Enns B, Ghosh SM. Virtual overdose monitoring services/mobile overdose response services: estimated number of potentially averted drug poisoning fatality events by various telephone and digital-based overdose prevention/harm reduction services in North America. Front Public Health 2023; 11:1242795. [PMID: 37927877 PMCID: PMC10622778 DOI: 10.3389/fpubh.2023.1242795] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Background Virtual overdose monitoring services or Mobile Overdose Response Services (MORS) are novel virtual harm reduction tools which have gained popularity as an adjunct public health intervention especially for those who cannot access harm reduction resources through traditional means. At this time, relatively little is known about their ability to reach their goals of reducing overdose mortality. Our study aims to summarize the potential effectiveness of various MORS collectively to avoid potential mortality from a drug poisoning event/drug overdose. Methods Utilizing publicly available data from various MORS alongside some usage data provided by these services for this study, we model the impact of these services on fatal drug poisoning/overdose. In order to calculate the number of deaths averted, a Monte Carlo simulation was used to calculate point estimates with 95% confidence for fatal drug poisonings/drug overdose potentially averted through the utilization of various MORS. Results From the earliest mention of MORS in current literature (2019), a total of 299 drug poisoning/overdose events occurred across these services. Noting the broad range of mortality statistics available in current literature, these technologies have potentially prevented between 33 to 243 deaths. Our Monte Carlo estimates 135 potentially fatal drug poisonings/overdose were overall averted by the various MORS. Conclusions While there is yet to be a robust data set proving the effectiveness of these services, conservative estimates show that MORS can reduce mortality associated with substance use and therefore should be considered as a viable harm-reduction strategy but as an adjunct to more established harm reduction services such as supervised consumption sites and supervised injection facilities. While more research is needed, clinicians and practitioners should consider the suggestion of these tools for patients who use drugs.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Benjamin Enns
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - S. Monty Ghosh
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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24
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Rioux W, Enns B, Jackson J, Quereshi H, Irvine M, Ghosh SM. A cost benefit analysis of a virtual overdose monitoring service/mobile overdose response service: the national overdose response service. Subst Abuse Treat Prev Policy 2023; 18:57. [PMID: 37794482 PMCID: PMC10548617 DOI: 10.1186/s13011-023-00565-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The overdose crisis continues across Canada which calls for novel harm reduction strategies. Previous research indicates that a majority of eHealth solutions are cost-effective however current literature on the cost-benefit of eHealth for harm reduction is sparse. The National Overdose Response Service (NORS) is a Canada-wide telephone-based harm reduction service. Service users can call the phone number and connect to a peer who can virtually monitor the substance use session and dispatch appropriate interventions in the case of overdose. OBJECTIVES OF THE RESEARCH/PROJECT We aim to assess the cost-benefit of NORS by comparing the estimated cost-savings from prevented overdose mortality to the operating costs of the program, alongside healthcare costs associated with its operation. METHODS Data around systems costs and operational costs were gathered for our calculations. Our primary outcome was cost-benefit ratios, derived from estimates and models of mortality rates in current literature and value of life lost. We presented our main results across a range of values for costs and the probability of death following an unwitnessed overdose. These values were utilized to calculate cost-benefit ratios and value per dollar spent on service provision by NORS over the length of the program's operation (December 2020-2022). RESULTS Over the total funded lifespan of the program, and using a Monte Carlo estimate, the benefit-to-cost ratio of the NORS program was 8.59 (1.53-15.28) per dollar spent, depending on estimated mortality rates following unwitnessed overdose and program operation costs. Further, we conservatively estimate that early community-based naloxone intervention results in healthcare system savings of $4470.82 per overdose response. CONCLUSIONS We found the NORS program to have a positive benefit-to-cost ratio when the probability of death following an unwitnessed overdose was greater than 5%. NORS and potentially other virtual overdose monitoring services have the potential to be cost-effective solutions for managing the drug poisoning crisis.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Benjamin Enns
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | | | - Hena Quereshi
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mike Irvine
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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25
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Ferguson M, Rittenbach K, Leece P, Adams A, Ali F, Elton-Marshall T, Burmeister C, Brothers TD, Medley A, Choisil P, Strike C, Ng J, Lorenzetti DL, Gallant K, Buxton JA. Document d’orientation sur la distribution et l’utilisation de trousses de naloxone à emporter par les intervenants et intervenantes communautaires en cas de surdose au Canada. CMAJ 2023; 195:E1312-E1325. [PMID: 37788838 PMCID: PMC10637331 DOI: 10.1503/cmaj.230128-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Affiliation(s)
- Max Ferguson
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Katherine Rittenbach
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Pamela Leece
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Alison Adams
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Farihah Ali
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Tara Elton-Marshall
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Charlene Burmeister
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Thomas D Brothers
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Andrea Medley
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Paul Choisil
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Carol Strike
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Justin Ng
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Diane L Lorenzetti
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Kat Gallant
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B
| | - Jane A Buxton
- Centre de contrôle des maladies de la Colombie-Britannique (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, C.-B.; Département de psychiatrie (Rittenbach), Université de Calgary, Calgary, Alb.; Département de psychiatrie (Rittenbach), Université de l'Alberta, Edmonton, Alb.; Santé publique Ontario (Leece); École Dalla Lana de santé publique (Leece, Elton-Marshall, Strike) et Département de médecine familiale et communautaire (Leece), Université de Toronto; Institut de recherche sur les politiques de santé mentale (Ali, Elton-Marshall), Centre de toxicomanie et de santé mentale, Toronto, Ont.; École d'épidémiologie et de santé publique (Elton-Marshall), Université d'Ottawa, Ottawa, Ont.; Département de médecine (Brothers), Université Dalhousie, Halifax, N.-É.; Centre collaboratif pour la santé inclusive UCL (Brothers), Collège universitaire de Londres, Londres, Royaume-Uni; Centre de santé des Autochtones (Medley), École de santé publique Johns Hopkins Bloomberg, Baltimore, Md.; Programme d'interventions d'urgence en cas de surdose et de toxicomanie (Medley), Régie de la santé du littoral de Vancouver, Vancouver, C.-B.; Bibliothèque des sciences de la santé (Lorenzetti), Université de Calgary; Département des sciences de la santé communautaire (Lorenzetti), École de médecine Cumming, Université de Calgary; Institut O'Brien de santé publique (Lorenzetti), Université de Calgary, Calgary, Alb.; Centre de traitement de la toxicomanie de la Colombie-Britannique (Gallant); École de santé des populations et de santé publique (Buxton), Université de Colombie-Britannique, Vancouver, C.-B.
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Olding M, Boyd J, Kerr T, McNeil R. "We just don't have the space for it": Geographies of survival and spatial triage in overdose prevention sites. Health Place 2023; 83:103067. [PMID: 37352615 PMCID: PMC10589902 DOI: 10.1016/j.healthplace.2023.103067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/22/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
This study explores the role of Overdose Prevention Sites (OPS) within the geographies of survival of vulnerably housed people who use drugs (PWUD) in Vancouver, British Columbia (BC), Canada. In BC, OPS are low-barrier spaces where people may use drugs under monitoring of trained staff. OPS have been established by people who use drugs, activists, and allied organizations as an emergency measure to prevent overdose deaths. However, OPS have other important uses for PWUD who are vulnerably housed and rely on public spaces for survival. Drawing on two years (2018-2020) of ethnographic fieldwork and interviews with fifty-five people who work at and/or use OPS, we explore how OPS operators negotiated multiple and at times competing uses of service space for everyday survival. Data analysis was guided by critical urban theory to explore the place of OPS within PWUD's geographies of survival, with attention to how different uses of space were negotiated within the context of an illicit drug poisoning crisis and urban control practices that displace and exclude unhoused and vulnerably housed PWUD from the city. We find that OPS accommodated other important potential uses of space for unhoused and vulnerably housed PWUD who relied on public space for survival and were routinely displaced by revanchist urban control strategies. Low-barrier approaches and facility enhancements to OPS improved program accessibility and enabled PWUD to use the sites more broadly to meet survival needs including for mutual-aid, sheltering, and income-generation. However, these secondary uses of OPS presented multiple operational challenges as service volumes increased. We observed processes of 'spatial triage' emerge within sites to manage these challenges, which we characterise as a pragmatic set of rules, procedures, and spatial practices that constrained broader uses of OPS within PWUD's geographies of survival. While spatial triage offered a pragmatic way of prioritizing service delivery to address the most acute survival threats of overdose fatality, these practices had unintended and inequitable impacts on service access. Our findings indicate the need for complementary structural changes as part of overdose responses to reduce the need for spatial triage (i.e., safe, affordable housing and drug decriminalisation) and service innovations to mitigate potential harms (e.g., Expanded drop-in and chill spaces, temporary storage spaces for service user).
