Polysubstance use poisoning deaths in Canada: an analysis of trends from 2014 to 2017 using mortality data

Konefal, Sarah; Sherk, Adam; Maloney‐Hall, Bridget; Young, Matthew M.; Kent, Pam; Biggar, Emily

doi:10.1186/s12889-022-12678-z

Cited by 13 publications

(14 citation statements)

References 50 publications

(55 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given the rapid ly evolving nature of the drug toxicity crisis, a public safety response is urgently required and may include continued funding of Proportion of all-cause deaths, % safer opioid supply programs that were expanded beginning in March 2020, 25 improved flexibility in take-home doses of opioid agon ist treatment, 26 and enhanced training for health care workers, harm reduction workers, and people who use drugs on appropriate responses to opioid toxicities involving polysubstance use. 27,28 Our findings add to those that characterized trends in the burden of opioid-related deaths before the pandemic. In Canada, the YLL from opioid-related deaths increased by 142% over the 24-year period from 1990 to 2014, 29 compared with a 50% increase observed over just 3 years in our study.…”

Section: Discussionsupporting

confidence: 58%

Opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories

Ledlie,

Juurlink,

Tadrous

et al. 2024

CMAJ

View full text Add to dashboard Cite

In Canada, the COVID-19 pandemic occurred in the midst of a growing drug toxicity crisis. Before the emergence of COVID-19, the number of accidental opioid-related deaths across Canada rose from 2470 in 2016 to 3447 in 2019. 1 This was accompanied by rising opioid-related hospital admissions 1 and growing infectious complications associated with substance use. 2 Although both prescription and unregulated opioids contribute to toxicity deaths, 3 the relative contribution of these substances has changed considerably over time, with fentanyl from the unregulated drug supply involved in more than 80% of opioid-related deaths in recent years (2020 to early 2023). 1 In 2021, almost 37 million people lived in Canada across 13 provinces and territories, with almost 40% residing in the province of Ontario, 4 where the first 6 months of the pandemic saw an estimated 17 843 additional years of life lost (YLL) from opioid-related premature death. 5 The observed acceleration in opioid-related harm across Canada has been attributed in part to public health measures implemented to curb the spread of SARS-CoV-2, including reduced access to harm reduction programs and border restrictions that may have increased the toxicity of the drug supply. [6][7][8] In addition, for many, the pandemic exacerbated feelings of anxiety, uncertainty, and loneliness, contributing to increased substance use globally. [9][10][11][12] The intersection of the COVID-19 pandemic with the drug toxicity crisis in Canada has created an urgent need to better understand the patterns of opioid-related deaths across the country to inform targeted public health responses. Therefore, we sought to describe trends in premature opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories. Methods Study design and settingWe conducted a repeated cross-sectional analysis of all opioidrelated deaths in 9 Canadian provinces and territories, with data collected at annual intervals between Jan. 1, 2019, and Dec. 31, 2021. 13 We reported this study using the Reporting of Studies Conducted using Observational Routinely-Collected Data (RECORD) checklist. 14

show abstract

Section: Discussionsupporting

confidence: 58%

Opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories

Ledlie,

Juurlink,

Tadrous

et al. 2024

CMAJ

View full text Add to dashboard Cite

show abstract

“…Simultaneous use of multiple sedatives is particularly risky. Poly-drug use has increased over the past decade and an increasing proportion of opioid-related deaths in the UK and North America have multiple substances identified at post-mortem [ 46 , 47 ]. In many reports that we reviewed, patients’ poly-drug use or multiple sedative prescriptions were noted in medical records.…”

Section: Discussionmentioning

confidence: 99%

Opioid-related deaths during hospital admissions or shortly after discharge in the United Kingdom: A thematic framework analysis of coroner reports

