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Cumming C, Kinner SA, McKetin R, Young JT, Li I, Preen DB. Using the Alcohol, Smoking and Substance Involvement Screening Test to predict substance-related hospitalisation after release from prison: A cohort study. Addiction 2024; 119:236-247. [PMID: 37855049 PMCID: PMC10952305 DOI: 10.1111/add.16365] [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: 06/09/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND AND AIMS Poor substance use-related health outcomes after release from prison are common. Identifying people at greatest risk of substance use and related harms post-release would help to target support at those most in need. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) is a validated substance use screener, but its utility in predicting substance-related hospitalisation post-release is unestablished. We measured whether screening for moderate/high-risk substance use on the ASSIST was associated with increased risk of substance-related hospitalisation. DESIGN A prospective cohort study. SETTING Prisons in Queensland and Western Australia. PARTICIPANTS Participants were incarcerated and within 6 weeks of expected release when recruited. A total of 2585 participants were followed up for a median of 873 days. MEASUREMENTS Baseline survey data were combined with linked unit record administrative hospital data. We used the ASSIST to assess participants for moderate/high-risk cannabis, methamphetamine and heroin use in the 3 months prior to incarceration. We used International Classification of Diseases (ICD) codes to identify substance-related hospitalisations during follow-up. We compared rates of substance-related hospitalisation between those classified as low/no-risk and moderate/high-risk on the ASSIST for each substance. We estimated adjusted hazard ratios (aHR) by ASSIST risk group for each substance using Weibull regression survival analysis allowing for multiple failures. FINDINGS During follow-up, 158 (6%) participants had cannabis-related, 178 (7%) had opioid-related and 266 (10%) had methamphetamine-related hospitalisation. The hazard rates of substance-related hospitalisation after prison were significantly higher among those who screened moderate/high-risk compared with those screening low risk on the ASSIST for cannabis (aHR 2.38, 95% confidence interval [CI] 1.74, 3.24), methamphetamine (aHR 2.23, 95%CI 1.75, 2.84) and heroin (aHR 5.79, 95%CI 4.41, 7.60). CONCLUSIONS Incarcerated people with an Alcohol Smoking and Substance Involvement Screening Test (ASSIST) screening of moderate/high-risk substance use appear to have a significantly higher risk of post-release substance-related hospitalisation than those with low risk. Administering the ASSIST during incarceration may inform who has the greatest need for substance use treatment and harm reduction services in prison and after release from prison.
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Affiliation(s)
- Craig Cumming
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
| | - Stuart A. Kinner
- Centre for Adolescent HealthMurdoch Children's Research InstituteParkvilleAustralia
- Melbourne School of Population and Global HealthThe University of MelbourneParkvilleAustralia
- Griffith Criminology InstituteGriffith UniversityMt GravattAustralia
- School of Population HealthCurtin UniversityPerthAustralia
| | - Rebecca McKetin
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | - Jesse T. Young
- Centre for Adolescent HealthMurdoch Children's Research InstituteParkvilleAustralia
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental HealthTorontoCanada
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneParkvilleAustralia
- National Drug Research InstituteCurtin UniversityPerthAustralia
- School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
| | - Ian Li
- School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
| | - David B. Preen
- Centre for Health Services Research, School of Population and Global HealthUniversity of Western AustraliaCrawleyAustralia
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van Draanen J, Jamula R, Karamouzian M, Mitra S, Richardson L. Pathways connecting socioeconomic marginalization and overdose: A qualitative narrative synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 113:103971. [PMID: 36822011 DOI: 10.1016/j.drugpo.2023.103971] [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: 08/17/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE This qualitative narrative synthesis sought to identify pathways connecting socioeconomic marginalization (SEM) and overdose for people who use drugs. METHODS We included studies with qualitative examination of SEM and fatal and non-fatal overdose published in English between 2000 and 2021. Studies were systematically identified and screened by searching MEDLINE (Ovid), Embase (Ovid), PsycINFO (EBSCOhost), CINAHL (EBSCOhost), Google Scholar, Cochrane Central Registry of Controlled Trials (CENTRAL), and Cochrane Drug and Alcohol Group (CDAG) Specialized Registry, citations, and contacting experts. Risk of bias and quality assessments were performed using the Critical Appraisal Skills Programme checklist and the Confidence in the Evidence from Reviews of Qualitative Research approach. Data were synthesized using a thematic synthesis approach. RESULTS The primary search strategy found 5909 articles that met the initial screening criteria. The review and screening process led to a final dataset of 27 qualitative articles. The four key findings of this narrative synthesis revealed aspects of SEM which shaped drug poisoning risk for people who use drugs: (1) resource insufficiency, labor market exclusion and deindustrialization, (2) homelessness and housing, (3) policing, criminalization, and interactions with emergency services, and (4) gendered and racialized dimensions of inequality. Findings led to creating a typology that includes material, behavioral, psychological, social, and environmental pathways that contain multiple mechanisms connecting SEM to overdose. This review revealed reciprocal connections between overdose and SEM via institutional pathways with reinforcing mechanisms, and interrelationships present within and between pathways. Quality assessments indicated moderate confidence in three of four findings (Findings 2,3, and 4 above) and high confidence in one finding (Finding 1). CONCLUSION SEM is strongly linked to drug poisoning, and the mechanisms establishing these connections can be classified within four pathways. The interconnectedness of these mechanisms can lead to intensification of overdose risk and reinforcement of SEM itself.