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Affiliation(s)
- Michelle Olding
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Dalla Lana School of Public Health, 155 College Street, Toronto, ON, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 1Y6, Canada; Yale School of Medicine, New Haven, CT, USA.
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Mitra S, Choi J, van Draanen J, Kerr T, Gilbert M, Hayashi K, Milloy MJ, Johnson C, Richardson L. Socioeconomic marginalization and risk of overdose in a community-recruited cohort of people who use drugs: A longitudinal analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104117. [PMID: 37453374 PMCID: PMC10842635 DOI: 10.1016/j.drugpo.2023.104117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Poverty and socioeconomic disadvantage are important contributors to drug-related harm, but their precise role in overdose risk remains poorly understood. We sought to examine linkages between socioeconomic marginalization and non-fatal overdose risk in a community deeply affected by the ongoing drug poisoning crisis. METHODS This observational study used data derived from two community-recruited prospective cohorts of people who use drugs (PWUD) in Vancouver, British Columbia, Canada. Generalized linear mixed-effects models were used to assess longitudinal associations between multiple dimensions of socioeconomic disadvantage and self-reported non-fatal overdose. RESULTS Between 2014 and 2020, 1,493 participants (38.2% women; 59.6% white; 35.7% Indigenous) provided 9,968 interviews. Non-fatal overdose was reported by 32.5% of participants over the study period. In multivariable analyses, non-fatal overdose was independently associated with incarceration (adjusted odds ratios [AOR]: 1.42, 95% confidence interval [CI]: 1.08-1.88, p=0.012), homelessness (AOR: 1.57, 95%CI: 1.27-1.93, p<0.001), increased monthly income (AOR: 1.01, 95%CI: 1.00-1.01, p=0.029), and lower material security (AOR: 0.76, 95%CI: 0.67-0.88, p<0.001). We also observed differing strengths of association between illegal income generation and overdose in men (AOR: 1.84, 95%CI: 1.46-2.32, p<0.001) compared to women (AOR: 1.37, 95%CI: 1.06-1.78, p=0.016). CONCLUSION Non-fatal overdose was positively associated with incarceration, homelessness, higher monthly income, material insecurity, and engagement illegal income generating activities, underscoring the importance of addressing the socioeconomic production of overdose risk. These initiatives may include supportive housing interventions, alternative economic supports, and broader drug policy reform.
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Affiliation(s)
- Sanjana Mitra
- Interdisciplinary Graduate Studies Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC V6T 1Z4, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - JinCheol Choi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Jenna van Draanen
- School of Nursing, Department of Child, Family, and Population Health Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7263, USA
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada; British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, 8888 University Drive, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - M J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Cheyenne Johnson
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC V6T 1Z1, Canada.
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Ferguson M, Rittenbach K, Leece P, Adams A, Ali F, Elton-Marshall T, Burmeister C, Brothers TD, Medley A, Choisil P, Strike C, Ng J, Lorenzetti DL, Gallant K, Buxton JA. Guidance on take-home naloxone distribution and use by community overdose responders in Canada. CMAJ 2023; 195:E1112-E1123. [PMID: 37640401 PMCID: PMC10462409 DOI: 10.1503/cmaj.230128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The increasing toxicity of opioids in the unregulated drug market has led to escalating numbers of overdoses in Canada and worldwide; takehome naloxone (THN) is an evidence-based intervention that distributes kits containing naloxone to people in the community who may witness an overdose. The purpose of this guidance is to provide policy recommendations for territorial, provincial and federal THN programs, using evidence from scientific and grey literature and community evidence that reflects 11 years of THN distribution in Canada. METHODS The Naloxone Guidance Development Group - a multidisciplinary team including people with lived and living experience and expertise of drug use - used the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument to inform development of this guidance. We considered published evidence identified through systematic reviews of all literature types, along with community evidence and expertise, to generate recommendations between December 2021 and September 2022. We solicited feedback on preliminary recommendations through an External Review Committee and a public input process. The project was funded by the Canadian Institutes of Health Research through the Canadian Research Initiative in Substance Misuse. We used the Guideline International Network principles for managing competing interests. RECOMMENDATIONS Existing evidence from the literature on THN was of low quality. We incorporated evidence from scientific and grey literature, and community expertise to develop our recommendations. These were in 3 areas: routes of naloxone administration, THN kit contents and overdose response. Take-home naloxone programs should offer the choice of both intramuscular and intranasal formulations of naloxone in THN kits. Recommended kit contents include naloxone, a naloxone delivery device, personal protective equipment, instructions and a carrying case. Trained community overdose responders should prioritize rescue breathing in the case of respiratory depression, and conventional cardiopulmonary resuscitation in the case of cardiac arrest, among other interventions. INTERPRETATION This guidance development project provides direction for THN programs in Canada in the context of limited published evidence, with recommendations developed in collaboration with diverse stakeholders.
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Affiliation(s)
- Max Ferguson
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Katherine Rittenbach
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Pamela Leece
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Alison Adams
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Farihah Ali
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Tara Elton-Marshall
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Charlene Burmeister
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Thomas D Brothers
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Andrea Medley
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Paul Choisil
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Carol Strike
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Justin Ng
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Diane L Lorenzetti
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Kat Gallant
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
| | - Jane A Buxton
- BC Centre for Disease Control (Ferguson, Adams, Burmeister, Choisil, Ng, Buxton), Vancouver, BC; Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Public Health Ontario (PHO) (Leece); Dalla Lana School of Public Health (Leece, Elton-Marshall, Strike) and Department of Family and Community Medicine (Leece), University of Toronto; Institute for Mental Health Policy Research (Ali, Elton-Marshall), Centre for Addiction and Mental Health, Toronto, Ont.; School of Epidemiology and Public Health (Elton-Marshall), University of Ottawa, Ottawa, Ont.; Department of Medicine (Brothers), Dalhousie University, Halifax, NS; UCL Collaborative Centre for Inclusion Health (Brothers), University College London, London, UK; Center for Indigenous Health (Medley), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Overdose Emergency Response and Addictions Program (Medley), Vancouver Coastal Health, Vancouver, BC; Health Sciences Library (Lorenzetti), University of Calgary; Department of Community Health Sciences (Lorenzetti), Cumming School of Medicine, University of Calgary; O'Brien Institute for Public Health (Lorenzetti), University of Calgary, Calgary, Alta.; BC Centre on Substance Use (Gallant); School of Population and Public Health (Buxton), University of British Columbia, Vancouver, BC
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Freiermuth CE, Ancona RM, Brown JL, Punches BE, Ryan SA, Ingram T, Lyons MS. Evaluation of a large-scale health department naloxone distribution program: Per capita naloxone distribution and overdose morality. PLoS One 2023; 18:e0289959. [PMID: 37566565 PMCID: PMC10420337 DOI: 10.1371/journal.pone.0289959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES To report per-capita distribution of take-home naloxone to lay bystanders and evaluate changes in opioid overdose mortality in the county over time. METHODS Hamilton County Public Health in southwestern Ohio led the program from Oct 2017-Dec 2019. Analyses included all cartons distributed within Hamilton County or in surrounding counties to people who reported a home address within Hamilton County. Per capita distribution was estimated using publicly available census data. Opioid overdose mortality was compared between the period before (Oct 2015-Sep 2017) and during (Oct 2017-Sep 2019) the program. RESULTS A total of 10,416 cartons were included for analyses, with a total per capita distribution of 1,275 cartons per 100,000 county residents (average annual rate of 588/100,000). Median monthly opioid overdose mortality in the two years before (28 persons, 95% CI 25-31) and during (26, 95% CI 23-28) the program did not differ significantly. CONCLUSIONS Massive and rapid naloxone distribution to lay bystanders is feasible. Even large-scale take-home naloxone distribution may not substantially reduce opioid overdose mortality rates.
