Drug use patterns predict risk of non-fatal overdose among street-involved youth in a Canadian setting

Mitra, Goldis; Wood, Evan; Nguyen, Paul; Kerr, Thomas; DeBeck, Kora

doi:10.1016/j.drugalcdep.2015.05.035

Cited by 27 publications

(17 citation statements)

References 41 publications

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“…The outcome of interest was self-reporting experiencing an overdose in the previous six months, which was assessed and recorded at baseline and every follow-up interview over the study period. Consistent with previous work (Kerr et al, 2007; Mitra et al, 2015) participants who responded ‘yes’ to the question “In the previous six months, have you overdosed by accident (i.e., where you had a negative reaction from using too much drugs)?” were considered recent survivors of non-fatal overdose. PO injection was assessed through the question: “In the last six months, which of the following drugs did you inject?”, to which participants were provided a list and pictures of common POs.…”

Section: Methodssupporting

confidence: 62%

The effect of prescription opioid injection on the risk of non-fatal overdose among people who inject drugs

Lake

Hayashi

Buxton

et al. 2015

Drug and Alcohol Dependence

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Objectives Prescription opioid (PO) use by people who inject drugs (PWID) is a growing public health concern. Non-fatal overdose remains a leading source of morbidity among PWID, however, little is known about the relationship between PO injection and non-fatal overdose in this population. In this study we sought to examine the impact of PO injection on non-fatal overdose among PWID from Vancouver, Canada. Methods Data were derived from two open prospective cohorts of PWID for the period of December, 2005 to May, 2014. Multivariable generalized estimating equations were used to examine the odds of overdose among those who injected: POs; heroin; and POs and heroin. Results In total, 1660 PWID (33.7% women) participated in this study. In multivariable analyses, in comparison to those who were injecting non-opioid drugs, exclusive PO injection was not significantly associated with non-fatal overdose (adjusted odds ratio [AOR]: 1.17, 95% confidence interval [CI]: 0.74 – 1.86). The odds of non-fatal overdose were elevated for heroin injection (AOR: 1.72, 95% CI: 1.31 – 2.27), but were greatest for those who injected both heroin and POs (AOR: 2.46, 95% CI: 1.83 – 3.30). Discussion Compared to injecting non-opioids, injecting POs exclusively did not increase risk of non-fatal overdose; however, injecting both POs and heroin doubled the risk. This may reflect consistencies in drug potency and composition when POs are used, as well as unique characteristics of exclusive PO injectors. Our findings call for the continued scale-up of evidence-based overdose prevention interventions for people who inject opioids, including POs.

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Section: Methodssupporting

confidence: 62%

The effect of prescription opioid injection on the risk of non-fatal overdose among people who inject drugs

Lake

Hayashi

Buxton

et al. 2015

Drug and Alcohol Dependence

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“…Several factors identified in previous studies as correlates of non-fatal overdose were significantly associated with FCH use in the present study, including white racial background (Sherman, Cheng, & Kral, 2007), longer duration of drug use (Schrager et al, 2014; Sherman et al, 2007), regular non-medical benzodiazepine use and heroin use (Silva, Schrager, Kecojevic, & Lankenau, 2013), and injection drug use (Mitra, Wood, Nguyen, Kerr, & DeBeck, 2015; Richer, Bertrand, Vandermeerschen, & Roy, 2013; Schrager et al, 2014; Sherman et al, 2007; Silva et al, 2013; Werb, Kerr, Lai, Montaner, & Wood, 2008). Therefore, individuals with FCH exposure appear to be at highest risk for overdose.…”