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Affiliation(s)
- Jenna van Draanen
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Faculty of Arts, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada; Department of Child, Family, and Population Health Nursing; School of Nursing; University of Washington, Seattle, WA, USA; Department of Health Systems and Population Health; School of Public Health; University of Washington, Seattle, WA, USA
| | - Ryan Jamula
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Faculty of Arts, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Mohammad Karamouzian
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Brown School of Public Health, Brown University, 121 S Main St, Providence, RI, 02903, USA; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616913555, Iran; Centre On Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
| | - Sanjana Mitra
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Interdisciplinary Studies Graduate Program, 270, 2357 Main Mall, H. R. MacMillan Building, Vancouver, BC, V6T 1Z4, Canada; Centre On Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
| | - Lindsey Richardson
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Faculty of Arts, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
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Injecting drugs alone during an overdose crisis in Vancouver, Canada. Harm Reduct J 2022; 19:125. [PMID: 36397146 PMCID: PMC9670082 DOI: 10.1186/s12954-022-00701-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/12/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Settings throughout Canada and the USA continue to experience crises of overdose death due to the toxic unregulated drug supply. Injecting drugs alone limits the potential for intervention and has accounted for a significant proportion of overdose deaths, yet the practice remains understudied. We sought to examine the practice of injecting alone among people who inject drugs (PWID) in Vancouver, Canada. METHODS Data were derived from two prospective cohorts of people who use drugs between June 2016 and November 2018. This analysis was restricted to participants who, in the previous 6 months, reported any injection drug use. Rates of injecting alone were categorized as always, usually, sometimes, or occasionally. We fit a multivariable generalized linear mixed model to identify factors associated with injecting drugs alone. RESULTS Among 1070 PWID who contributed 3307 observations, 931 (87%) reported injecting alone at least once during the study period. In total, there were 729 (22%) reports of always injecting alone, 722 (21.8%) usually, 471 (14.2%) sometimes, 513 (15.5%) occasionally, and 872 (26.4%) never. In a multivariable model, factors positively associated with injecting drugs alone included male sex (adjusted odds ratio [AOR] 1.69; 95% confidence interval [CI] 1.20-2.37), residence in the Downtown Eastside neighbourhood (AOR 1.43; 95% CI 1.08-1.91), binge drug use (AOR 1.36; 95% CI 1.08-1.72), and experiencing physical or sexual violence or both (AOR 1.43; 95% CI 1.00-2.03). Protective factors included Indigenous ancestry (AOR 0.71; 95% CI 0.52-0.98) and being in a relationship (AOR 0.30; 95% CI 0.23-0.39). CONCLUSION We observed that injecting alone, a key risk for overdose mortality, was common among PWID in Vancouver. Our findings underline the need for additional overdose prevention measures that are gender-specific, culturally appropriate, violence- and trauma-informed, and available to those who inject alone.
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Nickel NC, Enns JE, Freier A, McCulloch SC, Chartier M, Casidsid HJM, Balogun OD, Mulhall D, Dragan R, Sarkar J, Bolton J, Konrad G, Phillips-Beck W, Sanguins J, Shimmin C, McDonald N, Mignone J, Hinds A. Characterising methamphetamine use to inform health and social policies in Manitoba, Canada: a protocol for a retrospective cohort study using linked administrative data. BMJ Open 2022; 12:e062127. [PMID: 36261234 PMCID: PMC9582321 DOI: 10.1136/bmjopen-2022-062127] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Rising use of methamphetamine is causing significant public health concern in Canada. The biological and behavioural effects of methamphetamine range from wakefulness, vigour and euphoria to adverse physical health outcomes like myocardial infarction, haemorrhagic stroke, arrhythmia and seizure. It can also cause severe psychological complications such as psychosis. National survey data point to increasing rates of methamphetamine use, as well as increasing ease of access and serious methamphetamine-related harms. There is an urgent need for evidence to address knowledge gaps, provide direction to harm reduction and treatment efforts and inform health and social policies for people using methamphetamine. This protocol describes a study that aims to address this need for evidence. METHODS The study will use linked, whole population, de-identified administrative data from the Manitoba Population Research Data Repository. The cohort will include individuals in the city of Winnipeg, Manitoba, who came into contact with the health system for reasons related to methamphetamine use from 2013 to 2021 and a comparison group matched on age, sex and geography. We will describe the cohort's sociodemographic characteristics, calculate incidence and prevalence of mental disorders associated with methamphetamine use and examine rates of health and social service use. We will evaluate the use of olanzapine pharmacotherapy in reducing adverse emergency department outcomes. In partnership with Indigenous co-investigators, outcomes will be stratified by First Nations and Métis identity. ETHICS AND DISSEMINATION The study was approved by the University of Manitoba Health Research Ethics Board, and access datasets have been granted by all data providers. We also received approval from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Métis Federation. Dissemination will be guided by an 'Evidence 2 Action' group of public rightsholders, service providers and knowledge users who will ensure that the analyses address the critical issues.
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Affiliation(s)
- Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Inuit Association, Winnipeg, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Freier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott C McCulloch
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hera J M Casidsid
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Drew Mulhall
- Department of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Carolyn Shimmin
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Neil McDonald
- Winnipeg Fire Paramedic Service, Winnipeg, Manitoba, Canada
| | - Javier Mignone
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aynslie Hinds
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Valencia J, Troya J, Lazarus JV, Cuevas G, Alvaro-Meca A, Torres J, Gardeta C, Lozano D, Moreno S, Ryan P. Recurring Severe Injection-Related Infections in People Who Inject Drugs and the Need for Safe Injection Sites in Madrid, Spain. Open Forum Infect Dis 2021; 8:ofab251. [PMID: 34250189 PMCID: PMC8266667 DOI: 10.1093/ofid/ofab251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An estimated 58 749 people with opioid use disorder engaged in opioid agonist therapy (OAT) in 1132 centers in Spain during 2017. We aimed to calculate the incidence of severe injection-related infections in people who inject drugs (PWID) engaged in OAT in harm reduction settings without a safe consumption space. METHODS A retrospective cohort study was performed in PWID engaged in OAT and in a mobile harm reduction unit to quantify admissions to a referral hospital for any severe injection-related infections between 1 January 2016 and 31 December 2019. A Cox proportional hazard regression analysis was used to assess factors associated with any severe injection-related infection. RESULTS Two hundred thirty-seven PWID who engaged in OAT were included in the study. After a median follow-up of 5.5 months (interquartile range [IQR], 1.3-22.7 months), a total of 104 episodes of severe injection-related infections occurred among 56 individuals, and admission due to a second event occurred in 35.7% of this same group. The incidence density of any type of severe injection-related infection was 26.8 (95% confidence interval [CI], 20.2-34.8) episodes per 100 person-years, and the incidence density of complicated skin and soft tissue infections that required hospital admission was 20.4 (95% CI, 15.0-27.3) episodes per 100 person-years. Fifty-six (53.8%) of all the episodes were patient-directed discharge (PDD), and people who had 2 or more hospital admissions had a higher PDD frequency. CONCLUSIONS Severe injection-related infections remain highly prevalent among PWID cared for in a harm reduction setting without a safe consumption space. PDD was more frequent among higher-risk individuals who presented 2 or more hospital readmissions.