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Affiliation(s)
- Caroline E. Freiermuth
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Rachel M. Ancona
- Department of Emergency Medicine, Washington University, St Louis, Missouri, United States of America
| | - Jennifer L. Brown
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Brittany E. Punches
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Shawn A. Ryan
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
- Brightview Health LLC, Cincinnati, Ohio, United States of America
| | - Tim Ingram
- Hamilton County Public Health, Cincinnati, Ohio, United States of America
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Michael S. Lyons
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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Eugenia Socias M, Choi JC, Fairbairn N, Johnson C, Wilson D, Debeck K, Brar R, Hayashi K. Impacts of the COVID-19 pandemic on enrollment in medications for opioid use disorder (MOUD) in Vancouver, Canada: An interrupted time series analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104075. [PMID: 37271070 PMCID: PMC10201318 DOI: 10.1016/j.drugpo.2023.104075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/15/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND In anticipation of COVID-19 related disruptions to opioid use disorder (OUD) care, new provincial and federal guidance for the management of OUD and risk mitigation guidance (RMG) for prescription of pharmaceutical opioids were introduced in British Columbia, Canada, in March 2020. This study evaluated the combined impacts of the COVID-19 pandemic and counteracting OUD policies on enrollment in medications for OUD (MOUD). METHODS Using data from three cohorts of people with presumed OUD in Vancouver, we conducted an interrupted time series analysis to estimate the combined effects impact of the COVID-19 pandemic and counteracting OUD policies on the prevalence of enrollment in MOUD overall, as well as in individual MOUDs (methadone, buprenorphine/naloxone, slow-release oral morphine) between November 2018 and November 2021, controlling for pre-existing trends. In sub-analysis we considered RMG opioids together with MOUD. RESULTS We included 760 participants with presumed OUD. In the post-COVID-19 period, MOUD and slow-release oral morphine prevalence rates showed an estimated immediate increase in level (+7.6%, 95% CI: 0.6%, 14.6% and 1.8%, 95% CI: 0.3%, 3.3%, respectively), followed by a decline in the monthly trend (-0.8% per month, 95% CI: -1.4%, -0.2% and -0.2% per month, 95% CI: -0.4, -0.1, respectively). There were no significant changes in the prevalence trends of enrollment in methadone, buprenorphine/naloxone, or when RMG opioids were considered together with MOUD. CONCLUSIONS Despite immediate improvements in MOUD enrollment in the post-COVID-19 period, this beneficial trend reversed over time. RMG opioids appeared to have provided additional benefits to sustain retention in OUD care.
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Affiliation(s)
- M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - Jin Cheol Choi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Cheyenne Johnson
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall. Vancouver, BC V6T 2B, Canada
| | - Dean Wilson
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Kora Debeck
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Simon Fraser University Faculty of Health Sciences, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Rupinder Brar
- Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada; Regional Addiction Program, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Simon Fraser University Faculty of Health Sciences, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
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Maguet S, Laliberte N, Moore L, Milkovich T, Burmeister C, Scow M, Sproule W, Dove N, Martens S. An evaluation of the Compassion, Inclusion, and Engagement initiative: learning from PWLE and communities across British Columbia. Harm Reduct J 2023; 20:89. [PMID: 37452328 PMCID: PMC10347729 DOI: 10.1186/s12954-023-00819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The Compassion, Inclusion and Engagement initiative (CIE) was a social contact intervention that operated in British Columbia between 2015 and 2021. The primary objective of CIE was to increase the participation of people with lived experience of substance use (PWLE) in the planning, design, implementation, and evaluation of harm reduction supports and services. CASE PRESENTATION CIE used the developmental evaluation methodology outcome mapping to define and measure progress towards its goals. Developmental evaluation emphasizes learning in contrast to other forms of evaluation which are often more focused on determining the value or success of a project or programme based on predetermined criteria. Outcome mapping is a relational practice which acknowledges that change is achieved by an initiative's partners and the role of the initiative is to provide access to resources, ideas and opportunities that can facilitate and support change. CONCLUSIONS Through the implementation and evaluation of CIE, it became clear that directly supporting PWLE facilitated more meaningful and lasting change than solely working to improve the health and social services that supported them. The impacts of the CIE initiative extend far beyond the outcomes of any of the dialogues it facilitated and are largely the result of an increase in social capital. CIE engagements created the opportunity for change by inviting people most affected by the toxic drug supply together with those committed to supporting them, but their ability to bring about systemic change was limited. Both PWLE and service providers noted the lack of support to attend CIE engagements, lack of support for actions that came from those engagements, and lack of PWLE inclusion in decision-making by health authorities as limiting factors for systemic change. The lack of response at a systemic level often resulted in PWLE carrying the burden of responding to toxic drug poisonings, often without resources, support, or compensation.
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Affiliation(s)
- Sally Maguet
- Provincial Health Services Authority, Vancouver, Canada.
| | | | - Laura Moore
- BC Centre for Disease Control, Vancouver, Canada
| | | | | | - Marnie Scow
- BC Centre for Disease Control, Vancouver, Canada
| | | | - Naomi Dove
- BC Centre for Disease Control, Vancouver, Canada
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Trayner K, Yeung A, Sumnall HR, Anderson M, Glancy ME, Atkinson A, Smith M, McAuley A. National increase in the community supply of take-home naloxone associated with a mass media campaign in Scotland: a segmented time series analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104106. [PMID: 37563038 DOI: 10.1016/j.drugpo.2023.104106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Take-home naloxone (THN) programmes have been associated with reductions in opioid-related mortality. In response to high rates of drug-related deaths in Scotland, the Scottish Government commissioned the 'How to save a life' (HTSAL) mass media campaign to: (1) increase awareness of drug-related deaths and how to respond to an overdose, and (2) increase the supply of THN. The aim of this study was to assess the effect of the campaign on the supply of THN. METHODS We used an interrupted time series design to assess the effect of the HTSAL mass media campaign on the national community supply of THN. The study time period was August 2020-December 2021. We modelled two key dates: the start of the campaign (week beginning (w/b) 30th of August 2021) and after the end of the main campaign (w/b 25th of October 2021). RESULTS The total number of THN kits distributed in the community in Scotland during the study period was 27,064. The mean number of THN kits distributed per week (relative to the pre-campaign period), increased by 126% during the campaign and 57% post-campaign. In segmented regression analyses, the pre-campaign trend in the number of THN kits supplied was increasing by an average of 1% each week (RR=1.01, 95% CI 1.01 to 1.01, p<0.001). Once the campaign started, a significant change in level was observed, and the number of kits increased by 75% (RR=1.75, 95% CI 1.29 to 2.40, p<0.001). The trend during the campaign was stable (i.e. not increasing or decreasing) but a significant change in level was observed when the campaign ended, and the number of THN kits supplied decreased by 32% (RR=0.68, 95% CI 0.46 to 0.98, p = 0.042). The trend during the post-campaign period was stable. CONCLUSIONS The HTSAL campaign had a short term, but large and significant impact, on the community supply of THN in Scotland. Mass media campaigns could be combined with other interventions and strategies to maintain the increased uptake of THN outside of campaign periods.
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Affiliation(s)
- Kma Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK.
| | - A Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - H R Sumnall
- Liverpool John Moores University, Liverpool, UK
| | | | - M E Glancy
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - A Atkinson
- Liverpool John Moores University, Liverpool, UK
| | - M Smith
- Public Health Scotland, Glasgow, UK
| | - A McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
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Sumnall HR, Atkinson AM, Anderson M, McAuley A, Trayner K. How to save a life: Public awareness of a national mass media take home naloxone campaign, and effects of exposure to campaign components on overdose knowledge and responses. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104111. [PMID: 37563039 DOI: 10.1016/j.drugpo.2023.104111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Take home naloxone (THN) programmes are effective at reducing opioid related mortality, but require high levels of distribution, including to the general public. Mass media campaigns can be effective in improving public understanding of a topic and encouraging behavior change. Whilst mass media campaigns focusing on naloxone have been developed internationally, there is a lack of research on their potential impact. We investigated the effects of components of a recent national mass media campaign (Scotland, UK) designed to improve public awareness of drug related deaths, and readiness to intervene. METHODS We undertook a cross-sectional online experimental study with a randomized design, conducted with a nationally representative sample. Participants (N = 1551; 52.6% female; age 46.1±16.5 years) were assessed on overdose knowledge and readiness to intervene after presentation of eight combinations of campaign components. RESULTS Compared to a basic campaign description, exposure to all types of campaign component were associated with higher overdose knowledge (p < .001), but not knowledge of what to do in response to an overdose (p = .374), or readiness to intervene (p= .286). The greatest effects were associated with a media rich audio-visual resource (animated video with a popular song on the soundtrack, and narrated by a well-known actor). CONCLUSION Our data suggest that harm reduction is an appropriate topic for large-scale mass media campaigns. However, effects may be limited to knowledge and awareness raising in the general public, and may be related to the types of media used. Audience segmentation is important and more general messaging about drug related deaths may be more appropriate for the majority of audiences.
