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Aboriginal ethnicity and female sex were associated with increased rates of HCV clearance, while HIV coinfection and illicit drug use were associated with increased HCV persistence.

Background and aimsThe province of British Columbia (BC) Canada has experienced a rapid increase in illicit drug overdoses and deaths during the last 4 years, with a provincial emergency declared in April 2016. These deaths have been driven primarily by the introduction of synthetic opioids into the illicit opioid supply. This study aimed to measure the combined impact of large‐scale opioid overdose interventions implemented in BC between April 2016 and December 2017 on the number of deaths averted.DesignWe expanded on the mathematical modelling methodology of our previous study to construct a Bayesian hierarchical latent Markov process model to estimate monthly overdose and overdose‐death risk, along with the impact of interventions.Setting and CasesOverdose events and overdose‐related deaths in BC from January 2012 to December 2017.InterventionsThe interventions considered were take‐home naloxone kits, overdose prevention/supervised consumption sites and opioid agonist therapyMeasurementsCounterfactual simulations were performed with the fitted model to estimate the number of death events averted for each intervention and in combination.FindingsBetween April 2016 and December 2017, BC observed 2177 overdose deaths (77% fentanyl‐detected). During the same period, an estimated 3030 (2900–3240) death events were averted by all interventions combined. In isolation, 1580 (1480–1740) were averted by take‐home naloxone, 230 (160–350) by overdose prevention services and 590 (510–720) were averted by opioid agonist therapy.ConclusionsA combined intervention approach has been effective in averting overdose deaths during British Columbia's opioid overdose crisis in the period since declaration of a public health emergency (April 2016–December 2017). However, the absolute numbers of overdose deaths have not changed.

COVID-19 has turned the world upside down in a very short period of time. The impact of COVID-19 will disproportionately effect people who are least able to protect themselves and this will include people who use drugs. The arrival of the COVID-19 pandemic comes at time when North America is in the midst of a protracted overdose epidemic caused by a toxic illegal drug supply. Overdose deaths are likely to rise when people are isolated, social support programs are cut back, and the illicit drug supply is further compromised. Safer opioid distribution in response to a toxic street drug supply is a pragmatic and effective way to reduce overdose deaths. COVID-19 makes such an approach even more urgent and compelling.