Association of Illicit Fentanyl Use with Injection Risk Practices Among People who Inject Drugs

Kenny, Kathleen S.; Kolla, Gillian; Greig, Sarah; Bannerman, Molly; Phillips, Debbie; Altenberg, Jason; Strike, Carol; Bayoumi, Ahmed M.

doi:10.1007/s10461-022-03908-x

Cited by 10 publications

(5 citation statements)

References 32 publications

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“…Fentanyl and its analogues, like carfentanil, and recently synthetic benzodiazepines have significantly increased the potency of unregulated drugs and subsequently increased fatal overdoses [1]. Additionally, the shift to illicitly manufactured fentanyl has changed the way people use drugs, further increasing the risk of overdose [2,3]. For example, fentanyl is relatively short acting compared with other opioids and can lead to more frequent injecting [3].…”

Section: Introductionmentioning

confidence: 99%

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‘I don't chase drugs as much anymore, and I'm not dead’: Client reported outcomes associated with safer opioid supply programs in Ontario, Canada

Schmidt,

Kaminski,

Kryszajtys

et al. 2023

Drug and Alcohol Review

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IntroductionThe ongoing opioid overdose crisis, which has killed over 30,000 people in Canada since 2016, is driven by the volatility of an unregulated opioid drug supply comprised primarily of fentanyl. The Canadian government has recently funded safer opioid supply (SOS) programs, which include off‐label prescriptions of pharmaceutical‐grade opioids to high risk individuals with the goal of reducing overdose deaths.MethodsIn 2021, we examined the implementation and adaption of four SOS programs in Ontario. These programs use a primary care model and serve communities experiencing marginalisation. We conducted semi‐structured interviews with program clients. We present the results of a thematic analysis with the aim of describing clients' self‐reported impact of these programs on their health and well‐being.ResultsWe interviewed 52 clients between June and October 2021 (mean age 47 years, 56% men, 17% self‐identified Indigenous, 14% living with HIV). Our results indicate multifaceted pathways to improved self‐reported health and well‐being among clients including changes to drug use practices, fewer overdoses, reduced criminalised activity, improved trust and engagement in health care, and increased social stability (e.g., housing).Discussion and ConclusionMost clients reported that the intervention saved their life because of the reduced frequency of overdoses. Findings suggest that SOS programs improved clients' health outcomes and increase opportunities for engagement in health services. Our results provide insight into the mechanisms behind some of the emergent evidence on the impact of safer supply prescribing.

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Section: Introductionmentioning

confidence: 99%

“…Additionally, the shift to illicitly manufactured fentanyl has changed the way people use drugs, further increasing the risk of overdose [2,3]. For example, fentanyl is relatively short acting compared with other opioids and can lead to more frequent injecting [3].…”

Section: Introductionmentioning

confidence: 99%

‘I don't chase drugs as much anymore, and I'm not dead’: Client reported outcomes associated with safer opioid supply programs in Ontario, Canada

Schmidt,

Kaminski,

Kryszajtys

et al. 2023

Drug and Alcohol Review

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“…In Canada, a confluence of factors may be contributing to increasing SSTVI morbidity among PWID [ 20 , 21 ]. In recent years, changes in consumption patterns owing to the introduction of more powerful but shorter acting synthetic opioids such as fentanyl in the unregulated market means the frequency of injection drug use may be on the rise [ 22 – 24 ]. Meanwhile, because PWID limit their use of health services owing to past experiences of mistreatment and/or stigma [ 25 ], treatment for SSTVI is often delayed [ 26 ], leading to more serious morbidity and costly hospitalizations [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of the effect of needle and syringe programs on skin, soft tissue, and vascular infections in people who inject drugs: a microsimulation modelling approach