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Affiliation(s)
- H R Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, UK.
| | - A M Atkinson
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - M Anderson
- Scottish Drugs Forum, Glasgow, UK; MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, UK
| | - A McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
| | - Kma Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Health Protection Scotland, Glasgow, UK
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Dong Q, Kline D, Hepler SA. A Bayesian Spatio-temporal Model to Optimize Allocation of Buprenorphine in North Carolina. STATISTICS AND PUBLIC POLICY (PHILADELPHIA, PA.) 2023; 10:2218448. [PMID: 37545670 PMCID: PMC10398789 DOI: 10.1080/2330443x.2023.2218448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 08/08/2023]
Abstract
The opioid epidemic is an ongoing public health crisis. In North Carolina, overdose deaths due to illicit opioid overdose have sharply increased over the last 5-7 years. Buprenorphine is a U.S. Food and Drug Administration approved medication for treatment of opioid use disorder and is obtained by prescription. Prior to January 2023, providers had to obtain a waiver and were limited in the number of patients that they could prescribe buprenorphine. Thus, identifying counties where increasing buprenorphine would yield the greatest overall reduction in overdose death can help policymakers target certain geographical regions to inform an effective public health response. We propose a Bayesian spatiotemporal model that relates yearly, county-level changes in illicit opioid overdose death rates to changes in buprenorphine prescriptions. We use our model to forecast the statewide count and rate of illicit opioid overdose deaths in future years, and we use nonlinear constrained optimization to identify the optimal buprenorphine increase in each county under a set of constraints on available resources. Our model estimates a negative relationship between death rate and increasing buprenorphine after accounting for other covariates, and our identified optimal single-year allocation strategy is estimated to reduce opioid overdose deaths by over 5.
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Affiliation(s)
- Qianyu Dong
- Department of Statistical Sciences, Wake Forest University
| | - David Kline
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine
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Gagnon M, Rudzinski K, Guta A, Schmidt RA, Kryszajtys DT, Kolla G, Strike C. Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada. Harm Reduct J 2023; 20:81. [PMID: 37380995 DOI: 10.1186/s12954-023-00817-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVES Fentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. It has also changed injection practices. Injection frequency has increased as a result and so has equipment sharing and health-related risks. The aim of this analysis was to explore the impact of safer supply programs on injection practices from the perspective of clients and providers in Ontario, Canada. METHODS The data set included qualitative interviews with 52 clients and 21 providers that were conducted between February and October 2021 across four safer supply programs. Interview excerpts discussing injection practices were extracted, screened, coded and then grouped into themes. RESULTS We identified three themes, each theme corresponding to a change in injection practices. The first change was a decrease in the amount of fentanyl used and a decrease in injection frequency. The second change involved switching to injecting hydromorphone tablets instead of fentanyl. Finally, the third change was stopping injecting altogether and taking safer supply medications orally. CONCLUSION Safer supply programs can contribute to reducing injection-related health risks in addition to overdose risks. More specifically, they have the potential to address disease prevention and health promotion gaps that stand-alone downstream harm reduction interventions cannot address, by working upstream and providing a safer alternative to fentanyl.
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Affiliation(s)
- Marilou Gagnon
- School of Nursing, University of Victoria, Victoria, BC, Canada.
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Avenue, Victoria, BC, V8N 5M8, Canada.
| | | | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
| | - Rose A Schmidt
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David T Kryszajtys
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Avenue, Victoria, BC, V8N 5M8, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Doran KM, Torsiglieri A, Blaufarb S, Hernandez P, Melnick E, Velez L, Cleland CM, Neighbors C, O'Grady MA, Shelley D. The POP (Permanent Supportive Housing Overdose Prevention) Study: protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial. Implement Sci 2023; 18:21. [PMID: 37287026 PMCID: PMC10246871 DOI: 10.1186/s13012-023-01278-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Permanent supportive housing (PSH)-subsidized housing paired with support services such as case management-is a key part of national strategic plans to end homelessness. PSH tenants face high overdose risk due to a confluence of individual and environmental risk factors, yet little research has examined overdose prevention in PSH. METHODS We describe the protocol for a hybrid type 3 stepped-wedge cluster randomized controlled trial (RCT) of overdose prevention practice implementation in PSH. We adapted evidence-based overdose prevention practices and implementation strategies for PSH using input from stakeholder focus groups. The trial will include 20 PSH buildings (with building size ranging from 20 to over 150 tenants) across New York City and New York's Capital Region. Buildings will be randomized to one of four 6-month intervention waves during which they will receive a package of implementation support including training in using a PSH Overdose Prevention (POP) Toolkit, time-limited practice facilitation, and learning collaboratives delivered to staff and tenant implementation champions appointed by each building. The primary outcome is building-level fidelity to a defined list of overdose prevention practices. Secondary and exploratory implementation and effectiveness outcomes will be examined using PSH staff and tenant survey questionnaires, and analysis of tenant Medicaid data. We will explore factors related to implementation success, including barriers and facilitators, using qualitative interviews with key stakeholders. The project is being conducted through an academic-community partnership, and an Advisory Board including PSH tenants and other key stakeholders will be engaged in all stages of the project. DISCUSSION We describe the protocol for a hybrid type 3 stepped-wedge cluster RCT of overdose prevention practice implementation in PSH. This study will be the first controlled trial of overdose prevention implementation in PSH settings. The research will make a significant impact by testing and informing future implementation strategies to prevent overdose for a population at particularly high risk for overdose mortality. Findings from this PSH-focused research are expected to be broadly applicable to other housing settings and settings serving people experiencing homelessness. TRIAL REGISTRATION ClinicalTrials.gov, NCT05786222 , registered 27 March 2023.
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Affiliation(s)
- Kelly M Doran
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA.
- Department of Population Health, NYU School of Medicine, New York, NY, USA.
| | | | - Stephanie Blaufarb
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA
| | | | - Emily Melnick
- Metro Team, Corporation for Supportive Housing, New York, NY, USA
| | - Lauren Velez
- Metro Team, Corporation for Supportive Housing, New York, NY, USA
| | - Charles M Cleland
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Charles Neighbors
- Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Megan A O'Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York, NY, USA
- Global Center for Implementation Science and Practice, NYU School of Global Public Health, New York, NY, USA
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Yeung MEM, Lee CH, Hartmann R, Lang E. Opioid-related emergency department visits and deaths after a harm-reduction intervention: a retrospective observational cohort time series analysis. CMAJ Open 2023; 11:E537-E545. [PMID: 37339791 DOI: 10.9778/cmajo.20220104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND To date, there has been little research on the effect of safe consumption site and community-based naloxone programs on regional opioid-related emergency department visits and deaths. We sought to determine the impact of these interventions on regional opioid-related emergency department visit and death rates in the province of Alberta. METHODS We used a retrospective observational design, via interrupted time series analysis, to assess municipal opioid-related emergency department visit volume and opioid-related deaths (defined by poisoning and opioid use disorder). We compared rates before and after program implementation in individual Alberta municipalities and province-wide after safe consumption site (March 2018 to October 2018) and community-based naloxone (January 2016) program implementation. RESULTS A total of 24 107 emergency department visits and 2413 deaths were included in the study. After safe consumption site opening, we saw decreased opioid-related emergency department visits in Calgary (level change -22.7 [-20%] visits per month, 95% confidence interval [CI] -29.7 to -15.8) and Lethbridge (level change -8.8 [-50%] visits per month, 95% CI -11.7 to -5.9), and decreased deaths in Edmonton (level change -5.9 [-55%] deaths per month, 95% CI -8.9 to -2.9). We observed increased emergency department visits after community-based naloxone program implementation in urban Alberta (level change 38.9 [46%] visits, 95% CI 33.3 to 44.4). We also observed an increase in urban opioid-related deaths (level change 9.1 [40%] deaths, 95% CI 6.7 to 11.5). INTERPRETATION The results of this study suggest differences exist between municipalities employing similar interventions. Our results also suggest contextual variation; for example, illicit drug supply toxicity may modify the ability of a community-based naloxone program to prevent opioid overdose without a thorough public health response.