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Affiliation(s)
- Jorge Valencia
- Harm Reduction Unit “SMASD,” Addictions and Mental Health Department, Madrid, Spain
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Jesús Troya
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona,Spain
| | - Guillermo Cuevas
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Alejandro Alvaro-Meca
- Unit of Preventive Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Juan Torres
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Carlos Gardeta
- Harm Reduction Unit “SMASD,” Addictions and Mental Health Department, Madrid, Spain
| | - David Lozano
- Harm Reduction Unit “SMASD,” Addictions and Mental Health Department, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Ramon y Cajal Hospital, IRYCIS, University of Alcalá de Henares, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
- School of Medicine, Complutense University of Madrid, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid,Spain
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van Draanen J, Tsang C, Mitra S, Karamouzian M, Richardson L. Socioeconomic marginalization and opioid-related overdose: A systematic review. Drug Alcohol Depend 2020; 214:108127. [PMID: 32650191 PMCID: PMC7313902 DOI: 10.1016/j.drugalcdep.2020.108127] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Socioeconomic marginalization (SEM) is an important but under-explored determinant of opioid overdose with important implications for health equity and associated public policy initiatives. This systematic review synthesizes evidence on the role of SEM in both fatal and non-fatal overdose among people who use opioids. METHODS Studies published between January 1, 2000 and March 31, 2018 were identified through searching electronic databases, citations, and by contacting experts. The titles, abstracts, citation information, and descriptor terms of citations were screened by two team members. Data were synthesized using the lumping technique. RESULTS A total of 37 studies met inclusion criteria and were included in the review, with 34 of 37 finding a significant association between at least one socioeconomic factor and overdose. The included studies contained variables related to eight socioeconomic factors: criminal justice system involvement, income, employment, social support, health insurance, housing/homelessness, education, and composite measures of socio-economic status. Most studies found associations in the hypothesized direction, whereby increased SEM was associated with a higher rate or increased likelihood of the overdose outcome measured. The review revealed an underdeveloped evidence base. CONCLUSIONS Nearly all reviewed studies found a connection between a socioeconomic variable and overdose, but more research is needed with an explicit focus on SEM, using robust and nuanced measures that capture multiple dimensions of disadvantage, and collect data over time to better inform decision making around opioid overdose.
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Affiliation(s)
- Jenna van Draanen
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Christie Tsang
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, School of Social Work, The Jack Bell Building, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada
| | - Sanjana Mitra
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Interdisciplinary Studies Graduate Program, 270, 2357 Main Mall, H. R. MacMillan Building, Vancouver, BC, V6T 1Z4, Canada
| | - Mohammad Karamouzian
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Lindsey Richardson
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
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Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study. PLoS Med 2019; 16:e1002964. [PMID: 31770391 PMCID: PMC6879115 DOI: 10.1371/journal.pmed.1002964] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND People who inject drugs (PWID) experience elevated rates of premature mortality. Although previous studies have demonstrated the role of supervised injection facilities (SIFs) in reducing various harms associated with injection drug use, including accidental overdose death, the possible impact of SIF use on all-cause mortality is unknown. Therefore, we examined the relationship between frequent SIF use and all-cause mortality among PWID in Vancouver, Canada. METHODS AND FINDINGS Data were derived from 2 prospective cohort studies of PWID in Vancouver, Canada, between December 2006 and June 2017. Every 6 months, participants completed questionnaires that elicited information regarding sociodemographic characteristics, substance use patterns, social-structural exposures, and use of health services including SIFs. These data were confidentially linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariable extended Cox regression analyses to estimate the independent association between frequent (i.e., at least weekly) SIF use and all-cause mortality. Of 811 participants, 278 (34.3%) were women, and the median age was 39 years (IQR 33-46) at baseline. In total, 432 (53.3%) participants reported frequent SIF use at baseline, and 379 (46.7%) did not. At baseline, frequent SIF users were on average younger than nonfrequent users, and a higher proportion of frequent SIF users than nonfrequent users were unstably housed, resided in the Downtown Eastside neighbourhood, injected in public, had a recent non-fatal overdose, used prescription opioids at least daily, injected heroin at least daily, injected cocaine at least daily, and injected crystal methamphetamine at least daily. A lower proportion of frequent SIF users than nonfrequent users were HIV positive and enrolled in addiction treatment at baseline. The median duration of follow-up among study participants was 72 months (IQR 24-123). In total, 112 participants (13.8%) died during the study period, yielding a crude mortality rate of 22.7 (95% CI 18.7-27.4) deaths per 1,000 person-years. The median years of potential life lost per death was 34 (IQR 27-42) years. In a time-updated multivariable model, frequent SIF use was inversely associated with risk of all-cause mortality after adjusting for potential confounders, including age, sex, HIV seropositivity, unstable housing, at least daily cocaine injection, public injection, incarceration, enrolment in addiction treatment, and calendar year of interview (adjusted hazard ratio 0.46, 95% CI 0.26-0.80, p = 0.006). The main study limitations are the limited generalizability of findings due to non-random sampling, the potential for reporting biases due to reliance on some self-reported information, and the possibility that residual confounding influenced findings. CONCLUSIONS We observed a high burden of premature mortality among a community-recruited cohort of PWID. Frequent SIF use was associated with a lower risk of death, independent of relevant confounders. These findings support efforts to enhance access to SIFs as a strategy to reduce mortality among PWID. Further analyses of individual-level data are needed to determine estimates of, and potential causal pathways underlying, associations between SIF use and specific causes of death.
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Cao L, Burton VS, Liu L. Correlates of Illicit Drug Use Among Indigenous Peoples in Canada: A Test of Social Support Theory. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2018; 62:4510-4527. [PMID: 29484913 DOI: 10.1177/0306624x18758853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Relying on a national stratified random sample of Indigenous peoples aged 19 years old and above in Canada, this study investigates the correlates of illicit drug use among Indigenous peoples, paying special attention to the association between social support measures and illegal drug use. Results from multivariate logistical regression show that measures of social support, such as residential mobility, strength of ties within communities, and lack of timely counseling, are statistically significant correlates of illicit drug use. Those identifying as Christian are significantly less likely to use illegal drugs. This is the first nationwide analysis of the illicit drug usage of Indigenous peoples in Canada. The results are robust because we have controlled for a range of comorbidity variables as well as a series of sociodemographic variables. Policy implications from these findings are discussed.
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Affiliation(s)
- Liqun Cao
- 1 University of Ontario Institute of Technology, Oshawa, Canada
| | | | - Liu Liu
- 3 Nanjing University, Nanjing, China
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Goldman-Hasbun J, DeBeck K, Buxton JA, Nosova E, Wood E, Kerr T. Knowledge and possession of take-home naloxone kits among street-involved youth in a Canadian setting: a cohort study. Harm Reduct J 2017; 14:79. [PMID: 29273031 PMCID: PMC5741899 DOI: 10.1186/s12954-017-0206-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The distribution of take-home naloxone (THN) kits has been an important strategy in reducing overdose fatalities among people who use drugs. However, little is known about the use of THN among youth who are street-involved. The present study explores knowledge and possession of THN among street-involved youth in a Canadian setting. METHODS Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth age 14-28 at enrollment in Vancouver, Canada. Participants completed a standardized questionnaire, which included items related to knowledge and possession of THN, sociodemographic characteristics, and substance use-related factors. Multivariable logistic regression models were used to identify factors independently associated with knowledge and possession of THN. RESULTS Between December 2014 and November 2016, 177 youth were interviewed, including 68 females (38.4%). While 126 (71.2%) participants reported knowledge of THN, only 40 (22.6%) possessed a THN kit. Caucasian/white ethnicity was found to be positively associated with both knowledge and possession of THN (both p < 0.05). Public injection drug use in the last 6 months was found to be positively associated with knowledge of THN, while daily heroin use and daily methamphetamine use were associated with possession of THN (all p < 0.05). Male gender was negatively associated with possession of THN (p < 0.05). CONCLUSIONS These findings highlight important gaps between knowledge and possession of THN among youth and the need to increase participation in THN programs among specific populations including non-white and male youth. Further research is needed to gain a better understanding of the barriers that may prevent certain youth from acquiring THN kits.
