Abstract 19 transmission among people who use drugs, in March 2020, prescribed safer supply guidance was released in British Columbia. This study describes demographic and substance use characteristics associated with obtaining prescribed safer supply and examines the association between last six month harm reduction service access and obtaining prescribed safer supply. Methods: Data come from the 2021 Harm Reduction Client Survey administered at 17 harm reduction sites across British Columbia. The sample included all who self-reported use of opioids, stimulants, or benzodiazepines in the prior 3 days (N=491), given active use of these drugs was a requirement for eligibility for prescribed safer supply. The dependent variable was obtaining a prescribed safer supply prescription (Yes vs. No). The primary independent variables were access to drug checking services, and access to overdose prevention services in the last six months (Yes vs. No). Descriptive statistics (Chi-square tests) were used to compare the characteristics of people who did and did not obtain a prescribed safer supply prescription. Multivariable logistic regression models were run to examine the association of drug checking services and overdose prevention services access with obtaining prescribed safer supply. Results: A small proportion (n=81(16.5%)) of the sample obtained prescribed safer supply. After adjusting for gender, age, and urbanicity, people who reported drug checking services access in the last six months had 1.67 (95% CI: 1.00-2.79) times the odds of obtaining prescribed safer supply compared to people who had not contacted these services, and people who reported last six months overdose prevention services access had more than twice the odds (OR: 2.08 (95% CI: 1.20-3.60)) of prescribed safer supply access, compared to people who did not access these services. Conclusions: Overall, the proportion of respondents who received prescribed safer supply was low, suggesting that this intervention is not reaching all those in need. Harm reduction services may serve as a point of contact for referral to prescribed safer supply. Additional outreach strategies and service models are needed to improve the accessibility of harm reduction services and of prescribed safer supply in British Columbia.
Introduction La Colombie-Britannique (C.-B.) a déclaré un état d'urgence en santé publique en avril 2016 en réaction à une augmentation rapide du nombre de décès par surdose. Une meilleure compréhension de l'utilisation des soins de santé est nécessaire pour guider les stratégies de prévention pour les personnes qui font une surdose de drogues illicites. Méthodologie La cohorte provinciale des victimes de surdoses comprend des données administratives couplées sur l'utilisation des soins de santé par les personnes qui ont été victimes d'une surdose de drogues illicites en Colombie-Britannique entre le 1er janvier 2015 et le 30 novembre 2016. Les cas de surdose ont été relevés à l'aide de données provenant des services ambulanciers, des enquêtes des coroners, des appels aux centres antipoison et des dossiers administratifs des hôpitaux, des services d'urgence et des médecins. Au total, 10 455 cas de surdose ont été recensés et comparés à 52 275 témoins appariés selon l'âge, le sexe et la zone de résidence en vue d'une analyse descriptive de l'utilisation des soins de santé. Résultats Les deux tiers (66 %) des cas de surdose concernaient des hommes, et environ la moitié (49 %) les 20 à 39 ans. Plus de la moitié des cas (54 %) se sont rendus au service d'urgence, et environ le quart (26 %) ont été admis à l'hôpital au cours de l'année précédant la surdose, comparativement à respectivement 17 % et 9 % des témoins. Cependant, près d'un cinquième (19 %) des cas ont été enregistrés comme ayant quitté le service d'urgence sans avoir été vus par le médecin ou contre son avis. Des proportions élevées de cas (75 %) et de témoins (72 %) ont consulté un médecin en milieu communautaire. La consommation de substances et des problèmes en santé mentale ont été les diagnostics les plus courants chez les personnes qui ont fait une surdose. Conclusion Les personnes qui ont fait une surdose ont souvent eu accès au système de soins de santé au cours de l'année précédant la surdose. Compte tenu de ces taux élevés d'utilisation des soins de santé, on pourrait peut-être repérer les personnes à risque avant qu'elles ne fassent de surdose et les aiguiller vers des programmes ciblés et des interventions fondées sur des données probantes. Il est prévu d'utiliser la cohorte provinciale des victimes de surdoses de la Colombie-Britannique pour déterminer les facteurs de risque relatifs aux surdoses et aux décès par surdose.
