Drug Overdoses During the COVID‐19 Pandemic Among Recently Homeless Individuals

Liu, Michael; Richard, Lucie; Campitelli, Michael A.; Nisenbaum, Rosane; Dosani, Naheed; Dhalla, Irfan A.; Wadhera, Rishi K.; Shariff, Salimah Z.; Hwang, Stephen W.

doi:10.1111/add.15823

Cited by 13 publications

(7 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Shelters are high risk settings for COVID-19 outbreak due to the crowded and communal environment, as well as the higher rates of comorbidities among people deprived of housing. Homeless individuals in one Canadian study were disproportionately impacted by overdoses during reopening compared to those individuals with stable housing [ 2 ]. Shelter-in-place orders, in the USA, were associated with a higher risk of emergency room visits for overdose [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of an integrated safer use space and safer supply program on non-fatal overdose among emergency shelter residents during a COVID-19 outbreak: a case study

et al. 2022

View full text Add to dashboard Cite

Background Opioid-related harms, including fatal and non-fatal overdoses, rose dramatically during the COVID-19 pandemic and presented unique challenges during outbreaks in congregate settings such as shelters. People who are deprived of permanent housing have a high prevalence of substance use and substance use disorders, and need nimble, rapid, and portable harm reduction interventions to address the harms of criminalized substance use in an evidence-based manner. Case study In February 2021, a COVID-19 outbreak was declared at an emergency men’s shelter in Hamilton, Ontario, Canada. Building on pre-existing relationships, community and hospital-based addictions medicine providers and a local harm reduction group collaborated to establish a shelter-based opioid agonist treatment and safer supply program, and a volunteer run safer drug use space that also distributed harm reduction supplies. In the 4 weeks preceding the program, the rate of non-fatal overdoses was 0.93 per 100 nights of shelter bed occupancy. During the 26 days of program operation, there were no overdoses in the safer use space and the rate of non-fatal overdoses in the shelter was 0.17 per 100 nights of shelter bed occupancy. The odds ratio of non-fatal overdose pre-intervention to during intervention was 5.5 (95% CI 1.63–18.55, p = 0.0059). We were not able to evaluate the impact of providing harm reduction supplies and did not evaluate the impact of the program on facilitating adherence to public health isolation and quarantine orders. The program ended as the outbreak waned, as per the direction from the shelter operator. Conclusions There was a significant reduction in the non-fatal overdose rate after the safer drug use and safer supply harm reduction program was introduced. Pre-existing relationships between shelter providers, harm reduction groups, and healthcare providers were critical to implementing the program. This is a promising approach to reducing harms from the criminalization of substance use in congregate settings, particularly in populations with a higher prevalence of substance use and substance use disorders.

show abstract

Section: Introductionmentioning

confidence: 99%

The impact of an integrated safer use space and safer supply program on non-fatal overdose among emergency shelter residents during a COVID-19 outbreak: a case study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…This incline in opioid‐related deaths attributed to people experiencing homelessness has also outpaced the increase in the number of people experiencing homelessness in Canada, which has been estimated to have grown by 12% from 2018 to 2022 [7]. This study adds to other research showing that PEH have been harmed disproportionately by the opioid poisoning epidemic, and particularly so during the COVID‐19 pandemic [3, 27].…”

Section: Discussionmentioning

confidence: 79%

“…Drawing upon coroner and medical examiner data, this report found that among Canadians who died of a drug toxicity in the 2‐year period, 7.8% were experiencing homelessness at the time of death. However, these findings probably no longer represent the current landscape of substance‐related harms, which has been further exacerbated by the COVID‐19 pandemic and a variety of changes in other social and environmental factors [3, 21–28]. As a priority population, which has already experienced disproportionate effects of the pandemic [29, 30], deeper examination of the intersection of PEH, opioid‐related overdose deaths and the contextual details surrounding these fatal events is critical to inform supportive measures and policies towards harm reduction and housing solutions in the COVID era.…”

Section: Introductionmentioning

confidence: 99%

“…From 2017 to 2021 alone, the national rate of apparent opioid-related overdose deaths nearly doubled from 10.7 to 20.7 deaths per 100 000 population [2]. One segment of the population disproportionally impacted by the opioid epidemic are people experiencing homelessness (PEH) [3][4][5][6]. Recent point-in-time (PiT) counts between 2020 and 2022 observed a 12% increase in enumeration to comparable PiT counts conducted in 2018, and estimated that 0.7%, or one in 150 Canadians, encounter homelessness in a year [7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Opioid‐related overdose deaths among people experiencing homelessness, 2017 to 2021: A population‐based analysis using coroner and health administrative data from Ontario, Canada