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Affiliation(s)
- Julia Goldman-Hasbun
- British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada.,School of Public Policy, Simon Fraser University, 515 West Hastings Street, Vancouver, V6B 5K3, BC, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, BC, Canada.,British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, V5Z 4R4, BC, Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada.
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Jongbloed K, Pearce ME, Pooyak S, Zamar D, Thomas V, Demerais L, Christian WM, Henderson E, Sharma R, Blair AH, Yoshida EM, Schechter MT, Spittal PM. The Cedar Project: mortality among young Indigenous people who use drugs in British Columbia. CMAJ 2017; 189:E1352-E1359. [PMID: 29109208 DOI: 10.1503/cmaj.160778] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Young Indigenous people, particularly those involved in the child welfare system, those entrenched in substance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in British Columbia and explore predictors of mortality over time. METHODS We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression. RESULTS Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person-years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2-17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6-10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47-5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01-3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00-8.09). INTERPRETATION Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care.
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Affiliation(s)
- Kate Jongbloed
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Margo E Pearce
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Sherri Pooyak
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - David Zamar
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Vicky Thomas
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Lou Demerais
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Wayne M Christian
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Earl Henderson
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Richa Sharma
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Alden H Blair
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Eric M Yoshida
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Martin T Schechter
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Patricia M Spittal
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
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Cressman AM, Mazereeuw G, Guan Q, Jia W, Gomes T, Juurlink DN. Availability of naloxone in Canadian pharmacies:a population-based survey. CMAJ Open 2017; 5:E779-E784. [PMID: 29117991 PMCID: PMC5741422 DOI: 10.9778/cmajo.20170123] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Naloxone is life-saving when administered after opioid overdose. In March 2016, the Canadian government made the antidote available without prescription, but anecdotal reports suggest members of the public have difficulty in procuring it. We examined the availability of naloxone in community pharmacies across Canada. METHODS We identified community pharmacies in Canada (n = 10 296) and randomly selected 506, stratified using proportionate allocation by population size. We excluded pharmacies in Alberta and Manitoba because these provinces released data indicating which pharmacies made naloxone available to the public during the data collection phase of the study. We contacted pharmacies by telephone during working hours and used a standardized survey to enquire about the availability of naloxone, the associated cost and the need for a prescription. When a pharmacy did not have naloxone available, we ascertained if it could be procured within 7 days. RESULTS We contacted 429 community pharmacies. Of these, 103 (24.0%) had naloxone available. Availability was highest in British Columbia (33 of 65; 50.8%), followed by the Maritimes (12 of 35; 34.3%), Ontario (52 of 193; 26.9%) and central and northern Canada (5 of 21; 23.8%). In Quebec, 1 of 115 (0.9%) pharmacies had naloxone available. Of pharmacies without naloxone, fewer than 1 in 5 anticipated being able to provide it within 1 week (63 of 326; 19.3%). INTERPRETATION Most community pharmacies in Canada did not have naloxone on hand and in those without naloxone available, fewer than 1 in 5 anticipated being able to provide it within 1 week. Our findings emphasize the need for increased availability of naloxone in pharmacies across Canada.
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Affiliation(s)
- Alex M Cressman
- Affiliations: Departments of Internal Medicine (Cressman) and Undergraduate Medical Education (Mazereeuw), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Guan), Dalla Lana School of Public Health; Leslie Dan Faculty of Pharmacy (Jia, Gomes), University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Institute for Clinical Evaluative Sciences (Gomes, Juurlink); Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Graham Mazereeuw
- Affiliations: Departments of Internal Medicine (Cressman) and Undergraduate Medical Education (Mazereeuw), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Guan), Dalla Lana School of Public Health; Leslie Dan Faculty of Pharmacy (Jia, Gomes), University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Institute for Clinical Evaluative Sciences (Gomes, Juurlink); Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Qi Guan
- Affiliations: Departments of Internal Medicine (Cressman) and Undergraduate Medical Education (Mazereeuw), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Guan), Dalla Lana School of Public Health; Leslie Dan Faculty of Pharmacy (Jia, Gomes), University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Institute for Clinical Evaluative Sciences (Gomes, Juurlink); Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Wenting Jia
- Affiliations: Departments of Internal Medicine (Cressman) and Undergraduate Medical Education (Mazereeuw), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Guan), Dalla Lana School of Public Health; Leslie Dan Faculty of Pharmacy (Jia, Gomes), University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Institute for Clinical Evaluative Sciences (Gomes, Juurlink); Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - Tara Gomes
- Affiliations: Departments of Internal Medicine (Cressman) and Undergraduate Medical Education (Mazereeuw), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Guan), Dalla Lana School of Public Health; Leslie Dan Faculty of Pharmacy (Jia, Gomes), University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Institute for Clinical Evaluative Sciences (Gomes, Juurlink); Sunnybrook Research Institute (Juurlink), Toronto, Ont
| | - David N Juurlink
- Affiliations: Departments of Internal Medicine (Cressman) and Undergraduate Medical Education (Mazereeuw), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Guan), Dalla Lana School of Public Health; Leslie Dan Faculty of Pharmacy (Jia, Gomes), University of Toronto; Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Institute for Clinical Evaluative Sciences (Gomes, Juurlink); Sunnybrook Research Institute (Juurlink), Toronto, Ont
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12
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Das S, Shah N, Ghadiali M. Intravenous use of intranasal naloxone: A case of overdose reversal. Subst Abus 2016; 38:18-21. [DOI: 10.1080/08897077.2016.1267686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Smita Das
- Department of Addiction Psychiatry, University of California San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Nina Shah
- Chemical Dependency Recovery Program, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Murtuza Ghadiali
- Department of Addiction Psychiatry, University of California San Francisco, San Francisco, California, USA
- Department of Addiction Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
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13
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Landry M, Veilleux N, Arseneault JE, Abboud S, Barrieau A, Bélanger M. Impact of a methadone maintenance program on an Aboriginal community: a qualitative study. CMAJ Open 2016; 4:E431-E435. [PMID: 27730106 PMCID: PMC5047842 DOI: 10.9778/cmajo.20150076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Methadone maintenance treatment programs implemented in Aboriginal communities have proven to be beneficial for the control of opioid addiction and its associated consequences, but the perceptions and opinions of different community members about these programs remain elusive. The goal of this study was to determine the perceptions of members of a First Nation community in New Brunswick, Canada, on the implementation of a methadone maintenance treatment program and its effects on the community. METHODS We conducted a qualitative study using semistructured focus group discussions with 3 distinct groups composed of health care professionals and influential community members, patients in the methadone maintenance treatment program and community members at large. Thematic analysis of discussion transcripts was performed. RESULTS A total of 22 partipants were included in the 3 focus groups. All groups of participants expressed that patients in the program are stigmatized and marginalized. Discussions also revealed widespread misconceptions about the program. Participants associated the program with improvements in community-level outcomes and in parenting abilities of patients, but also with difficulties preserving family unity. INTERPRETATION Despite being culturally adapted to the community, elements surrounding the methadone maintenance treatment program in this First Nation community appear to be misunderstood and stigmatized. It may be beneficial to provide community education on these programs to assure community buy-in for the successful implementation of harm reduction programs in Aboriginal communities.