Background The overdose crisis in North America has prompted system-level efforts to restrict opioid prescribing for chronic pain. However, little is known about how discontinuing or tapering prescribed opioids for chronic pain shapes overdose risk, including possible differential effects among people with and without concurrent opioid use disorder (OUD). We examined associations between discontinuation and tapering of prescribed opioids and risk of overdose among people on long-term opioid therapy for pain, stratified by diagnosed OUD and prescribed opioid agonist therapy (OAT) status. Methods and findings For this retrospective cohort study, we used a 20% random sample of residents in the provincial health insurance client roster in British Columbia (BC), Canada, contained in the BC Provincial Overdose Cohort. The study sample included persons aged 14 to 74 years on long-term opioid therapy for pain (≥90 days with ≥90% of days on therapy) between October 2014 and June 2018 ( n = 14,037). At baseline, 7,256 (51.7%) persons were female, the median age was 55 years (quartile 1–3: 47–63), 227 (1.6%) persons had been diagnosed with OUD (in the past 3 years) and recently (i.e., in the past 90 days) been prescribed OAT, and 483 (3.4%) had been diagnosed with OUD but not recently prescribed OAT. The median follow-up duration per person was 3.7 years (quartile 1–3: 2.6–4.0). Marginal structural Cox regression with inverse probability of treatment weighting (IPTW) was used to estimate the effect of prescribed opioid treatment for pain status (discontinuation versus tapered therapy versus continued therapy [reference]) on risk of overdose (fatal or nonfatal), stratified by the following groups: people without diagnosed OUD, people with diagnosed OUD receiving OAT, and people with diagnosed OUD not receiving OAT. In marginal structural models with IPTW adjusted for a range of demographic, prescription, comorbidity, and social-structural exposures, discontinuing opioids (i.e., ≥7-day gap[s] in therapy) was associated with increased overdose risk among people without OUD (adjusted hazard ratio [AHR] = 1.44; 95% confidence interval [CI] 1.12, 1.83; p = 0.004), people with OUD not receiving OAT (AHR = 3.18; 95% CI 1.87, 5.40; p < 0.001), and people with OUD receiving OAT (AHR = 2.52; 95% CI 1.68, 3.78; p < 0.001). Opioid tapering (i.e., ≥2 sequential decreases of ≥5% in average daily morphine milligram equivalents) was associated with decreased overdose risk among people with OUD not receiving OAT (AHR = 0.31; 95% CI 0.14, 0.67; p = 0.003). The main study limitations are that the outcome measure did not capture overdose events that did not result in a healthcare encounter or death, medication dispensation may not reflect medication adherence, residual confounding may have influenced findings, and findings may not be generalizable to persons on opioid therapy in other settings. Conclusions Discontinuing prescribed opioids was associated with increased overdose risk, particularly among people with OUD. Prescribed opioid tapering was associated with reduced overdose risk among people with OUD not receiving OAT. These findings highlight the need to avoid abrupt discontinuation of opioids for pain. Enhanced guidance is needed to support prescribers in implementing opioid therapy tapering strategies with consideration of OUD and OAT status.