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Affiliation(s)
- Matthew E M Yeung
- Departments of Emergency Medicine (Yeung, Lang) and Critical Care Medicine (Lee), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Hartmann), University of Saskatchewan, Saskatoon, Sask.
| | - Chel Hee Lee
- Departments of Emergency Medicine (Yeung, Lang) and Critical Care Medicine (Lee), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Hartmann), University of Saskatchewan, Saskatoon, Sask
| | - Riley Hartmann
- Departments of Emergency Medicine (Yeung, Lang) and Critical Care Medicine (Lee), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Hartmann), University of Saskatchewan, Saskatoon, Sask
| | - Eddy Lang
- Departments of Emergency Medicine (Yeung, Lang) and Critical Care Medicine (Lee), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Hartmann), University of Saskatchewan, Saskatoon, Sask
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Enns B, Krebs E, Whitehurst DGT, Jutras-Aswad D, Le Foll B, Socias ME, Nosyk B. Cost-effectiveness of flexible take-home buprenorphine-naloxone versus methadone for treatment of prescription-type opioid use disorder. Drug Alcohol Depend 2023; 247:109893. [PMID: 37120920 DOI: 10.1016/j.drugalcdep.2023.109893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/21/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Our objective was to examine the cost-effectiveness of flexible take-home buprenorphine-naloxone (BNX) versus methadone alongside the OPTIMA trial in Canada. METHODS The OPTIMA study was a pragmatic, open-label, noninferiority, two-arm randomized controlled trial, to assess the comparative effectiveness of flexible take-home BNX vs. methadone in routine clinical care for individuals with prescription-type opioid use disorder. We evaluated cost-effectiveness using a semi-Markov cohort model. Probabilities of overdose were calibrated, accounting for fentanyl prevalence and other overdose risk factors such as naloxone availability. We considered health sector and societal cost perspectives, including costs (2020 CAD) for treatment, health resource use, criminal activity, and health state-specific preference weights as outcomes to calculate incremental cost-effectiveness ratios. Six-month and lifetime (3% annual discount rate) time-horizons were explored. RESULTS Over a lifetime time horizon, individuals accumulated -0.144 [CI: -0.302, -0.025] incremental quality-adjusted life years (QALYs) in BNX compared with methadone. Incremental costs were -$2047 [CI: -$39,197, $24,250] from a societal perspective, and -$4549 [CI: -$6332, -$3001] from a health sector perspective. Over a six-month time-horizon, individuals accumulated 0.002 [credible interval (CI): -0.011, 0.016] incremental QALYs in BNX compared with methadone. Incremental costs were -$307 [CI: -$10,385, $8466] from a societal perspective and -$1111 [CI: -$1517, -$631] from a health sector perspective. BNX was dominated (costlier, less effective) in 49.7% of simulations when adopting a societal perspective over a lifetime time horizon. CONCLUSIONS Flexible take-home BNX was not cost-effective versus methadone over a lifetime time horizon, resulting from better treatment retention in methadone compared to BNX.
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Affiliation(s)
- Benjamin Enns
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Emanuel Krebs
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, QuébecH2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, QuébecH3T1J4, Canada
| | - Bernard Le Foll
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, OntarioM5S 1A8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 250 College Street, 8th floor, Toronto, OntarioM5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, OntarioM5T 3M7, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, OntarioM5S 2S1, Canada; Acute Care Program, CAMH, 33 Ursula Franklin Street, Toronto, OntarioM5S 2S1, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British ColumbiaV6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 1045 Howe Street, Vancouver, British ColumbiaV6Z 2A9, Canada
| | - Bohdan Nosyk
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
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Bohler RM, Freeman PR, Villani J, Hunt T, Linas BS, Walley AY, Green TC, Lofwall MR, Bridden C, Frazier LA, Fanucchi LC, Talbert JC, Chandler R. The policy landscape for naloxone distribution in four states highly impacted by fatal opioid overdoses. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100126. [PMID: 36643788 PMCID: PMC9838196 DOI: 10.1016/j.dadr.2022.100126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Expanding access to naloxone is one of the most impactful interventions in decreasing opioid-related mortality. However, state distribution rates of naloxone are insufficient to meet community need. The current study sought to better understand this gap by focusing on state policies that may facilitate or impede naloxone distribution in four states highly impacted by fatal opioid overdoses - Kentucky, Massachusetts, New York, and Ohio. Methods We provide a descriptive analysis of the policy landscape impacting naloxone distribution through pharmacy and community channels in the four states participating in the HEALing Communities Study (HCS). Publicly available data and the expertise of the research team were used to describe each state's naloxone access laws (NALs), Medicaid coverage of naloxone, and community overdose education and naloxone distribution infrastructure. Data presented in this study represent the most current policy landscape through September 2022. Results Variation exists between specific components of the NALs of each state, the structure of Medicaid coverage of naloxone, and the community distribution infrastructure networks. Massachusetts and New York have a statewide standing order, but other states use different strategies short of a statewide standing order to expand access to naloxone. Quantity limits specific to naloxone may limit access to Medicaid beneficiaries in some states. Conclusion States participating in the HCS have developed innovative but different mechanisms to ensure naloxone access. Policies were dynamic and moved towards greater access. Research should consider the policy landscape in the implementation and sustainability of interventions as well as the analysis of outcomes.
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Affiliation(s)
- Robert M. Bohler
- Institute for Behavioral Health, Brandeis University, 415 South Street, Waltham, MA 02453, United States,Corresponding author. (R.M. Bohler)
| | - Patricia R. Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Tim Hunt
- School of Social Work, Social Intervention Group (SIG), Center for Healing of Opioid and Other Substance Use Disorders (CHOSEN), Columbia University, New York, NY, United States
| | - Beth S. Linas
- RTI International, Research Triangle Park, NC, United States
| | - Alexander Y. Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Traci C. Green
- Institute for Behavioral Health, Brandeis University, 415 South Street, Waltham, MA 02453, United States
| | - Michelle R. Lofwall
- Departments of Behavioral Science and Psychiatry, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Carly Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, United States
| | - Lisa A. Frazier
- Center for Health Outcomes and Policy Evaluation Studies, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Laura C. Fanucchi
- Department of Internal Medicine, Division of Infectious Disease, Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Jeffery C. Talbert
- Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Redonna Chandler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
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Rajabali F, Turcotte K, Zheng A, Purssell R, Buxton JA, Pike I. The impact of poisoning in British Columbia: a cost analysis. CMAJ Open 2023; 11:E160-E168. [PMID: 36787989 PMCID: PMC9933990 DOI: 10.9778/cmajo.20220089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Poisoning, from substances such as illicit drugs, prescribed and over-the-counter medications, alcohol, pesticides, gases and household cleaners, is the leading cause of injury-related death and the second leading cause for injury-related hospital admission in British Columbia. We examined the health and economic costs of poisoning in BC for 2016, using a societal perspective, to support public health policies aimed at minimizing losses to society. METHODS Costs by intent, sex and age group were calculated in Canadian dollars using a classification and costing framework based on existing provincial injury data combined with data from the published literature. Direct cost components included fatal poisonings, hospital admissions, emergency department visits, ambulance attendance without transfer to hospital and calls to the British Columbia Drug and Poison Information Centre (BC DPIC) not resulting in ambulance attendance, emergency care or transfer to hospital. Indirect costs, measured as loss of earnings and informal caregiving costs, were also calculated. RESULTS We estimate that poisonings in BC totalled $812.5 million in 2016 with $108.9 million in direct health care costs and $703.6 million in indirect costs. Unintentional poisoning injuries accounted for 84% of total costs, 46% of direct costs and 89% of indirect costs. Males accounted for higher proportions of direct costs for all patient dispositions except hospital admissions. Patients aged 25-64 years accounted for higher proportions of direct costs except for calls to BC DPIC, where proportions were highest for children younger than 15 years. INTERPRETATION Hospital care expenditures represented the largest direct cost of poisoning, and lost productivity following death represented the largest indirect cost. Quantifying and understanding the financial burden of poisoning has implications not only for government and health care, but also for society, employers, patients and families.
