Expanding access to diacetylmorphine and hydromorphone for people who use opioids in Canada

Maghsoudi, Nazlee; Bowles, Jeanette M.; Werb, Dan

doi:10.17269/s41997-020-00315-4

Cited by 22 publications

(14 citation statements)

References 3 publications

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“…Most patients will stop or reduce their use of street opioids, and may improve their physical and mental health and social connections [ 4 ]. Another effective alternative treatment available in some European and Canadian settings, is injectable OAT (iOAT) with either diacetylmorphine or hydromorphone [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Take home injectable opioids for opioid use disorder during and after the COVID-19 Pandemic is in urgent need: a case study

Oviedo‐Joekes

Macdonald

Boissonneault

et al. 2021

Subst Abuse Treat Prev Policy

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Background In North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they’re financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT. Case presentation Here we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics. Conclusion In the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.

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Section: Introductionmentioning

confidence: 99%

Take home injectable opioids for opioid use disorder during and after the COVID-19 Pandemic is in urgent need: a case study

Oviedo‐Joekes

Macdonald

Boissonneault

et al. 2021

Subst Abuse Treat Prev Policy

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show abstract

“…Ensuring drug consumption rooms tailor to marginalized groups could reduce this concern [ 20 , 24 ]. Moreover, improving low-barrier access to opioid agonist treatments [ 25 ] and safer opioid supply programs [ 26 , 27 ] could lessen harms associated with consuming drugs from the unregulated market.…”

Section: Discussionmentioning

confidence: 99%

Xylazine detected in unregulated opioids and drug administration equipment in Toronto, Canada: clinical and social implications

Bowles¹,

McDonald²,

Maghsoudi

et al. 2021

Harm Reduct J

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Background The North American opioid overdose crisis is driven in large part by the presence of unknown psychoactive adulterants in the dynamic, unregulated drug supply. We herein report the first detection of the psychoactive veterinary compound xylazine in Toronto, the largest urban center in Canada, by the city’s drug checking service. Methods Toronto’s Drug Checking Service launched in October 2019. Between then and February 2021, 2263 samples were submitted for analysis. The service is offered voluntarily at harm reduction agencies that include supervised consumption services. Samples were analyzed using gas chromatography–mass spectrometry or liquid chromatography-high resolution mass spectrometry. Targeted and/or untargeted screens for psychoactive substances were undertaken. Results In September 2020, xylazine was first detected by Toronto’s Drug Checking Service. Among samples analyzed from September 2020 to February 2021 expected to contain fentanyl in isolation (610) or in combination with methamphetamine (16), xylazine was detected in 46 samples (7.2% and 12.5% of samples, respectively). Samples were predominantly drawn from used drug equipment. Three of the samples containing xylazine (6.5%) were associated with an overdose. Conclusion We present the first detection of xylazine in Toronto, North America’s fourth-largest metropolitan area. The increased risk of overdose associated with use of xylazine and its detection within our setting highlights the importance of drug checking services in supporting rapid responses to the emergence of potentially harmful adulterants. These data also highlight the clinical challenges presented by the dynamic nature of unregulated drug markets and the concomitant need to establish regulatory structures to reduce their contribution to overdose morbidity and mortality.

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“…In the United States, the only means of observed drug consumption stems from one's network and the public as interventions like supervised consumption services (SCSs) remain illegal, placing the burden of overdose response one's social networks, which takes an emotional toll [36]. There is only one known underground SCS in the US, which has demonstrated individual and social bene ts, showcasing the viability of this proven intervention in Canada and Europe within U.S. contexts [37][38][39]. The high rates of overdose fatalities in private residences [9] are a strong reminder that THN adaptation for solitary living, housing and shelter systems are sorely needed to assist people who use drugs, including supervised use spaces easily accessible in residences and group trainings that may have the secondary function of helping to connect people after explaining the value of having a buddy system [40].…”

Section: Discussionmentioning

confidence: 99%

Naloxone Protection, Social Support, Network Characteristics, and Overdose Experiences Among a Cohort of People Who Use Illicit Opioids in New York City

Bennett

Scheidell

Bowles³

et al. 2021

Preprint

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Background Despite increased availability of take-home naloxone, many people who use opioids do so in unprotected contexts, with no other person who might administer naloxone present, increasing the likelihood that an overdose will result in death. Thus, there is a social nature to being “protected” from overdose mortality, which highlights the importance of identifying background factors that promote access to protective social networks among people who use opioids. Methods We used respondent-driven sampling to recruit adults residing in New York City who reported recent (past 3-day) nonmedical opioid use (n=575). Participants completed a baseline assessment that included past 30-day measures of substance use, overdose experiences, and number of “protected” opioid use events, defined as involving naloxone and the presence of another person who could administer it, as well as measures of network characteristics and social support. We used modified Poisson regression with robust variance to estimate unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). Results 66% of participants had ever been trained to administer naloxone, 18% had used it in the past three months, and 32% had experienced a recent overdose (past 30 days). During recent opioid use events, 64% reported never having naloxone and a person to administer present. This was more common among those: aged ≥50 years (PR: 1.18 (CI: 1.03, 1.34); who identified as non-Hispanic Black (PR: 1.27 (CI: 1.05, 1.53); experienced higher levels of stigma consciousness (PR: 1.13 (CI: 1.00, 1.28); and with small social networks (<5 persons) (APR: 1.14 (CI: 0.98, 1.31). Having a recent overdose experience was associated with severe opioid use disorder (PR: 2.45 (CI: 1.49, 4.04), suicidality (PR: 1.72 (CI: 1.19, 2.49), depression (PR: 1.54 (CI: 1.20, 1.98) and positive urinalysis result for benzodiazepines (PR: 1.56 (CI: 1.23, 1.96), but not with network size. Conclusions Results show considerable gaps in naloxone protection among people who use opioids, with more vulnerable and historically disadvantaged subpopulations less likely to be protected. Larger social networks of people who use opioids may be an important resource to curtail overdose mortality, but more effort is needed to harness the protective aspects of social networks.

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Expanding access to diacetylmorphine and hydromorphone for people who use opioids in Canada

Cited by 22 publications

References 3 publications

Take home injectable opioids for opioid use disorder during and after the COVID-19 Pandemic is in urgent need: a case study

Take home injectable opioids for opioid use disorder during and after the COVID-19 Pandemic is in urgent need: a case study

Xylazine detected in unregulated opioids and drug administration equipment in Toronto, Canada: clinical and social implications

Naloxone Protection, Social Support, Network Characteristics, and Overdose Experiences Among a Cohort of People Who Use Illicit Opioids in New York City

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