et al. 2023

View full text Add to dashboard Cite

Background People who use heroin and other illicit opioids are at high risk of fatal overdose in the days after hospital discharge, but the reasons for this risk have not been studied. Methods We used the National Programme on Substance Abuse Deaths, a database of coroner reports for deaths following psychoactive drug use in England, Wales, and Northern Ireland. We selected reports where the death occurred between 2010 and 2021, an opioid was detected in toxicology testing, the death was related to nonmedical opioid use, and death was either during an acute medical or psychiatric hospital admission or within 14 days after discharge. We used thematic framework analysis of factors that may contribute to the risk of death during hospital admission or after discharge. Results We identified 121 coroners’ reports; 42 where a patient died after using drugs during hospital admission, and 79 where death occurred shortly after discharge. The median age at death was 40 (IQR 34–46); 88 (73%) were male; and sedatives additional to opioids were detected at postmortem in 88 cases (73%), most commonly benzodiazepines. In thematic framework analysis, we categorised potential causes of fatal opioid overdose into three areas: (a) hospital policies and actions. Zero-tolerance policies mean that patients conceal drug use and use drugs in unsafe places such as locked bathrooms. Patients may be discharged to locations such as temporary hostels or the street while recovering. Some patients bring their own medicines or illicit opioids due to expectations of low-quality care, including undertreated withdrawal or pain; (b) high-risk use of sedatives. People may increase sedative use to manage symptoms of acute illness or a mental health crisis, and some may lose tolerance to opioids during a hospital admission; (c) declining health. Physical health and mobility problems posed barriers to post-discharge treatment for substance use, and some patients had sudden deteriorations in health that may have contributed to respiratory depression. Conclusion Hospital admissions are associated with acute health crises that increase the risk of fatal overdose for patients who use illicit opioids. Hospitals need guidance to help them care for this patient group, particularly in relation to withdrawal management, harm reduction interventions such as take-home naloxone, discharge planning including continuation of opioid agonist therapy during recovery, management of poly-sedative use, and access to palliative care.

show abstract

“…Many providers indicated that youth report both illicit and prescription opioid use, as well as other substances including alcohol, cannabis, and stimulants, suggesting that service providers are working within a polysubstance use context. Indeed, prior research has confirmed that polysubstance use is common among youth engaging in opioid use and a recent study showed that polysubstance use and specifically the co-use of opioids and stimulants are becoming the primary driver of increased mortality due to substances in Canada 24 . A large prospective cohort study in Canada recently indicated that polysubstance use increased between 2013 and 2018 among youth in Canada, and argue there is still a need for programs, policies, and public health initiatives that target polysubstance use 25 .…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, prior research has confirmed that polysubstance use is common among youth engaging in opioid use and a recent study showed that polysubstance use and specifically the co-use of opioids and stimulants are becoming the primary driver of increased mortality due to substances in Canada. 24 A large prospective cohort study in Canada recently indicated that polysubstance use increased between 2013 and 2018 among youth in Canada, and argue there is still a need for programs, policies, and public health initiatives that target polysubstance use. 25 Our current findings and these studies continue to highlight the importance of prevention efforts geared towards both opioids and other commonly used substances like stimulants.…”

Section: Discussionmentioning

confidence: 99%

Characterizing the Landscape of Service Provider Needs and Gaps in Services During the Canadian Youth Polysubstance Use Health Crisis

Nairn

Hawke

Isaacs

et al. 2022

Canadian Journal of Addiction

View full text Add to dashboard Cite

Objectives:This study characterizes service provider needs, gaps, and problem areas in the provision of opioid-related services for young people ages 15 to 25 across Canada.Methods:A total of 154 service providers completed a 25-question survey that was comprised of closed-ended and open-ended questions about opioid-related services for youth. Descriptive statistics were generated using RStudio software and open-ended responses were coded using a content analysis approach.Results:The majority of participants were in the addiction and mental health (35.1%), prevention (18.2%), or housing/shelter (12.3%) sectors, provided services to youth in early adulthood demographic (19–21), and reported both illicit and prescription opioid use among the youth they served. The most common opioid-specific youth services provided were, referrals to other organizations (72.1%), individual therapy (64.9%), assessment/consultation (57.1%), and overdose prevention medication (Naloxone) (49.4%). Open-ended questions revealed needs for both a continuum of care and continuity of care, a lack of accessible and available services, organizational and financial barriers, and a lack of funding. Several respondents indicated that harm reduction services, counselling, and opioid agonist therapy were “well-developed” for youth.Conclusions:The majority of our respondents appear to be working in a polysubstance use context that includes both illicit and prescription opioid use by youth. Despite this, there was an emphasis on referrals to other organizations as the most common type of service for young people. This is a potentially interesting and alarming finding in the context of provider reports of fractured continuums of care and continuity of care for young people using opioids. There was some encouraging awareness of harm reduction and in particular Naloxone availability for young people, although as we noted, it is uncertain whether youth are actually provided with Naloxone and to what extent pharmacological and counselling therapies are made available and accessible (affordable) for them. Our results suggest that there is still a need for programs and initiatives for youth that target polysubstance use (including both illicit and prescription opioid use) for young people.

show abstract

Polysubstance use poisoning deaths in Canada: an analysis of trends from 2014 to 2017 using mortality data

Cited by 13 publications

References 50 publications

Opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories

Opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories

Opioid-related deaths during hospital admissions or shortly after discharge in the United Kingdom: A thematic framework analysis of coroner reports

Characterizing the Landscape of Service Provider Needs and Gaps in Services During the Canadian Youth Polysubstance Use Health Crisis

Contact Info

Product

Resources

About