Modelling the combined impact of interventions in averting deaths during a synthetic‐opioid overdose epidemic

Abstract

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.

Accessing Take-Home Naloxone in British Columbia and the role of community pharmacies: Results from the analysis of administrative data

“…Understanding correlates of take-home naloxone distribution and access is crucial for planning and targeting services aimed at curbing opioid overdoses. While analyses from the BCCDC shows that the BC THN program, combined with other harm reduction interventions, has averted thousands of opioid overdose deaths [20,21], there is still relatively little data in the published literature examining community reach and barriers to access of naloxone distribution programs in Canada. Furthermore, preliminary evidence from the BC Coroners Service suggests a spike in drug toxicity deaths corresponding with COVID-19 physical distancing measures and changes to the illicit drug supply; the Coroners Service reported a 130% increase in drug toxicity deaths in June 2020 compared to June 2019 [22].…”

Understanding the Implications of a Shifting Opioid Landscape in Ontario

“…We have an opportunity to design policy responses to the current opioid crisis that are informed by the successes and limitations of past approaches and that promote more thoughtful, judicious prescribing to opioid-naïve individuals while avoiding unintended harm to those already using opioids. The end goal of reducing opioid-related harm can only be achieved by broad, multidisciplinary implementation of evidence-informed harm reduction programs, including naloxone distribution (Irvine et al 2019), supervised consumption sites (Kerr et al 2017;Marshall et al 2011;Young and Fairbairn 2018) and safer drug supplies (Canadian Association of People Who Use Drugs 2019; Oviedo-Joekes et al 2009, 2016van den Brink et al 2003). Finally, it is imperative that we undertake policy evaluation and revision when unintended harms are identified and meaningful, consistent dialogue between policy makers and people with lived experience to better understand the emerging needs and priorities of the people affected by the shifting opioid policy environment every day.…”

Convenience and comfort: reasons reported for using drugs alone among clients of harm reduction sites in British Columbia, Canada

“…Additionally, the use of harm reduction services is encouraged, with many services having undergone significant expansion to meet demand. Among others, this includes the BC take-home naloxone (THN) program, expanded opioid agonist treatment (OAT) availability, and observed consumption sites, all of which had a significant impact on preventing overdose deaths [ 14 ]. The THN program, for instance, has been responsive to the overdose crisis by getting naloxone kits into the hands of those that need it most [ 15 , 16 ], with more than 53,000 THN kits reported as used to reverse an overdose between 2017 and 2019 [ 17 ].…”