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Affiliation(s)
- Michel Landry
- Department of Family Medicine (Landry, Bélanger, Veilleux, Arseneault, Abboud, Barrieau), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Veilleux, Arseneault, Landry, Abboud, Barrieau), Université de Moncton, Moncton, NB
| | - Nadia Veilleux
- Department of Family Medicine (Landry, Bélanger, Veilleux, Arseneault, Abboud, Barrieau), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Veilleux, Arseneault, Landry, Abboud, Barrieau), Université de Moncton, Moncton, NB
| | - Julie-Eve Arseneault
- Department of Family Medicine (Landry, Bélanger, Veilleux, Arseneault, Abboud, Barrieau), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Veilleux, Arseneault, Landry, Abboud, Barrieau), Université de Moncton, Moncton, NB
| | - Saneea Abboud
- Department of Family Medicine (Landry, Bélanger, Veilleux, Arseneault, Abboud, Barrieau), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Veilleux, Arseneault, Landry, Abboud, Barrieau), Université de Moncton, Moncton, NB
| | - André Barrieau
- Department of Family Medicine (Landry, Bélanger, Veilleux, Arseneault, Abboud, Barrieau), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Veilleux, Arseneault, Landry, Abboud, Barrieau), Université de Moncton, Moncton, NB
| | - Mathieu Bélanger
- Department of Family Medicine (Landry, Bélanger, Veilleux, Arseneault, Abboud, Barrieau), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Veilleux, Arseneault, Landry, Abboud, Barrieau), Université de Moncton, Moncton, NB
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Martins SS, Sampson L, Cerdá M, Galea S. Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature. Am J Public Health 2016; 105:e29-49. [PMID: 26451760 DOI: 10.2105/ajph.2015.302843] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Drug overdose is an important, yet an inadequately understood, public health problem. Global attention to unintentional drug overdose has been limited by comparison with the scope of the problem. There has been a substantial increase in drug overdose incidence and prevalence in several countries worldwide over the past decade, contributing to both increased costs and mortality. OBJECTIVES The aim of this study was to systematically synthesize the peer-reviewed literature to document the global epidemiological profile of unintentional drug overdoses and the prevalence, time trends, mortality rates, and correlates of drug overdoses. We searched different combinations of Medical Subject Headings (MeSH) terms in PubMed for articles published from 1980 until July 2013, and we organized these results in tabular spreadsheets and compared them. We restricted the search to English-language articles that deal with unintentional overdose, focusing on 1 or more of the following key constructs: prevalence, time trends, mortality rates, and correlates. The term "overdose" as a MeSH major topic yielded 1076 publications. In addition, we searched the following combinations of nonmajor MeSH terms: "street drugs" and "overdose" yielded 180, "death" and "overdose" yielded 114, and "poisoning" and "drug users" yielded 17. There was some overlap among the searches. Based on the search and inclusion and exclusion criteria, we selected a total of 169 relevant articles for this article based on a close review of abstracts. RESULTS We found wide variability in lifetime prevalence of experiencing a nonfatal overdose or witnessing an overdose, and in mortality rates attributable to overdose. Lifetime prevalence of witnessed overdose among drug users (n = 17 samples) ranged from 50% to 96%, with a mean of 73.3%, a median of 70%, and a standard deviation of 14.1%. Lifetime prevalence of drug users personally experiencing a nonfatal overdose (n = 27 samples), ranged from 16.6% to 68.0% with a mean of 45.4%, a median of 47%, and a standard deviation of 14.4%. Population-based crude overdose mortality rates (n = 28 samples) ranged from 0.04 to 46.6 per 100 000 person-years. This range is likely attributable to the diversity in regions, time periods, and samples. Most studies on longitudinal trends of overdose death rates or overdose-related hospitalization rates showed increases in overdose death rates and in overdose-related hospitalization rates across time, which have led to peaks in these rates at the present time. An overall trend of increasing deaths from prescription opioid use and decreasing deaths from illicit drug use in the past several years has been noted across most of the literature. With the increase in prescription opioid overdose deaths, drug overdose is not just an urban problem: rural areas have seen an important increase in overdose deaths. Lastly, cocaine, prescription opioids, and heroin are the drugs most commonly associated with unintentional drug overdoses worldwide and the demographic and psychiatric correlates associated with unintentional drug overdoses are similar globally. CONCLUSIONS There is a need to invest in research to understand the distinct determinants of prescription drug overdose worldwide. Several other countries need to collect in a systematic and continuous fashion such data on sales of prescription opioids and other prescription drugs, nonmedical use of prescription drugs, and hospitalization secondary to overdoses on prescription drugs. The sparse evidence on the environmental determinants of overdose suggests a need for research that will inform the types of environmental interventions we can use to prevent drug overdose. Methodological issues for future studies include enhancing data collection methods on unintentional fatal and nonfatal overdoses, and collecting more detailed information on drug use history, source of drug use (for prescription drugs), and demographic and psychiatric history characteristics of the individual who overdosed.