Booth,

Shariff,

Carter

et al. 2023

Addiction

Self Cite

View full text Add to dashboard Cite

AimsTo measure the change in proportion of opioid‐related overdose deaths attributed to people experiencing homelessness and to compare the opioid‐related fatalities between individuals experiencing homelessness and not experiencing homelessness at time of death.Design, setting and participantsPopulation‐based, time‐trend analysis using coroner and health administrative databases from Ontario, Canada from 1 July 2017 and 30 June 2021.MeasurementsQuarterly proportion of opioid‐related overdose deaths attributed to people experiencing homelessness. We also obtained socio‐demographic and health characteristics of decedents, health‐care encounters preceding death, substances directly contributing to death and circumstances surrounding deaths.FindingsA total of 6644 individuals (median age = 40 years, interquartile range = 31–51; 74.1% male) experienced an accidental opioid‐related overdose death, among whom 884 (13.3%) were identified as experiencing homelessness at the time of death. The quarterly proportion of opioid‐related overdose deaths attributed to people experiencing homelessness increased from 7.2% (26/359) in July–September 2017 to 16.8% (97/578) by April–June 2021 (trend test P < 0.01). Compared with housed decedents, those experiencing homelessness were younger (61.3 versus 53.1% aged 25–44), had higher prevalence of mental health or substance use disorders (77.1 versus 67.1%) and more often visited hospitals (32.1 versus 24.5%) and emergency departments (82.6 versus 68.5%) in the year prior to death. Fentanyl and its analogues more often directly contributed to death among people experiencing homelessness (94.0 versus 81.4%), as did stimulants (67.4 versus 51.6%); in contrast, methadone was less often present (7.8 versus 12.4%). Individuals experiencing homelessness were more often in the presence of a bystander during the acute toxicity event that led to death (55.8 versus 49.7%); and where another individual was present, more often had a resuscitation attempted (61.7 versus 55.1%) or naloxone administered (41.2 versus 28.9%).ConclusionsPeople experiencing homelessness account for an increasing proportion of fatal opioid‐related overdoses in Ontario, Canada, reaching nearly one in six such deaths in 2021.

show abstract

“…People using illicit opioids experience a high burden of disease [17,18] and may be disproportionately impacted by major disruptive events such as a pandemic [19,20], particularly when facing other challenges such as housing instability [21,22]. Apart from risks related to COVID-19 exposure [23], public health responses to the pandemic directly impacted the risk environment shaping drug-related harms [24]: many low-threshold services that people with OUD rely on to meet essential needs or reduce harms associated with drug consumption, such as day shelters and supervised consumption sites, were forced to temporarily close or reduce their capacity, making already scarce resources even less accessible, while pandemic-related prevention measures also affected people's ability to generate income, secure shelter, and obtain safe and secure supplies of drugs [25][26][27][28][29].…”

Section: People With Oud the Covid-19 Pandemic And Oat Delivery Via T...mentioning

confidence: 99%

Co-Constructing a Community-Based Telemedicine Program for People With Opioid Use Disorder During the COVID-19 Pandemic: Lessons Learned and Implications for Future Service Delivery

Høj,

de Montigny,

Chougar

et al. 2023

JMIR Public Health Surveill

View full text Add to dashboard Cite

The COVID-19 pandemic triggered unprecedented expansion of telemedicine, including in the delivery of opioid agonist treatment (OAT) for people with opioid use disorder (OUD). However, many people with OUD lack the technological resources necessary for remote care, have complex needs, and are underserved, with precarious access to mainstream services. To address the needs of these individuals, we devised a unique program to deliver OAT via telemedicine with the support of community outreach workers in Montreal (Quebec, Canada). The program was co-constructed by the service de médecine des toxicomanies of the Centre hospitalier de l’Université de Montréal (CHUM-SMT)—a hospital-based addiction medicine service—and CACTUS Montréal—a community-based harm reduction organization known and trusted by its clientele. All procedures were jointly developed to enable flexible and rapid appointment scheduling. CACTUS Montréal workers promoted the program, facilitated private on-site telemedicine connections to the CHUM-SMT, accompanied patients during web-based appointments if requested, and provided ongoing holistic support and follow-up. The CHUM-SMT offered individualized OAT regimens and other health services as needed. Overall, our experience as clinicians and community-based workers intimately involved in establishing and running this initiative suggests that participants found it to be convenient, nonjudgmental, and responsive to their needs, and that the implication of CACTUS Montréal was highly valued and integral to patient engagement and retention. Beyond the context of the COVID-19 pandemic, similar programs may present a flexible and accessible means to deliver alternative treatment options for people with OUD disengaged from traditional care, bridge gaps between communities and health providers, and improve access to care in rural or remote settings.

show abstract

Drug Overdoses During the COVID‐19 Pandemic Among Recently Homeless Individuals

Cited by 13 publications

References 55 publications

The impact of an integrated safer use space and safer supply program on non-fatal overdose among emergency shelter residents during a COVID-19 outbreak: a case study

The impact of an integrated safer use space and safer supply program on non-fatal overdose among emergency shelter residents during a COVID-19 outbreak: a case study

Opioid‐related overdose deaths among people experiencing homelessness, 2017 to 2021: A population‐based analysis using coroner and health administrative data from Ontario, Canada

Co-Constructing a Community-Based Telemedicine Program for People With Opioid Use Disorder During the COVID-19 Pandemic: Lessons Learned and Implications for Future Service Delivery

Contact Info

Product

Resources

About