At-a-glance - Concurrent monitoring of opioid prescribing practices and opioid-related deaths: the context in Nova Scotia, Canada

Schleihauf, Emily; Crabtree, Kirstin; Dohoo, Carolyn; Fleming, Sarah; McPeake, Heather; Bowes, Matthew

doi:10.24095/hpcdp.38.9.05

Cited by 9 publications

(9 citation statements)

References 15 publications

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“…Among patients with IDU-IE in both Halifax and Saint John sites who reported injection opioid use, all patients used diverted or non-prescribed pharmaceutical opioids (primarily hydromorphone tablets) and none reported heroin or fentanyl use. This pattern is consistent with the drug supply available in these communities during the study period; nearly all illicit or non-prescribed opioids were pharmaceutical and there has been very little availability of heroin in the Canadian Maritimes for several decades [ 33 , 61 , 62 ]. Illicitly-manufactured fentanyl and its analogues have become more available since the study period, but pharmaceutical opioids still comprise the majority of illicit or non-prescribed opioids in these communities [ 63 ].…”

Section: Discussionsupporting

confidence: 70%

“…For patients with IDU-IE, unsafe injection drug use is the underlying cause of their infection and addiction treatment should be incorporated into treatment plans for secondary prevention [ 5 , 32 ]. All patients with IDU-IE in Halifax and 92% of patients with IDU-IE in Saint John reported opioid injection [ 33 ]. Treatment with OAT is the standard-of-care for opioid use disorder; it is associated with large reductions in risk of death [ 12 ] and may be associated with decreased risk of readmission [ 14 ] among patients with IDU-IE.…”

Section: Discussionmentioning

confidence: 99%

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Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

et al. 2022

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Background Addiction treatment and harm reduction services reduce risks of death and re-infection among patients with injection drug use-associated infective endocarditis (IDU-IE), but these are not offered at many hospitals. Among hospitalized patients with IDU-IE at the two tertiary-care hospitals in the Canadian Maritimes, we aimed to identify (1) the availability of opioid agonist treatment (OAT) and sterile drug injecting equipment, and (2) indicators of potential unmet addiction care needs. Methods Retrospective review of IDU-IE hospitalizations at Queen Elizabeth II Health Sciences Centre (Halifax, Nova Scotia) and the Saint John Regional Hospital (Saint John, New Brunswick), October 2015 -March 2017. In Halifax, there are no addiction medicine providers on staff; in Saint John, infectious diseases physicians also practice addiction medicine. Inclusion criteria were: (1) probable or definite IE as defined by the modified Duke criteria; and (2) injection drug use within the prior 3 months. Results We identified 38 hospitalizations (21 in Halifax and 17 in Saint John), for 30 unique patients. Among patients with IDU-IE and untreated opioid use disorder, OAT was offered to 36% (5/14) of patients in Halifax and 100% (6/6) of patients in Saint John. Once it was offered, most patients at both sites initiated OAT and planned to continue it after discharge. In Halifax, no patients were offered sterile injecting equipment, and during five hospitalizations staff confiscated patients’ own equipment. In Saint John, four patients were offered (and one was provided) injecting equipment in hospital, and during two hospitalizations staff confiscated patients’ own equipment. Concerns regarding undertreated pain or opioid withdrawal were documented during 66% (25/38) of hospitalizations, and in-hospital illicit or non-medical drug use during 32% (12/38). Two patients at each site (11%; 4/38) had self-directed discharges against medical advice. Conclusions Patients with IDU-IE in the Canadian Maritimes have unequal access to evidence-based addiction care depending on where they are hospitalized, which differs from the community-based standard of care. Indicators of potential unmet addiction care needs in hospital were common.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

et al. 2022

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“…The dosing strategy informed by the BCCSU guidelines were appropriate for most patients in this setting (Halifax, Nova Scotia) where the illicit drug supply is comprised primarily of pharmaceutical hydromorphone and cocaine, with relatively little fentanyl and methamphetamine availability in the community compared to elsewhere in Canada ( Brothers et al, 2021 , Brothers et al, 2022 , Lapointe-Gagner, 2022 , Schleihauf et al, 2018 ). Compared to Nova Scotia, British Columbia has much higher rates of illicitly manufactured fentanyl, fentanyl analogues, novel benzodiazepines, and methamphetamine availability and use ( Biggar et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Brothers

Leaman²,

Bonn³

et al. 2022

Drug and Alcohol Dependence

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“…The dosing strategy informed by the BCCSU guidelines were appropriate for most patients in this setting (Halifax, Nova Scotia) where the illicit drug supply is comprised primarily of pharmaceutical hydromorphone and of cocaine, with relatively little fentanyl and methamphetamine availability in the community (23,24,43,44). In other settings, dosages may need to be higher than those recommended in these guidelines or different medications may be for effective.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Brothers¹,

Leaman²,

Bonn³

et al. 2022

Preprint

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Background: During a COVID-19 outbreak in the congregate shelter system in Halifax, Nova Scotia, Canada, a multidisciplinary health care team provided an emergency safe supply of pharmaceutical-grade medications and beverage-grade alcohol to facilitate isolation in COVID-19 hotel shelters for residents who are dependent on these substances. We aimed to evaluate (a) substances and dosages provided, and (b) effectiveness and safety of the program. Methods: We retrospectively reviewed medical records of all COVID-19 isolation hotel shelter residents during May 2021. We extracted data on medication and alcohol dosages provided each day. The primary outcome was residents prematurely leaving isolation against public health orders. Adverse events included (a) overdose; (b) intoxication; and (c) diversion, selling, or sharing of medications or alcohol. Results: Over 25 days, 77 isolation hotel residents were assessed (mean age 42 +/- 14 years; 24% women). Sixty-two (81%) residents were provided medications, alcohol, or cigarettes. Seventeen residents (22%) received opioid agonist treatment medications (methadone, buprenorphine, or slow-release oral morphine) and 27 (35%) received hydromorphone tablets. Thirty-one (40%) residents received stimulant tablets with methylphenidate (27; 35%), dextroamphetamine (8; 10%), or lisdexamfetamine (2; 3%). Six residents (8%) received benzodiazepines. Forty-two (55%) residents received alcohol, including 41 (53%) with strong beer, three (3%) with wine, and one (1%) with hard liquor. Over 14 days in isolation, mean daily dosages increased of hydromorphone (45 +/- 32 to 57 +/- 42mg), methylphenidate (51 +/- 28 to 77 +/- 37mg), dextroamphetamine (33 +/- 16 to 46 +/- 13mg), and alcohol (12.3 +/- 7.6 to 13.0 +/- 6.9 standard drinks). Six residents (8%) left isolation prematurely, but four of those residents returned. Over 1,059 person-days in isolation, there were zero overdoses. Documented concerns regarding intoxication occurred six times (0.005 events/person-day) and medication diversion or sharing three times (0.003 events/person-day). Conclusions: An emergency safe supply and managed alcohol program, paired with housing, was associated with low rates of adverse events and high rates of successful completion of the 14-day isolation period in COVID-19 isolation hotel shelters. This supports the effectiveness and safety of emergency safe supply prescribing and managed alcohol in this setting.

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At-a-glance - Concurrent monitoring of opioid prescribing practices and opioid-related deaths: the context in Nova Scotia, Canada

Cited by 9 publications

References 15 publications

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

Unequal access to opioid agonist treatment and sterile injecting equipment among hospitalized patients with injection drug use-associated infective endocarditis

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

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