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Affiliation(s)
- Silvia S Martins
- Silvia S. Martins is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Laura Sampson and Sandro Galea are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis
| | - Laura Sampson
- Silvia S. Martins is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Laura Sampson and Sandro Galea are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis
| | - Magdalena Cerdá
- Silvia S. Martins is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Laura Sampson and Sandro Galea are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis
| | - Sandro Galea
- Silvia S. Martins is with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Laura Sampson and Sandro Galea are with the Department of Epidemiology, Boston University School of Public Health, Boston, MA. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis
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15
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Fischer B, Murphy Y, Rudzinski K, MacPherson D. Illicit drug use and harms, and related interventions and policy in Canada: A narrative review of select key indicators and developments since 2000. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:23-35. [PMID: 26359046 DOI: 10.1016/j.drugpo.2015.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND By the year 2000, Canada faced high levels of illicit drug use and related harms. Simultaneously, a fundamental tension had raisen between continuing a mainly repression-based versus shifting to a more health-oriented drug policy approach. Despite a wealth of new data and numerous individual studies that have emerged since then, no comprehensive review of key indicators and developments of illicit drug use/harm epidemiology, interventions and law/policy exist; this paper seeks to fill this gap. METHODS We searched and reviewed journal publications, as well as key reports, government publications, surveys, etc. reporting on data and information since 2000. Relevant data were selected and extracted for review inclusion, and subsequently grouped and narratively summarized in major topical sub-theme categories. RESULTS Cannabis use has remained the principal form of illicit drug use; prescription opioid misuse has arisen as a new and extensive phenomenon. While new drug-related blood-borne-virus transmissions declined, overdose deaths increased in recent years. Acceptance and proliferation of - mainly local/community-based - health measures (e.g., needle exchange, crack paraphernalia or naloxone distribution) aiming at high-risk drug users has evolved, though reach and access limitations have persisted; Vancouver's 'supervised injection site' has attracted continued attention yet remains un-replicated elsewhere in Canada. While opioid maintenance treatment utilization increased, access to treatment for key (e.g., infectious disease, psychiatric) co-morbidities among drug users remained limited. Law enforcement continued to principally focus on cannabis and specifically cannabis users. 'Drug treatment courts' were introduced but have shown limited effectiveness; several attempts cannabis control law reform have failed, except for the recent establishment of 'medical cannabis' access provisions. CONCLUSIONS While recent federal governments introduced several law and policy measures reinforcing a repression approach to illicit drug use, lower-level jurisdictions (e.g., provincial/municipal levels) and non-governmental organizations increasingly promoted social- and health-oriented intervention frameworks and interventions, therefore creating an increasingly bifurcated - and inherently contradictory - drug policy landscape and reality in Canada.
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Affiliation(s)
- Benedikt Fischer
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
| | - Yoko Murphy
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada
| | - Katherine Rudzinski
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada
| | - Donald MacPherson
- Canadian Drug Policy Coalition, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
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Soukup-Baljak Y, Greer AM, Amlani A, Sampson O, Buxton JA. Drug quality assessment practices and communication of drug alerts among people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015. [PMID: 26205676 DOI: 10.1016/j.drugpo.2015.06.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Regional health bodies in British Columbia (BC) issue drug alerts to the public when health risks associated with drug quality are identified, such as increased illicit drug deaths, overdoses or other harms. There is a lack of evidence-based guidelines for producing timely, effective public health alerts to mitigate these harms. This study sought to understand (1) the practices used by people who use drugs (PWUD) to assess the quality of street drugs and reduce harms from adulterants and (2) how drug alerts could be better communicated to PWUD. METHODS Guided by interpretive and descriptive methodology, this study consisted of brief questionnaires and in-depth focus groups with 32 PWUD. RESULTS Findings suggest the most effective and trusted information about drug quality was primarily from: (a) trusted, reputable dealers or (b) peer-based social networks. Most PWUD thought information received through health service providers was not timely and did not discuss drug quality with them. A number of concrete guidelines were suggested by participants to improve the effectiveness of drug alert modes and methods of communication in the community, including the use of language on drug alert postings that implies harm, indicates what drug effects to look for, and suggests appropriate responses to overdose, such as the use of naloxone. Participants also emphasized the need to date posters and remove them in a timely manner so as to not desensitize the community to such alerts. CONCLUSION Since it is difficult to control adulteration practices in an unregulated drug market, this study suggests methods of effectively producing and communicating drug alerts among PWUD to mitigate harms associated with drug use.
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Affiliation(s)
- Yuko Soukup-Baljak
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada
| | - Alissa M Greer
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada.
| | - Ashraf Amlani
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada
| | - Olivia Sampson
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada
| | - Jane A Buxton
- BC Center for Disease Control, 655 12th Avenue West, Vancouver, British Columbia V5Z 4R4, Canada
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Potential Years of Life Lost Due to Premature Mortality Among Treatment-Seeking Illicit Drug Users in Finland. J Community Health 2015; 40:1099-106. [PMID: 25967278 DOI: 10.1007/s10900-015-0035-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Premature death is a serious public health concern. The primary objective of this study was to examine premature deaths in terms of potential years of life lost (PYLL) in a cohort of 4817 treatment-seeking illicit drug users. Clients' data were linked to the Finnish national cause-of-death register and the follow-up period ranged from 31 January 1997 to 31 December 2010. PYLL before 70 years was calculated for all deaths and cause-specific deaths by gender. We observed 496 deaths (417 males and 79 females) at the end of 2010. The mean age at death was 33.8 years, 34.3 years for males (range 18-68) and 31.4 years for females (range 16-53). Overall, 17,951 life years were lost; 14,898 among males and 3053 among females. The overall PYLL rate for males was more than twice that of females (513.0/1000 vs. 243.7/1000 person-years) but the mean PYLL was higher in females than males (38.6 vs. 35.7 years). Of the total PYLL, 34.8 % was due to accidental overdose, and 24.0 % to suicide. In both genders, accidental overdose and suicide were the two top-ranking causes of PYLL. Premature deaths among drug users are a potential loss to the society. Our findings suggest that measures targeting accidental overdose and suicide are top priorities for reducing preventable loss of life.