Background:We sought to quantify the association between clinical, physiological, and contextual factors and opioid-related overdose, specifically focusing on current and past use of select prescription medications. Methods: We conducted a case-control study of individuals who experienced a non-fatal opioid-related overdose between January 2015 and November 2016 in British Columbia, Canada. We matched 8,831 cases to 44,155 controls on birth year, sex, and local health area of residence and examined 5-year prescribing history for opioids for pain, medications for opioid use disorder (MOUD), benzodiazepines/z-drugs, and other psychoactive medications. Results: The overall prevalence of prescription opioid drug use was generally low in the study population. Cases had a relatively higher use of selected prescription medications, a higher physical and mental morbidity burden, and were less connected to health services compared with controls. For opioids for pain, current therapy was associated with experiencing an overdose (OR = 8.5, 95%CI: 7.3-10); history of long-term use had a stronger association than history of short-term use (OR = 2.9, 95%CI: 2.6-3.3 vs OR = 1.7, 95%CI: 1.5-1.8, respectively). While persons on MOUD were more likely to overdose compared to persons who were not on therapy (OR = 2.0, 95%CI 1.7-2.4), recent discontinuation of MOUD greatly increased the likelihood of overdose (OR = 25.6, 95%CI 17.5-37.4). Active therapy of benzodiazepines/z-drugs and other sedating medications also significantly increased the likelihood of overdose. Conclusions: While this study supports expansion of efforts to prevent overdoses among individuals actively using opioids for pain and improve retention among those on MOUD, it is also important to address other clinical, physiological, and contextual risk and protective factors to help curb the current overdose crisis.
A substantial number of hospital admissions end in patient-initiated departure before medical treatment is complete. Whether "before medically advised" (BMA) discharge increases the risk of subsequent drug overdose remains uncertain.
Introduction The Good Samaritan Drug Overdose Act, a federal law enacted in Canada in 2017, aims to increase bystander response to overdoses by offering legal protection for arrests related to simple possession at the scene of an overdose. As this legislation suggests, a shift has occurred to view overdose events as a medical issue, constituting a shift in the role of police officers. Our study aimed to uncover the role police perceive for themselves at overdose events.Methods Twenty-two qualitative interviews were conducted with police officers across British Columbia (BC). A thematic analysis was completed to identify patterns in the data.Findings Police officers perceived their primary role was to ensure the safety of first responders and bystanders at overdose events. Some officers favored enforcing mandatory treatment and used coercive practices to ensure overdose victims received further medical care.Discussion Policies which reframe overdose events in terms of a health rather than criminal response put into question whether police officers have a role at overdose events and, if so, what it is.Conclusions Education and awareness are needed to reduce stigma towards people who use drugs, misunderstandings around naloxone and harmful practices such as coercion, at overdose events.
With growing rates of unregulated drug toxicity death and concerns regarding COVID-19 transmission among people who use drugs, in March 2020, prescribed safer supply guidance was released in British Columbia. This study describes demographic and substance use characteristics associated with obtaining prescribed safer supply and examines the association between last 6-month harm reduction service access and obtaining prescribed safer supply.
Abstract Background Patient‐initiated or “before medically advised” (BMA) hospital discharge is more common among people who use drugs. Transitions of care can be destabilizing and might increase the risk of subsequent illicit drug overdose. Objectives This study sought to evaluate whether BMA discharge is associated with an increased risk of subsequent drug overdose (primary objective) and whether physician‐advised discharge is associated with an increased risk of subsequent drug overdose (secondary objective). Methods We performed a case‐crossover analysis of population‐based linked administrative health data for individuals experiencing an overdose between 2016 and 2019 in British Columbia, Canada. Using conditional logistic regression, we compared the likelihood of hospital discharge in the 28 days before overdose (the “pre‐overdose interval”) to the likelihood of hospital discharge in two self‐matched 28‐day control intervals ending 26 and 52 weeks before overdose. Results Over the 3.5‐year study interval, 235 of 27,584 (0.9%) pre‐overdose intervals and 189 of 55,168 (0.3%) control intervals included a BMA discharge, suggesting that BMA discharge was associated with a twofold increase in the risk of subsequent drug overdose (adjusted odds ratio [aOR], 2.08; 95% confidence interval [95% CI], 1.68–2.58; p < 0.001). Physician‐advised hospital discharge was also a risk factor for subsequent overdose, occurring in 1350 of 27,584 (4.9%) pre‐overdose intervals and 1625 of 55,168 (2.9%) control intervals (aOR, 1.39; 95% CI, 1.27–1.52; p < .001). Conclusions Both BMA and physician‐advised hospital discharge are independently associated with transient increases in the risk of subsequent illicit drug overdose. Better in‐hospital treatment of substance use disorder and novel means of post‐discharge outreach should be deployed to reduce this risk.