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Affiliation(s)
- Fahra Rajabali
- BC Injury Research and Prevention Unit (Rajabali, Turcotte, Zheng, Pike), BC Children's Hospital; Department of Emergency Medicine (Purssell), University of British Columbia; BC Drug and Poison Information Centre (Purssell, Buxton); School of Population and Public Health (Buxton), University of British Columbia; Department of Pediatrics (Pike), University of British Columbia, Vancouver, BC
| | - Kate Turcotte
- BC Injury Research and Prevention Unit (Rajabali, Turcotte, Zheng, Pike), BC Children's Hospital; Department of Emergency Medicine (Purssell), University of British Columbia; BC Drug and Poison Information Centre (Purssell, Buxton); School of Population and Public Health (Buxton), University of British Columbia; Department of Pediatrics (Pike), University of British Columbia, Vancouver, BC
| | - Alex Zheng
- BC Injury Research and Prevention Unit (Rajabali, Turcotte, Zheng, Pike), BC Children's Hospital; Department of Emergency Medicine (Purssell), University of British Columbia; BC Drug and Poison Information Centre (Purssell, Buxton); School of Population and Public Health (Buxton), University of British Columbia; Department of Pediatrics (Pike), University of British Columbia, Vancouver, BC
| | - Roy Purssell
- BC Injury Research and Prevention Unit (Rajabali, Turcotte, Zheng, Pike), BC Children's Hospital; Department of Emergency Medicine (Purssell), University of British Columbia; BC Drug and Poison Information Centre (Purssell, Buxton); School of Population and Public Health (Buxton), University of British Columbia; Department of Pediatrics (Pike), University of British Columbia, Vancouver, BC
| | - Jane A Buxton
- BC Injury Research and Prevention Unit (Rajabali, Turcotte, Zheng, Pike), BC Children's Hospital; Department of Emergency Medicine (Purssell), University of British Columbia; BC Drug and Poison Information Centre (Purssell, Buxton); School of Population and Public Health (Buxton), University of British Columbia; Department of Pediatrics (Pike), University of British Columbia, Vancouver, BC
| | - Ian Pike
- BC Injury Research and Prevention Unit (Rajabali, Turcotte, Zheng, Pike), BC Children's Hospital; Department of Emergency Medicine (Purssell), University of British Columbia; BC Drug and Poison Information Centre (Purssell, Buxton); School of Population and Public Health (Buxton), University of British Columbia; Department of Pediatrics (Pike), University of British Columbia, Vancouver, BC
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Wallace B, van Roode T, Burek P, Hore D, Pauly B. Everywhere and for everyone: proportionate universalism as a framework for equitable access to community drug checking. Harm Reduct J 2022; 19:143. [PMID: 36539747 PMCID: PMC9763810 DOI: 10.1186/s12954-022-00727-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Illicit drug overdoses have reached unprecedented levels, exacerbated by the COVID-19 pandemic. Responses are needed that address the increasingly potent and unpredictable drug supply with better reach to a wide population at risk for overdose. Drug checking is a potential response offered mainly within existing harm reduction services, but strategies are needed to increase reach and improve equitable delivery of drug checking services. METHODS The purpose of this qualitative study was to explore how to extend the reach of drug checking services to a wide population at risk of overdose. We conducted 26 in-depth interviews with potential service users to identify barriers to service use and strategies to increase equitable delivery of drug checking services. Our analysis was informed by theoretical perspectives on equity, and themes were developed relevant to equitable delivery through attention to quality dimensions of service use: accessibility, appropriateness, effectiveness, safety, and respect. RESULTS Barriers to equitable service delivery included criminalization and stigma, geographic and access issues, and lack of cultural appropriateness that deter service use for a broad population with diverse needs. Strategies to enhance equitable access include 1ocating services widely throughout communities, integrating drug checking within existing health care services, reframing away from risk messaging, engaging peers from a broad range of backgrounds, and using discrete methods of delivery to help create safer spaces and better reach diverse populations at risk for overdose. CONCLUSIONS We propose proportionate universalism in drug checking as a guiding framework for the implementation of community drug checking as an equity-oriented harm reduction intervention and as a population health response. Both a universal equity-oriented approach and multiple tailored approaches are required to facilitate drug checking services that maximize reach and appropriateness to respond to diverse needs.
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Affiliation(s)
- Bruce Wallace
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada ,grid.143640.40000 0004 1936 9465School of Social Work, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Thea van Roode
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Piotr Burek
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Dennis Hore
- grid.143640.40000 0004 1936 9465Department of Chemistry, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC Canada ,grid.143640.40000 0004 1936 9465Department of Computer Science, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Bernadette Pauly
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research (CISUR), University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada ,grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
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Allen ST, O'Rourke A, Johnson JA, Cheatom C, Zhang Y, Delise B, Watkins K, Reich K, Reich R, Lockett C. Evaluating the impact of naloxone dispensation at public health vending machines in Clark County, Nevada. Ann Med 2022; 54:2692-2700. [PMID: 36168975 PMCID: PMC9542801 DOI: 10.1080/07853890.2022.2121418] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Implementing public health vending machines (PHVMs) is an evidence-based strategy for mitigating substance use-associated morbidity and mortality via the dispensation of essential supplies to people who use drugs, including overdose prevention resources. PHVMs have been implemented throughout the world; however, their implementation in the United States (US) is a recent phenomenon. In 2017, Trac-B Exchange (a syringe services program in Clark County, Nevada) installed three PHVMs. In 2019, naloxone dispensation was launched at PHVMs in Clark County. The purpose of this research is to examine the extent to which naloxone dispensation at PHVMs was associated with changes in opioid-involved overdose fatalities. METHODS Monthly counts of opioid-involved overdose fatalities among Clark County residents that occurred from January 2015 to December 2020 were used to build an autoregressive integrated moving averages (ARIMA) model to measure the impact of naloxone dispensation at PHVMs. We forecasted the number of expected opioid-involved overdose fatalities had naloxone dispensation at PHVMs not occurred and compared to observed monthly counts. Interrupted time series analyses (ITSA) were used to evaluate the step (i.e. the immediate impact of naloxone dispensation at PHVMs on opioid-involved overdose fatalities) and slope change (i.e. changes in trend and directionality of monthly counts of opioid-involved overdose fatalities following naloxone dispensation at PHVMs). RESULTS During the 12-months immediately following naloxone dispensation at PHVMs, our model forecasted 270 opioid-involved overdose fatalities, but death certificate data indicated only 229 occurred, suggesting an aversion of 41 deaths. ITSA identified a significant negative step change in opioid-involved overdose fatalities at the time naloxone dispensation at PHVMs was launched (B = -8.52, p = .0022) and a significant increasing slope change (B = 1.01, p<.0001). Forecasts that extended into the COVID-19 pandemic suggested worsening trends in overdose fatalities. CONCLUSION Naloxone dispensation at PHVMs was associated with immediate reductions in opioid-involved overdose fatalities. Key MessagesNaloxone dispensation at PHVMs was associated with immediate reductions in opioid-involved overdose fatalities.Communities should consider implementing public health vending machines in efforts to prevent opioid-involved overdose fatalities.The COVID-19 pandemic worsened the overdose crisis.
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Affiliation(s)
- Sean T Allen
- Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison O'Rourke
- DC Center for AIDS Research, Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | | | | | - Ying Zhang
- Southern Nevada Health District, Las Vegas, NV, USA
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Ackermann E, Kievit B, Xavier J, Barbic S, Ferguson M, Greer A, Loyal J, Mamdani Z, Palis H, Pauly B, Slaunwhite A, Buxton JA. Awareness and knowledge of the Good Samaritan Drug Overdose Act among people at risk of witnessing an overdose in British Columbia, Canada: a multi-methods cross sectional study. Subst Abuse Treat Prev Policy 2022; 17:42. [PMID: 35614474 PMCID: PMC9131579 DOI: 10.1186/s13011-022-00472-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Bystanders to drug overdoses often avoid or delay calling 9–1-1 and cite fear of police involvement as a main reason. In 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted by the Canadian government to provide people present at an overdose with legal protection from charges for simple drug possession, and conditions stemming from simple possession. Few studies have taken a multi-methods approach to evaluating the GSDOA. We used quantitative surveys and qualitative interviews to explore awareness, understanding, and perceptions of the GSDOA in people at risk of witnessing an overdose. Methods Quantitative cross-sectional surveys and qualitative telephone interviews were conducted with adults and youth at risk of witnessing an overdose across British Columbia. Cross-sectional survey participants were recruited at 19 Take Home Naloxone sites and online through Foundry. Multivariable logistic regression models were constructed hierarchically to determine factors associated with GSDOA awareness. Telephone interview participants were recruited by research assistants with lived/living experience of substance use. Deductive and inductive thematic analyses were conducted to identify major themes. Results Overall, 52.7% (n = 296) of the quantitative study sample (N = 453) reported being aware of the GSDOA. In multivariable analysis, cellphone possession (adjusted odds ratio [AOR] = 2.19; 95% confidence interval [CI] 1.36, 3.54) and having recently witnessed an opioid overdose (AOR = 2.34; 95% CI 1.45, 3.80) were positively associated with GSDOA awareness. Young adults (25 – 34 years) were more likely to be aware of the Act (AOR = 2.10; 95% CI 1.11, 3.98) compared to youth (16–24 years). Qualitative interviews (N = 42) revealed that many overestimated the protections offered by the GSDOA. To increase awareness and knowledge of the Act among youth, participants recommended adding the GSDOA to school curricula and using social media. Word of mouth was suggested to reach adults. Conclusion Both awareness and knowledge of the GSDOA remain low in BC, with many overestimating the protections the Act offers. Dissemination efforts should be led by people with lived/living experience and should target those with limited awareness and understanding of the Act as misunderstandings can erode trust in law enforcement and harm reduction policy. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-022-00472-4.