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Doe-Simkins M, Quinn E, Xuan Z, Sorensen-Alawad A, Hackman H, Ozonoff A, Walley AY. Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study. BMC Public Health 2014; 14:297. [PMID: 24684801 PMCID: PMC4004504 DOI: 10.1186/1471-2458-14-297] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 03/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND One approach to preventing opioid overdose, a leading cause of premature, preventable mortality, is to provide overdose education and naloxone distribution (OEND). Two outstanding issues for OEND implementation include 1) the dissemination of OEND training from trained to untrained community members; and 2) the concern that OEND provides active substance users with a false sense of security resulting in increased opioid use. METHODS To compare overdose rescue behaviors between trained and untrained rescuers among people reporting naloxone rescue kit use; and determine whether heroin use changed after OEND, we conducted a retrospective cohort study among substance users in the Massachusetts OEND program from 2006 to 2010. We used chi square and t-test statistics to compare the differences in overdose management characteristics among overdoses managed by trained versus untrained participants. We employed Wilcoxon signed rank test to compare median difference among two repeated measures of substance use among participants with drug use information collected more than once. RESULTS Among 4,926 substance-using participants, 295 trained and 78 untrained participants reported one or more rescues, resulting in 599 rescue reports. We found no statistically significant differences in help-seeking (p = 0.41), rescue breathing (p = 0.54), staying with the victim (p = 0.84) or in the success of naloxone administration (p = 0.69) by trained versus untrained rescuers. We identified 325 OEND participants who had drug use information collected more than once. We found no significant overall change in the number of days using heroin in past 30 days (decreased 38%, increased 35%, did not change 27%, p = 0.52). CONCLUSION Among 4926 substance users who participated in OEND, 373(7.6%) reported administering naloxone during an overdose rescue. We found few differences in behavior between trained and untrained overdose rescuers. Prospective studies will be needed to determine the optimal level of training and whether naloxone rescue kits can meet an over-the-counter standard. With no clear evidence of increased heroin use, this concern should not impede expansion of OEND programs or policies that support them.
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Affiliation(s)
- Maya Doe-Simkins
- Clinical Addiction Research Education Unit, Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, USA
| | - Emily Quinn
- Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, Third Floor, Boston, MA 02118, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Fourth Floor, Boston, MA 02118, USA
| | - Amy Sorensen-Alawad
- Clinical Addiction Research Education Unit, Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, USA
| | - Holly Hackman
- Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108, USA
| | - Al Ozonoff
- Boston Children’s Hospital, Center for Patient Safety and Quality Research, 300 Longwood Avenue, Boston, MA 02115, USA
- Harvard Medical School, Department of Pediatrics, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Alexander Y Walley
- Clinical Addiction Research Education Unit, Section of General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Second Floor, Boston, MA 02118, USA
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Williams AV, Marsden J, Strang J. Training family members to manage heroin overdose and administer naloxone: randomized trial of effects on knowledge and attitudes. Addiction 2014; 109:250-9. [PMID: 24103087 DOI: 10.1111/add.12360] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/04/2012] [Accepted: 09/09/2013] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate a heroin overdose management training programme for family members based on emergency recovery procedures and take-home naloxone (THN) administration. DESIGN A two-group, parallel-arm, non-blinded, randomized controlled trial of group-based training versus an information-only control. SETTING Training events delivered in community addiction treatment services in three locations in England. PARTICIPANTS A total of 187 family members and carers allocated to receive either THN training or basic information on opioid overdose management (n = 95 and n = 92, respectively), with 123 participants completing the study. MEASUREMENTS The primary outcome measure was a self-completion Opioid Overdose Knowledge Scale (OOKS; range 0-45) and an Opioid Overdose Attitudes Scale (OOAS; range 28-140) was the secondary outcome measure. Each group was assessed before receiving their assigned condition and followed-up 3 months after. Events of witnessing and managing an overdose during follow-up were also recorded. FINDINGS At follow-up, study participants who had received THN training reported greater overdose-related knowledge relative to those receiving basic information only [OOKS mean difference, 4.08 (95% confidence interval, 2.10-6.06; P < 0.001); Cohen's d = 0.74 (0.37-1.10)]. There were also more positive opioid overdose-related attitudes among the trained group at follow-up [OOAS mean difference, 7.47 (3.13-11.82); P = 0.001; d = 0.61 (0.25-0.97)]. At the individual level 35 and 54%, respectively, of the experimental group increased their knowledge and attitudes compared with 11 and 30% of the control group. During follow-up, 13 participants witnessed an overdose with naloxone administered on eight occasions: five among the THN-trained group and three among the controls. CONCLUSIONS Take-home naloxone training for family members of heroin users increases opioid overdose-related knowledge and competence and these benefits are well retained after 3 months.
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Affiliation(s)
- Anna V Williams
- Addictions Department, Institute of Psychiatry, King's College London, London, UK
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20
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21
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Tait CL. Resituating the ethical gaze: government morality and the local worlds of impoverished Indigenous women. Int J Circumpolar Health 2013; 72:21207. [PMID: 23986898 PMCID: PMC3754611 DOI: 10.3402/ijch.v72i0.21207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Over generations, government policies have impacted upon the lives of Indigenous peoples of Canada in unique and often devastating ways. In this context, Indigenous women who struggle with poverty, mental illness, trauma and substance abuse are among the most vulnerable, as are Indigenous children involved in child welfare systems. Objective By examining the life history of Wanda, a First Nations woman, this article examines the intergenerational role that government policies play in the lives of impoverished Indigenous women and their families. Questions of moral governance and responsibility and the need for ethical policies are raised. Design The life narrative presented in this article is part of a larger qualitative research programme that has collected over 100 life histories of Indigenous women with addictions and who have involvement with the child welfare system, as children or adults. Wanda's life story exemplifies the impact of government policies that is characteristic of vulnerable Indigenous women and draws attention to the lack of ethical standards in government policymaking in child welfare, public health and mental health/addictions. Results The path to recovery for Canadian Indigenous women in need of treatment for co-occurring mental disorders and substance addiction is too frequently characterized by an inadequate and ever shifting continuum of care. For those who feel intimidated, suspicious or have simply given up on seeking supports, a profound invisibility or forgetting of their struggle exists in areas of government policy and programming provision. Living outside the scope of mental health and addiction priorities, they become visible to the human service sector only if they become pregnant, their parenting draws the attention of child and family services (CFS), they need emergency health care, or are in trouble with the law. The intergenerational cycle of substance abuse, mental illness and poverty is commonly associated with child welfare involvement, specifically practices that place the health and well-being of Indigenous children at risk. In order to break this cycle, close attention to implementation of ethically based policies and best practice interventions is required. Conclusions From an ethical policy perspective, the focus of government policies and the practices they generate must be first and foremost to ensure that individuals, families and groups are not left worse off than prior to a government policy impacting upon their life. Furthermore, the impact of living a life determined by multiple government policies should not be a story of individual and family devastation, and government policies should not be the most significant determinant of health for any group of people.
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Affiliation(s)
- Caroline L Tait
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada.