Lim,

El-Sheikh,

Buckeridge

et al. 2024

Harm Reduct J

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Background Needle and syringe programs (NSP) are effective harm-reduction strategies against HIV and hepatitis C. Although skin, soft tissue, and vascular infections (SSTVI) are the most common morbidities in people who inject drugs (PWID), the extent to which NSP are clinically and cost-effective in relation to SSTVI in PWID remains unclear. The objective of this study was to model the clinical- and cost-effectiveness of NSP with respect to treatment of SSTVI in PWID. Methods We performed a model-based, economic evaluation comparing a scenario with NSP to a scenario without NSP. We developed a microsimulation model to generate two cohorts of 100,000 individuals corresponding to each NSP scenario and estimated quality-adjusted life-years (QALY) and cost (in 2022 Canadian dollars) over a 5-year time horizon (1.5% per annum for costs and outcomes). To assess the clinical effectiveness of NSP, we conducted survival analysis that accounted for the recurrent use of health care services for treating SSTVI and SSTVI mortality in the presence of competing risks. Results The incremental cost-effectiveness ratio associated with NSP was $70,278 per QALY, with incremental cost and QALY gains corresponding to $1207 and 0.017 QALY, respectively. Under the scenario with NSP, there were 788 fewer SSTVI deaths per 100,000 PWID, corresponding to 24% lower relative hazard of mortality from SSTVI (hazard ratio [HR] = 0.76; 95% confidence interval [CI] = 0.72–0.80). Health service utilization over the 5-year period remained lower under the scenario with NSP (outpatient: 66,511 vs. 86,879; emergency department: 9920 vs. 12,922; inpatient: 4282 vs. 5596). Relatedly, having NSP was associated with a modest reduction in the relative hazard of recurrent outpatient visits (HR = 0.96; 95% CI = 0.95–0.97) for purulent SSTVI as well as outpatient (HR = 0.88; 95% CI = 0.87–0.88) and emergency department visits (HR = 0.98; 95% CI = 0.97–0.99) for non-purulent SSTVI. Conclusions Both the individuals and the healthcare system benefit from NSP through lower risk of SSTVI mortality and prevention of recurrent outpatient and emergency department visits to treat SSTVI. The microsimulation framework provides insights into clinical and economic implications of NSP, which can serve as valuable evidence that can aid decision-making in expansion of NSP services.

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“…This finding is consistent with recent data from the Canadian Coinfection Cohort [ 34 ], which points to an increase in injection frequency among people who inject drugs. Finally, it is supported by a recent Canadian study that found a direct association between daily fentanyl injection, equipment sharing (i.e., syringes, cookers, and filters), and injection-related health risks [ 35 ].…”

Section: Introductionmentioning

confidence: 92%

Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada

et al. 2023

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Objectives Fentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. It has also changed injection practices. Injection frequency has increased as a result and so has equipment sharing and health-related risks. The aim of this analysis was to explore the impact of safer supply programs on injection practices from the perspective of clients and providers in Ontario, Canada. Methods The data set included qualitative interviews with 52 clients and 21 providers that were conducted between February and October 2021 across four safer supply programs. Interview excerpts discussing injection practices were extracted, screened, coded and then grouped into themes. Results We identified three themes, each theme corresponding to a change in injection practices. The first change was a decrease in the amount of fentanyl used and a decrease in injection frequency. The second change involved switching to injecting hydromorphone tablets instead of fentanyl. Finally, the third change was stopping injecting altogether and taking safer supply medications orally. Conclusion Safer supply programs can contribute to reducing injection-related health risks in addition to overdose risks. More specifically, they have the potential to address disease prevention and health promotion gaps that stand-alone downstream harm reduction interventions cannot address, by working upstream and providing a safer alternative to fentanyl.

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Association of Illicit Fentanyl Use with Injection Risk Practices Among People who Inject Drugs

Cited by 10 publications

References 32 publications

‘I don't chase drugs as much anymore, and I'm not dead’: Client reported outcomes associated with safer opioid supply programs in Ontario, Canada

‘I don't chase drugs as much anymore, and I'm not dead’: Client reported outcomes associated with safer opioid supply programs in Ontario, Canada

Economic evaluation of the effect of needle and syringe programs on skin, soft tissue, and vascular infections in people who inject drugs: a microsimulation modelling approach

Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada

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