Section: Discussionsupporting

confidence: 56%

Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically

Macmadu

Carroll

Hadland

et al. 2017

Addictive Behaviors

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Background The rate of overdose deaths caused by fentanyl-contaminated heroin (FCH) use is increasing rapidly in the United States. We examined risk factors for exposure to FCH and experiences with FCH use among young adult non-medical prescription opioids (NMPO) users. Methods We analyzed data from the Rhode Island Young Adult Prescription Drug Study (RAPiDS), which enrolled young adults aged 18 to 29 reporting prior 30 day NMPO use between January 2015 and February 2016. Participants completed questionnaires ascertaining drug use patterns and risk behaviors, including FCH exposure. Logistic regression was used to assess factors associated with known or suspected FCH exposure. Results Of 199 participants, the median age was 25 (IQR: 22, 27), 130 (65.3%) were male, and 122 (61.3%) were of white, non-Hispanic race/ethnicity. In total, 22 (11%) reported known or suspected FCH exposure in the prior six months. Several drug use patterns and risk behaviors were associated with FCH exposure, including: regular heroin and cocaine use; diverted pharmaceutical fentanyl use in the prior six months; NMPO use to avoid withdrawal symptoms; longer duration of NMPO use; injection drug use; and prior overdose (all p<0.001). Among participants who reported 3 FCH exposure, 59% were unaware that their heroin was contaminated with fentanyl prior to last use, 59% reported that FCH provides a better high, and all recognized that fentanyl increases overdose risk. Conclusions Exposure to fentanyl-contaminated heroin is an emerging trend among young adult NMPO users in Rhode Island. Overdose prevention programs addressing FCH use are urgently needed.

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“…People who inject drugs (PWID) contend with an array of health-related harms, including overdose (Mitra, Wood, Nguyen, Kerr, & DeBeck, 2015), HIV/AIDS (Montain et al, 2016), Hepatitis C (HCV) (Kim et al, 2009) and other infectious diseases (Lloyd-Smith et al, 2010). This population also experiences significant barriers in accessing addiction treatment and other health care and supportive services (McCoy, Metsch, Chitwood, & Miles, 2001).…”

Section: 1 Introductionmentioning

confidence: 99%

Use of on-site detoxification services co-located with a supervised injection facility

Gaddis

Kennedy

Nosova

et al. 2017

Journal of Substance Abuse Treatment

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Objectives Supervised injection facilities (SIFs) are increasingly being implemented worldwide in response to the harms associated with injection drug use. Although SIFs have been shown to promote engagement of people who use injection drugs (PWID) with external health services, little is known about the potential of co-locating on-site detoxification services with SIFs. The aim of this study was to characterize use of detoxification services co-located at Insite, North America’s first SIF, among PWID in Vancouver, Canada. Methods Data were derived from two prospective cohorts of PWID in Vancouver, Canada between November 2010 and December 2012. Using multivariable generalized estimating equation logistic regression, we identified factors independently associated with reporting use of detoxification services at the SIF. Results Among 1316 PWID, 147 (11.2%) reported enrolling in detoxification services co-located with the SIF at least once during the two year study period. In multivariable analyses, after adjustment for other potential cofounders, factors independently and positively associated with use of this service included residence <5 blocks from the SIF (Adjusted Odds Ratio [AOR] = 1.70), enrollment in methadone maintenance therapy (AOR = 1.90), public injection (AOR = 1.53), binge injection (AOR = 1.93), recent overdose (AOR = 1.90) and frequent SIF use (AOR = 8.15) (all p < 0.05). Discussion Use of on-site detoxification services offered at the SIF was common among PWID and associated with frequent SIF use and various markers of vulnerability and drug-related risk. These findings highlight the potential role of SIFs as a point of access to detoxification services for high-risk PWID. Future studies should examine if co-location leads to higher uptake of addiction services in comparison to services that create geographic or other obstacles.

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Drug use patterns predict risk of non-fatal overdose among street-involved youth in a Canadian setting

Cited by 27 publications

References 41 publications

The effect of prescription opioid injection on the risk of non-fatal overdose among people who inject drugs

The effect of prescription opioid injection on the risk of non-fatal overdose among people who inject drugs

Prevalence and correlates of fentanyl-contaminated heroin exposure among young adults who use prescription opioids non-medically

Use of on-site detoxification services co-located with a supervised injection facility

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