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22
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Abstract
Opioid overdose morbidity and mortality is recognized to have epidemic proportions. Medical and public health agencies are adopting opioid harm reduction strategies to reduce the morbidity and mortality associated with overdose. One strategy developed by emergency medical services and public health agencies is to deliver the opioid antidote naloxone injection intranasally to reverse the effects of opioids. Paramedics have used this route to quickly administer naloxone in a needle-free system and avoiding needle-stick injuries and contracting a blood-born pathogen disease such as hepatitis or human immunodeficiency virus. Public health officials advocate broader lay person access since civilians are likely witnesses or first responders to an opioid overdose in a time-acute setting. The barrier to greater use of naloxone is that a suitable and optimized needlefree drug delivery system is unavailable. The scientific basis for design and study of an intranasal naloxone product is described. Lessons from nasal delivery of opioid analgesics are applied to the consideration of naloxone nasal spray.
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Affiliation(s)
- Daniel P Wermeling
- Professor, University of Kentucky College of Pharmacy, 789 South Limestone Street, Lexington, KY USA, 40536-0596
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23
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Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, Ruiz S, Ozonoff A. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ 2013; 346:f174. [PMID: 23372174 PMCID: PMC4688551 DOI: 10.1136/bmj.f174] [Citation(s) in RCA: 657] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To evaluate the impact of state supported overdose education and nasal naloxone distribution (OEND) programs on rates of opioid related death from overdose and acute care utilization in Massachusetts. DESIGN Interrupted time series analysis of opioid related overdose death and acute care utilization rates from 2002 to 2009 comparing community-year strata with high and low rates of OEND implementation to those with no implementation. SETTING 19 Massachusetts communities (geographically distinct cities and towns) with at least five fatal opioid overdoses in each of the years 2004 to 2006. PARTICIPANTS OEND was implemented among opioid users at risk for overdose, social service agency staff, family, and friends of opioid users. INTERVENTION OEND programs equipped people at risk for overdose and bystanders with nasal naloxone rescue kits and trained them how to prevent, recognize, and respond to an overdose by engaging emergency medical services, providing rescue breathing, and delivering naloxone. MAIN OUTCOME MEASURES Adjusted rate ratios for annual deaths related to opioid overdose and utilization of acute care hospitals. RESULTS Among these communities, OEND programs trained 2912 potential bystanders who reported 327 rescues. Both community-year strata with 1-100 enrollments per 100,000 population (adjusted rate ratio 0.73, 95% confidence interval 0.57 to 0.91) and community-year strata with greater than 100 enrollments per 100,000 population (0.54, 0.39 to 0.76) had significantly reduced adjusted rate ratios compared with communities with no implementation. Differences in rates of acute care hospital utilization were not significant. CONCLUSIONS Opioid overdose death rates were reduced in communities where OEND was implemented. This study provides observational evidence that by training potential bystanders to prevent, recognize, and respond to opioid overdoses, OEND is an effective intervention.
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Affiliation(s)
- Alexander Y Walley
- Clinical Addiction Research Education Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
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Marshall BDL, Milloy MJ, Wood E, Galea S, Kerr T. Temporal and geographic shifts in urban and nonurban cocaine-related fatal overdoses in British Columbia, Canada. Ann Epidemiol 2012; 22:198-206. [PMID: 22266349 DOI: 10.1016/j.annepidem.2011.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/13/2011] [Accepted: 12/30/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Illicit drug overdose is a leading cause of premature mortality. We sought to examine fatal overdose trends from 2001 to 2005 in urban and nonurban areas of British Columbia, Canada. METHODS We conducted a review of all provincial coroner files in which drug overdose was the cause of death between January 1, 2001, and December 31, 2005. We compared cocaine and non-cocaine-related overdoses and examined temporal changes in cocaine-related mortality rates in urban and nonurban areas. Multilevel mixed effects models were used to determine the independent risk factors for cocaine-related death. Spatial analyses were conducted to identify clusters of these cases. RESULTS During the study period, 904 illicit drug overdoses were recorded, including 369 (40.8%) in nonurban areas and 532 (58.9%) related to cocaine consumption. In a multilevel model, we observed a significant interaction (p = .010) between population density and year, indicating a considerable and differential increase in the likelihood of cocaine-related deaths in nonurban areas. Cocaine-related deaths were clustered in the southeast region of the province. CONCLUSIONS Cocaine-related overdoses in nonurban areas should be a public health concern. Evidence-based interventions to reduce the risks associated with cocaine consumption and reach drug users in nonurban settings are needed.
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Affiliation(s)
- Brandon D L Marshall
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
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Christian G, Pike G, Santamaria J, Reece S, DuPont R, Mangham C. Overdose deaths and Vancouver's supervised injection facility. Lancet 2012; 379:117; author reply 118-9. [PMID: 22243818 DOI: 10.1016/s0140-6736(12)60054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Marshall BDL, Milloy MJ, Wood E, Montaner JSG, Kerr T. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. Lancet 2011; 377:1429-37. [PMID: 21497898 DOI: 10.1016/s0140-6736(10)62353-7] [Citation(s) in RCA: 312] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Overdose from illicit drugs is a leading cause of premature mortality in North America. Internationally, more than 65 supervised injecting facilities (SIFs), where drug users can inject pre-obtained illicit drugs, have been opened as part of various strategies to reduce the harms associated with drug use. We sought to determine whether the opening of an SIF in Vancouver, BC, Canada, was associated with a reduction in overdose mortality. METHODS We examined population-based overdose mortality rates for the period before (Jan 1, 2001, to Sept 20, 2003) and after (Sept 21, 2003, to Dec 31, 2005) the opening of the Vancouver SIF. The location of death was determined from provincial coroner records. We compared overdose fatality rates within an a priori specified 500 m radius of the SIF and for the rest of the city. FINDINGS Of 290 decedents, 229 (79·0%) were male, and the median age at death was 40 years (IQR 32-48 years). A third (89, 30·7%) of deaths occurred in city blocks within 500 m of the SIF. The fatal overdose rate in this area decreased by 35·0% after the opening of the SIF, from 253·8 to 165·1 deaths per 100,000 person-years (p=0·048). By contrast, during the same period, the fatal overdose rate in the rest of the city decreased by only 9·3%, from 7·6 to 6·9 deaths per 100,000 person-years (p=0·490). There was a significant interaction of rate differences across strata (p=0·049). INTERPRETATION SIFs should be considered where injection drug use is prevalent, particularly in areas with high densities of overdose. FUNDING Vancouver Coastal Health, Canadian Institutes of Health Research, and the Michael Smith Foundation for Health Research.
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Wilkes E, Wilson M, Ward J. Commentary on Milloy et al. (2010): The stark reality of overdose mortality among indigenous peoples--a(nother) plea for action. Addiction 2010; 105:1971-2. [PMID: 21064257 DOI: 10.1111/j.1360-0443.2010.03208.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Edward Wilkes
- Aboriginal Research Programs, National Drug Research Institute, Curtin University, Perth, WA 68451, Australia.
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