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Panagiotoglou D, Lim J. Using synthetic controls to estimate the population-level effects of Ontario's recently implemented overdose prevention sites and consumption and treatment services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103881. [PMID: 36274565 DOI: 10.1016/j.drugpo.2022.103881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/30/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Between 2017 and 2020, Ontario implemented overdose prevention sites (OPS) and consumption and treatment services (CTS) in nine of its 34 public health units (PHU). We tested for the effect of booth-hours (spaces within OPS/CTSs for supervised consumption) on opioid-related health service use and mortality rates at the provincial- (aggregate) and PHU-level. METHODS We used monthly rates of all opioid-related emergency department (ED) visits, hospitalizations, and deaths between January 2015 and March 2021 as our three outcomes. For each PHU that implemented OPS/CTSs, we created a synthetic control as a weighted combination of unexposed PHUs. Our exposure was the time-varying rate of booth-hours provided. We estimated the population-level effects of the intervention on each outcome per treated/synthetic-control pair using controlled interrupted time series with segmented regression; and tested for the aggregate effect using a multiple baseline approach. We adjusted for time-varying provision of prescription opioids for pain management, opioid agonist treatment (OAT), and naloxone kits; and corrected for seasonality and autocorrelation. All rates were per 100,000 population. For sensitivity analysis, we restricted the post-implementation period to before COVID-19 public health measures were implemented (March 2020). RESULTS Our aggregate analyses found no effect per booth-hour on ED visits (0.00, 95% CI: -0.01, 0.01; p-value=0.6684), hospitalizations (0.00, 95% CI: 0.00, 0.00; p-value=0.9710) or deaths (0.00, 95% CI: 0.00, 0.00; p-value=0.2466). However, OAT reduced ED visits (-0.20, 95% CI: -0.35, -0.05; p-value=0.0103) and deaths (-0.04, 95% CI: -0.05, -0.03; p-value=<0.0001). Conversely, prescription opioids for pain management modestly increased deaths (0.0008, 95% CI: 0.0002, 0.0015; p-value=0.0157) per 100,000 population, respectively. Except for a few treated PHU/synthetic control pairs, disaggregate results were congruent with overall findings. CONCLUSION Booth-hours had no population-level effect on opioid-related overdose ED visit, hospitalization, or death rates.
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Affiliation(s)
- Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
| | - Jihoon Lim
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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A concept mapping study of service user design of safer supply as an alternative to the illicit drug market. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103849. [PMID: 36215793 DOI: 10.1016/j.drugpo.2022.103849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Within North America and worldwide, drug-related overdoses have increased dramatically over the past decade. COVID-19 escalated the need for a safer supply of illicit substances to reduce overdoses with hopes of replacing substances obtained from the illicit drug market. Drug users1 should be at the centre of program and policy decisions related to the development and implementation of safer supply. Yet, there is little empirical research that conceptualizes effective safer supply from their perspectives. METHOD Within a community based participatory approach to research, we conducted a concept mapping study to foreground the perspectives of drug users and develop a conceptual model of effective safer supply. Our team was composed of researchers from a local drug user organization, a local harm reduction organization, and academic researchers. The focused prompt developed by the team was: "Safe supply would work well if…" Sixty-three drug users participated in three rounds of focus groups as part of the concept mapping process, involving brainstorming, sorting, rating and naming of themes. RESULTS The concept mapping process resulted in six clusters of statements: 1) Right dose and right drugs for me; 2) Safe, positive and welcoming spaces; 3) Safer supply and other services are accessible to me; 4) I am treated with respect; 5) I can easily get my safer supply; and 6) Helps me function and improves my quality of life (as defined by me). The statements within each cluster describe key components central to an effective model of safer supply as defined by drug users. CONCLUSION The results of this study provide insights into key components of effective safer supply to inform planning and evaluation of future safer supply programs informed by drug user perspectives.
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Cassie R, Hayashi K, DeBeck K, Milloy MJ, Cui Z, Strike C, West J, Kennedy MC. Difficulty accessing supervised consumption services during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. Harm Reduct J 2022; 19:126. [PMID: 36401299 PMCID: PMC9675060 DOI: 10.1186/s12954-022-00712-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The overdose crisis in Canada has worsened since the emergence of the COVID-19 pandemic. Although this trend is thought to be driven in part by closures or reduced capacity of supervised consumption services (SCS), little is known about the factors that may impede access to such services during the COVID-19 pandemic among people who use drugs. This study sought to characterize the prevalence and correlates of having difficulty accessing SCS during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. METHODS Cross-sectional data from two open prospective cohorts of people who use drugs were collected via phone or videoconferencing interviews conducted between July 2020 and November 2020. Multivariable logistic regression analyses were used to examine factors associated with experiencing difficulty accessing SCS. RESULTS Among the 428 people who use drugs who participated in the study, 223 (54.7%) self-identified as men and the median age was 51 years (1st to 3rd quartile: 42-58). A total of 58 (13.6%) participants reported experiencing difficulty accessing SCS. In a multivariable analysis, factors positively associated with difficulty accessing SCS included daily crystal methamphetamine use (Adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI] 1.28-5.30), active injection drug use (AOR = 4.06; 95% CI 1.38-11.90), recent non-fatal overdose (AOR = 2.45; 95% CI 1.24-4.85), and unstable housing (AOR = 2.14; 95% CI 1.08-4.23). Age was inversely associated with the outcome (AOR = 0.96; 95% CI 0.93-0.99) in multivariable analyses. The most commonly reported reasons for experiencing difficulty accessing SCS were: COVID-19-related site closure or shortened hours (42.9%) and having to wait too long to use a site (39.3%). CONCLUSIONS We found that people who use drugs with markers of structural vulnerability and drug-related risk were more likely to experience difficulty accessing SCS during the COVID-19 pandemic. These findings point to the need for strategies to support access to such services as part of pandemic response efforts.
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Affiliation(s)
- Rachel Cassie
- grid.17089.370000 0001 2190 316XSchool of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave., Edmonton, AB T6G 1C9 Canada
| | - Kanna Hayashi
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Kora DeBeck
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494School of Public Policy, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - M.-J. Milloy
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, St. Paul’s Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Zishan Cui
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Carol Strike
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7 Canada ,grid.415502.7La Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria St., Toronto, ON M5B 1T8 Canada
| | - Jeff West
- grid.498786.c0000 0001 0505 0734Vancouver Coastal Health, 828 W 10th Ave., Vancouver, BC V5Z 1L8 Canada
| | - Mary Clare Kennedy
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830School of Social Work, University of British Columbia - Okanagan, 1147 Research Road (ARTS Building), Kelowna, BC V1V 1V7 Canada
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Brown CH, Hedeker D, Gibbons RD, Duan N, Almirall D, Gallo C, Burnett-Zeigler I, Prado G, Young SD, Valido A, Wyman PA. Accounting for Context in Randomized Trials after Assignment. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1321-1332. [PMID: 36083435 PMCID: PMC9461380 DOI: 10.1007/s11121-022-01426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 10/25/2022]
Abstract
Many preventive trials randomize individuals to intervention condition which is then delivered in a group setting. Other trials randomize higher levels, say organizations, and then use learning collaboratives comprised of multiple organizations to support improved implementation or sustainment. Other trials randomize or expand existing social networks and use key opinion leaders to deliver interventions through these networks. We use the term contextually driven to refer generally to such trials (traditionally referred to as clustering, where groups are formed either pre-randomization or post-randomization - i.e., a cluster-randomized trial), as these groupings or networks provide fixed or time-varying contexts that matter both theoretically and practically in the delivery of interventions. While such contextually driven trials can provide efficient and effective ways to deliver and evaluate prevention programs, they all require analytical procedures that take appropriate account of non-independence, something not always appreciated. Published analyses of many prevention trials have failed to take this into account. We discuss different types of contextually driven designs and then show that even small amounts of non-independence can inflate actual Type I error rates. This inflation leads to rejecting the null hypotheses too often, and erroneously leading us to conclude that there are significant differences between interventions when they do not exist. We describe a procedure to account for non-independence in the important case of a two-arm trial that randomizes units of individuals or organizations in both arms and then provides the active treatment in one arm through groups formed after assignment. We provide sample code in multiple programming languages to guide the analyst, distinguish diverse contextually driven designs, and summarize implications for multiple audiences.
