Christopher Fairgrieve1,2, Ekaterina Nosova1, M-J Milloy1,3, Nadia Fairbairn1,3, Kora DeBeck1,4, Keith Ahamad1,2, Evan Wood1,3, Thomas Kerr1,3, Kanna Hayashi1,5. 1. British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, Canada. 2. Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada. 3. Department of Medicine, University of British Columbia, Vancouver, BC, Canada. 4. School of Public Policy, Simon Fraser University, Burnaby, BC, Canada. 5. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
Abstract
Background and Aims: Little is known about how the expansion of opioid agonist therapy (OAT) and emergence of fentanyl in the illicit drug supply in North America has influenced non-fatal opioid overdose (NFOD) risk. Therefore, we sought to identify patterns of substance use and addiction treatment engagement (i.e., OAT, other inpatient or outpatient treatment) prior to NFOD, as well as the trends and correlates of each pattern among people who use drugs (PWUD) in Vancouver, Canada. Methods: Data were derived from participants in three prospective cohorts of PWUD in Vancouver in 2009-2016. Observations from participants reporting opioid-related NFOD in the previous six months were included. A latent class analysis was used to identify classes based on substances used at the time of last NFOD and addiction treatment engagement in the month prior to the last NFOD. Multivariable generalized estimating equations estimated the correlates of each class membership. Results: In total, 889 observations from 570 participants were included. Four distinct classes were identified: (1) polysubstance use (PSU) and addiction treatment engagement; (2) PSU without treatment engagement; (3) exposure to unknown substances, mostly without treatment engagement; and (4) primary heroin users without treatment engagement. The class of exposure to unknown substances appeared in 2015 and became the dominant group (76.9%) in 2016. In multivariable analyses, the odds of membership in the class of primary heroin users decreased over time (adjusted odds ratio [AOR]: 0.74, 95% confidence interval [CI]: 0.68-0.81). Conclusions: Changing profiles of PWUD reporting opioid-related NFOD were seen over time. Notably, there was a sudden increase in reports of overdose following exposure to unknown substances since 2015, the majority of whom reported no recent addiction treatment engagement. Further study into patterns of substance use and strategies to improve addiction treatment engagement is needed to improve and focus overdose prevention efforts.
Background and Aims: Little is known about how the expansion of opioid agonist therapy (OAT) and emergence of fentanyl in the illicit drug supply in North America has influenced non-fatal opioid overdose (NFOD) risk. Therefore, we sought to identify patterns of substance use and addiction treatment engagement (i.e., OAT, other inpatient or outpatient treatment) prior to NFOD, as well as the trends and correlates of each pattern among people who use drugs (PWUD) in Vancouver, Canada. Methods: Data were derived from participants in three prospective cohorts of PWUD in Vancouver in 2009-2016. Observations from participants reporting opioid-related NFOD in the previous six months were included. A latent class analysis was used to identify classes based on substances used at the time of last NFOD and addiction treatment engagement in the month prior to the last NFOD. Multivariable generalized estimating equations estimated the correlates of each class membership. Results: In total, 889 observations from 570 participants were included. Four distinct classes were identified: (1) polysubstance use (PSU) and addiction treatment engagement; (2) PSU without treatment engagement; (3) exposure to unknown substances, mostly without treatment engagement; and (4) primary heroin users without treatment engagement. The class of exposure to unknown substances appeared in 2015 and became the dominant group (76.9%) in 2016. In multivariable analyses, the odds of membership in the class of primary heroin users decreased over time (adjusted odds ratio [AOR]: 0.74, 95% confidence interval [CI]: 0.68-0.81). Conclusions: Changing profiles of PWUD reporting opioid-related NFOD were seen over time. Notably, there was a sudden increase in reports of overdose following exposure to unknown substances since 2015, the majority of whom reported no recent addiction treatment engagement. Further study into patterns of substance use and strategies to improve addiction treatment engagement is needed to improve and focus overdose prevention efforts.
Entities:
Keywords:
Overdose; fentanyl; latent class analysis; opioid agonist therapy; opioids
Authors: Daniel Ciccarone; George Jay Unick; Jenny K Cohen; Sarah G Mars; Daniel Rosenblum Journal: Drug Alcohol Depend Date: 2016-04-14 Impact factor: 4.492
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Authors: Rose A Rudd; Len J Paulozzi; Michael J Bauer; Richard W Burleson; Rick E Carlson; Dan Dao; James W Davis; Jennifer Dudek; Beth Ann Eichler; Jessie C Fernandes; Anna Fondario; Barbara Gabella; Beth Hume; Theron Huntamer; Mbabazi Kariisa; Thomas W Largo; JoAnne Miles; Ashley Newmyer; Daniela Nitcheva; Beatriz E Perez; Scott K Proescholdbell; Jennifer C Sabel; Jessica Skiba; Svetla Slavova; Kathy Stone; John M Tharp; Tracy Wendling; Dagan Wright; Anne M Zehner Journal: MMWR Morb Mortal Wkly Rep Date: 2014-10-03 Impact factor: 17.586