Determinants of overdose incidents among illicit opioid users in 5 Canadian cities

Fischer, Benedikt; Brissette, Suzanne; Brochu, Serge; Bruneau, Julie; el‐Guebaly, Nady; Noël, Lina; Rehm, Jürgen; Tyndall, Mark W.; Wild, C.; Mun, Phil; Haydon, Emma; Baliunas, Dolly

doi:10.1503/cmaj.1031416

Cited by 89 publications

(68 citation statements)

References 41 publications

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“…Compared to current non-injectors, current injectors exhibited a higher level of HCV infection, selfreported worse health status, were more likely to be inadequately housed, more likely to generate illegal income and to have been arrested in the past year. These social and health determinants have been identifi ed in previous studies as major predictors of preeminent harms associated with street drug use and thus reinforce the notion that the current injector group in our study is of great public health concern [46][47][48][49] .…”

Section: Discussionsupporting

confidence: 87%

Comparing Injecting and Non-Injecting Illicit Opioid Users in a Multisite Canadian Sample (OPICAN Cohort)

2006

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Illicit opioid use in Canada and elsewhere increasingly involves a variety of opioids and non-injection routes of administration. Injection and non-injection opioid users tend to differ in various key characteristics. From a public health perspective, non-injection routes of opioid use tend to be less harmful due to lesser morbidity and mortality risks. Our study compared current injectors (80%) and non-injectors (20%) in a multi-site sample of regular illicit opioid users from across Canada (‘OPICAN’ study). In bivariate analysis, injectors and non-injectors differed by prevalence in social and health characteristics as well as drug use. Logistic regression analysis identified city, drug use, housing status and mental health problems as independent predictors of injection status. Further analysis revealed that the majority of current non-injectors had an injection history. Our results reinforce the need to explore potential interventions aimed at preventing the transition from non-injectors to injecting, or facilitating the transition of injectors to non-injecting, as initiated in several other contexts.

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Section: Discussionsupporting

confidence: 87%

Comparing Injecting and Non-Injecting Illicit Opioid Users in a Multisite Canadian Sample (OPICAN Cohort)

2006

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“…For example, our data have consistently shown that illicit opioid users characterized by unstable housing or criminal justice sanctions (for example, arrest or detention) are more likely to be at elevated risk for morbidity or mortality related to opioid use (111). The role of social determinants in predicting harm outcomes among drug-using populations has also been demonstrated more broadly (69,121,122).…”

Section: Discussionmentioning

confidence: 63%

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

2006

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Clinical Implications • Illicit opioid use to a large extent manifests via the illicit use of prescription opioids and typically includes polysubstance use. • Physical and (or) mental health comorbidities are highly prevalent in illicit opioid user populations. • Morbidity and (or) mortality risks are often associated with social marginalization. Limitations • Little is known about the patterns and consequences of illicit opioid use in general populations. • Owing to the marginalized and illegal status of illicit opioid users, information is available only from selective populations with limited potential for generalizability of data. • The OPICAN study specifically builds largely on self-report and may be subject to bias. Objectives: To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). Method: We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n = 679) was collected in 2002. Results: Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine-crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in crime. Conclusions: Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.

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“…Numerous studies have investigated demographic, behavioural and drug use related parameters associated to drug-related mortality (Darke & Zador, 1996;Degenhardt, Bucello, Mathers, Briegleb, & Ali, 2011;Fischer et al, 2004;Mathers et al, 2013). Research focusing on social and economic determinants appears to be less prevalent, although previous studies have reported associations between fatal overdoses and poor educational attainment (Arias & Borrell, 1998;Farrell, Neeleman, Griffiths, & Strang, 1996), unemployment (Harlow, 1990;Pasarin, Borrell, & Plasencia, 1999), low income (Pasarin et al, 1999;Torralba et al, 1996), poverty status (Jones et al, 2002;Marzuk et al, 1997;Torralba et al, 1996), living in a neighbourhood presenting important income inequalities (Galea et al, 2003;Nandi et al, 2006), homelessness (Langendam, van Brussel, Coutinho, & van Ameijden, 2001;O'Driscoll et al, 2001), poor psychosocial functioning (Darke & Zador, 1996), social exclusion and poor social support (Farrell et al, 1996).…”

Section: Introductionmentioning

confidence: 99%

Social and economic inequalities in fatal opioid and cocaine related overdoses in Luxembourg: A case–control study

Origer¹,

Bihan²,

Baumann³

2014

International Journal of Drug Policy

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a b s t r a c tBackground: To investigate social and economic inequalities in fatal overdose cases related to opioid and cocaine use, recorded in Luxembourg between 1994 and 2011. Methods: Cross-examination of national data from law enforcement and drug use surveillance sources and of forensic evidence in a nested case-control study design. Overdose cases were individually matched with four controls, when available, according to sex, year of birth, drug administration route and duration of drug use. 272 cases vs 1056 controls were analysed. Conditional logistic regression analysis was performed to assess the respective impact of a series of socioeconomic variables. Conclusions: Socioeconomic inequalities in drug users impact on the occurrence of fatal overdoses. Compared to their peers, users of illicit drugs with lower socioeconomic profiles show increased odds of dying from overdose. However, actual and self-referred socioeconomic characteristics of drug users, such as educational attainment and employment, may have a greater predictive value of overdose mortality than the parental socioeconomic status. Education, vocational training and socio-professional reintegration should be part of drug-related mortality prevention policies.

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Determinants of overdose incidents among illicit opioid users in 5 Canadian cities

Cited by 89 publications

References 41 publications

Comparing Injecting and Non-Injecting Illicit Opioid Users in a Multisite Canadian Sample (OPICAN Cohort)

Comparing Injecting and Non-Injecting Illicit Opioid Users in a Multisite Canadian Sample (OPICAN Cohort)

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

Social and economic inequalities in fatal opioid and cocaine related overdoses in Luxembourg: A case–control study

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