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Affiliation(s)
- C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Donald Hedeker
- Center for Health Statistics, The University of Chicago, Chicago, IL, USA
| | - Robert D Gibbons
- Center for Health Statistics, The University of Chicago, Chicago, IL, USA
| | - Naihua Duan
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Daniel Almirall
- Institute for Social Research and Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Carlos Gallo
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Sean D Young
- Department of Emergency Medicine, School of Medicine, Department of Informatics, Bren School of Information and Computer Sciences, University of California, Irvine, CA, USA
| | - Alberto Valido
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, Orange, NC, USA
| | - Peter A Wyman
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA
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Holland A, Stevens A, Harris M, Lewer D, Sumnall H, Stewart D, Gilvarry E, Wiseman A, Howkins J, McManus J, Shorter GW, Nicholls J, Scott J, Thomas K, Reid L, Day E, Horsley J, Measham F, Rae M, Fenton K, Hickman M. Analysis of the UK Government's 10-Year Drugs Strategy-a resource for practitioners and policymakers. J Public Health (Oxf) 2022:6779883. [PMID: 36309802 DOI: 10.1093/pubmed/fdac114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/10/2022] [Indexed: 11/12/2022] Open
Abstract
In 2021, during a drug-related death crisis in the UK, the Government published its ten-year drugs strategy. This article, written in collaboration with the Faculty of Public Health and the Association of Directors of Public Health, assesses whether this Strategy is evidence-based and consistent with international calls to promote public health approaches to drugs, which put 'people, health and human rights at the centre'. Elements of the Strategy are welcome, including the promise of significant funding for drug treatment services, the effects of which will depend on how it is utilized by services and local commissioners and whether it is sustained. However, unevidenced and harmful measures to deter drug use by means of punishment continue to be promoted, which will have deleterious impacts on people who use drugs. An effective public health approach to drugs should tackle population-level risk factors, which may predispose to harmful patterns of drug use, including adverse childhood experiences and socioeconomic deprivation, and institute evidence-based measures to mitigate drug-related harm. This would likely be more effective, and just, than the continuation of policies rooted in enforcement. A more dramatic re-orientation of UK drug policy than that offered by the Strategy is overdue.
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Affiliation(s)
- Adam Holland
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Alex Stevens
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, CT2 7NZ
| | - Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Dan Lewer
- Public Health Specialty Registrar, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, L3 5UX, UK
| | - Daniel Stewart
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Eilish Gilvarry
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, NE1 7RU, UK
| | - Alice Wiseman
- Association of Directors of Public Health, London, EC4Y 0HA, UK
| | - Joshua Howkins
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Jim McManus
- Association of Directors of Public Health, London, EC4Y 0HA, UK
| | | | - James Nicholls
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Jenny Scott
- Department of Pharmacy & Pharmacology, University of Bath, Bath, BA2 7AY
| | - Kyla Thomas
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | | | - Edward Day
- Institute of Mental Health, University of Birmingham, Birmingham, B15 2TT
| | - Jason Horsley
- National Institute for Health Research Evaluation Trials and Studies Coordinating Centre, University of Southampton, Southampton, SO17 1BJ, UK
| | - Fiona Measham
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, L69 3BX
| | - Maggie Rae
- Epidemiological and Public Health Section, Royal Society of Medicine, London, W1G 0AE, UK
| | | | - Matthew Hickman
- Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
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Change in Police Attendance at Overdose Events following Implementation of a Police Non-Notification Policy in British Columbia. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/8778430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Bystanders at overdose events often hesitate to call 911 due to fear of police involvement. To address this, in 2016, British Columbia Emergency Health Services (BCEHS) introduced a policy to not routinely inform police of overdose events. This study explores change in police attended overdose events after the policy was implemented. Methods. Data on police attended overdose events were derived from naloxone administration forms in BC’s Take-Home Naloxone (THN) kits returned before and after the policy change. Segmented regression was conducted to quantify change in police attended overdose events. Results. The average proportion of police attended overdose events pre-policy was 55.6% compared to 37.9% post-policy. The segmented regression model demonstrated a 0.98% (95% CI: (−1.70 to −0.26)) decline (
) in police attended overdose events each month following the policy. Conclusion. Our findings suggest that the BCEHS policy contributed to a decrease in police attended overdose events.
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Foreman-Mackey A, Pauly B, Ivsins A, Urbanoski K, Mansoor M, Bardwell G. Moving towards a continuum of safer supply options for people who use drugs: A qualitative study exploring national perspectives on safer supply among professional stakeholders in Canada. Subst Abuse Treat Prev Policy 2022; 17:66. [PMID: 36209227 PMCID: PMC9547673 DOI: 10.1186/s13011-022-00494-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Novel public health interventions are needed to address the toxic drug supply and meet the needs of people who use drugs amidst the overdose crisis. Safer supply - low-barrier distribution of pharmaceutical grade substances - has been implemented in some jurisdictions to provide safer alternatives to the unregulated drug supply, yet no studies to date have explored professional stakeholder perspectives on this approach. METHODS We used purposive sampling to recruit professional stakeholders (n = 17) from four locations in British Columbia, Ontario, and Nova Scotia, including program managers, executive directors, political and health authority representatives, and healthcare providers involved in the design, implementation, and/or operation of safer supply programs in their communities. Semi-structured, one-to-one interviews were conducted, and interview data were coded and analyzed using thematic analyses. RESULTS Participants defined safer supply as low-barrier access to substances of known quality and quantity, offered on a continuum from prescribed to a legal, regulated supply, and focused on upholding autonomy and liberation of people who use drugs. Stakeholders expressed support for safer supply but explained that current iterations do not meet the needs of all people who use drugs and that implementation is limited by a lack of willing prescribers, stigma towards people who use drugs, and precarity of harm reduction programs to political ideology. Stakeholders expressed strong support for wider-reaching approaches such as decriminalization, legalization, and regulation of substances as a way to fully realize a continuum of safer supply, directly address the overdose crisis and toxic drug supply, and ensure equity of access nationally. CONCLUSION The results of this study highlight the need for innovative strategies to address the overdose crisis and that safer supply has the potential to benefit certain people who use drugs. A one-size-fits-all approach is not sufficient and the perspectives of professional stakeholders should be considered alongside those of people who use drugs when designing and implementing future safer supply.
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Affiliation(s)
- Annie Foreman-Mackey
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, V6Z 2A9 Vancouver, BC Canada ,grid.416553.00000 0000 8589 2327Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081, V6Z 1Y6 Burrard Street, Vancouver, BC Canada
| | - Bernie Pauly
- grid.143640.40000 0004 1936 9465Canadian Institute on Substance Use Research, University of Victoria, 2300 McKenzie Avenue, V8P 5C2 Victoria, BC Canada ,grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Box 1700 STN CSC, V8W 2Y2 Victoria, BC Canada
| | - Andrew Ivsins
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, V6Z 2A9 Vancouver, BC Canada ,grid.416553.00000 0000 8589 2327Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081, V6Z 1Y6 Burrard Street, Vancouver, BC Canada
| | - Karen Urbanoski
- grid.143640.40000 0004 1936 9465Canadian Institute on Substance Use Research, University of Victoria, 2300 McKenzie Avenue, V8P 5C2 Victoria, BC Canada ,grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, V8P 5C2 Victoria, BC Canada
| | - Manal Mansoor
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, V6Z 2A9 Vancouver, BC Canada
| | - Geoff Bardwell
- grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, V6Z 2A9 Vancouver, BC Canada ,grid.416553.00000 0000 8589 2327Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081, V6Z 1Y6 Burrard Street, Vancouver, BC Canada ,grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Ave. West, N2L 3G1 Waterloo, ON Canada ,grid.511486.f0000 0004 8021 645XBritish Columbia Centre on Substance Use, 400-1045 Howe Street, V6Z 1Y6 Vancouver, BC Canada
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