Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

Abstract

Clinical Implications • Illicit opioid use to a large extent manifests via the illicit use of prescription opioids and typically includes polysubstance use. • Physical and (or) mental health comorbidities are highly prevalent in illicit opioid user populations. • Morbidity and (or) mortality risks are often associated with social marginalization. Limitations • Little is known about the patterns and consequences of illicit opioid use in general populations. • Owing to the marginalized and illegal status of illicit opioid users, information is available only from selective populations with limited potential for generalizability of data. • The OPICAN study specifically builds largely on self-report and may be subject to bias. Objectives: To summarize key characteristics and consequences of illicit opioid use from the literature and to present corresponding data from a multisite sample of illicit opioid users in 5 Canadian cities (OPICAN study). Method: We undertook an overview of recent literature from North America, Australia, and Europe. We obtained data from the multicity OPICAN cohort study, which consisted of an interviewer-administered questionnaire, a standardized mental health instrument (the Composite International Diagnostic Interview Short Form for depression), and saliva-antibody tests for infectious disease (that is, HIV and hepatitis C virus). The baseline sample (n = 679) was collected in 2002. Results: Illicit opioid use in Canada and elsewhere is becoming increasingly heterogeneous in terms of opioid drugs used, with heroin playing an increasingly minor role; further, it predominantly occurs in a context of polydrug use (for example, cocaine-crack or benzodiazepines). Large proportions of illicit opioid users have physical and (or) mental health comorbidities, including infectious disease and (or) depression, and therefore require integrated interventions. Finally, morbidity risks among illicit opioid users are often predicted by social marginalization factors, for example, housing status or involvement in crime. Conclusions: Given the epidemiologic profile and high disease burden associated with contemporary forms of illicit opioid use, more effective treatment approaches are urgently needed in Canada and elsewhere. Specifically, treatment must adjust to the extensive polysubstance use realities, yet it must also more effectively address the complex physical and (or) mental health comorbidities presented by this high-risk population.

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

“…At least in Vancouver, this is consistent with the literature; the proportion of women in MMT in British Columbia is 34.8%, 25 36.3% in the Supervised Injection Facility Cohort, 53 and 48.8% in a cohort of illicit opioid users not in treatment. 54 In Montreal, the available data shows differences in the female proportion by study. For example, the OPICAN study had 19.8% females, 54 similar to the 16.7% of the St. Luc Cohort study with IDUs.…”

Prevalence and correlates of prescription opioid residue injection

“…Reports of PO injection have risen worldwide, including in the United States (Davis and Johnson, 2008;Young et al, 2010;Surrat et al, 2011;Lankenau et al, 2012;Black et al, 2013;MateuGelabert et al, 2015), Europe (Partanen et al, 2009;Keijzer and Imbert., 2011;Roux et al, 2011), South Asia (Larance et al, 2011) and Australia (Degenhardt et al, 2006). In Canada, over the past decade, PO injection has gained in popularity among drug users across the country (UHRI, 2013; Leclerc et al, 2013;Firestone and Fischer, 2008;Roy et al, 2011;Roy et al, 2013;Bruneau et al, 2012;Fischer et al, 2006;PHAC, 2014). Data from I-Track, a multisite surveillance system that monitors HIV and hepatitis C virus (HCV) infection rates and associated risk behaviors among persons who inject drugs (PWID) in Canada, revealed that hydromorphone, morphine and oxycodone, either in tablet or capsule form, were injected more often than heroin.…”

Injection Drug Use Among Homeless Adults With Mental Illness: A Gender-based Analysis

“…Injection drug users (IDUs) suffer an increased burden of infectious disease, co-morbid health conditions and elevated mortality rates in comparison to the general population (Fischer, Firestone-Cruz, & Rehm, 2006;Spittal, Hogg, Li, Craib, Recsky, Johnston et al, 2007). Further, IDU is linked to a multitude of vulnerabilities and social disadvantages (e.g., poverty, homelessness, mental illness), involvement in high-risk illegal income generating activities (e.g., sex work, drug dealing), and public disorder behaviours (e.g., public injecting), that also contribute to compromised health and well-being (Galea & Vlahov, 2002;Fischer et al, 2006;DeBeck, Shannon, Wood, Li, Montaner, & Kerr, 2007; DeBeck, Small, Wood, Li, Montaner, & Kerr, 2009;Miller, Pearce, Moniruzzaman, Thomas, Christian, Schecter et al, 2011). Consequently, IDUs are a highly marginalised and stigmatised population with multiple and complex needs, yet are hard to reach with mainstream health care services (Ahern, Stuber, & Galea, 2006;Simmonds & Coomber, 2007).…”

“…IDU is prevalent among homeless and street-involved individuals (Kerr, Marshall, Miller, Shannon, Zhang, Montaner et al, 2009;Miller et al, 2011), and high rates of co-occurring mental disorders among IDU are well documented (Fischer et al, 2006;Aitken, Wain, Lubman, Hides, & Hellard, 2008).…”

“…Recent evidence suggests that daily illicit drug use is positively associated with longer durations of homelessness among homeless adults with concurrent mental disorders (Patterson, Somers, & Moniruzzaman, 2011). Major depression, anxiety and post-traumatic stress disorder (PTSD) are widely observed amongst IDU populations (Braitstein, Tyndall, Spittal, O"Shaughnessy, Schilder, Johnston et al, 2003;Fischer et al, 2006;Aitken et al, 2008).…”