Approaches for Managing Benzodiazepine Dependence Arising From Use of the Adulterated Opioid Supply: A Delphi Technique.

Objectives: Benzodiazepine adulteration of the unregulated opioid supply presents significant clinical challenges, whereby patients can develop physical dependence to benzodiazepines inadvertently. Currently, clinicians lack evidence to guide care of patients potentially experiencing benzodiazepine withdrawal when ceasing use of unregulated opioids. We used a Delphi technique to build consensus around assessment and management of people at risk for benzodiazepine dependence due to the use of unregulated opioids.

COVID-19 vaccine uptake and effectiveness among people with recent history of injection drug use in British Columbia, Canada: A retrospective analysis.

Background: It is a public health priority to assess vaccine impact in marginalized populations disproportionately affected by COVID-19 to inform population-specific policies and reduce health disparities. We assessed COVID-19 vaccine uptake and effectiveness among people who inject drugs (PWID) in British Columbia, Canada.

Methods: We used a population-based, linked data platform and a validated algorithm with high specificity to create a cohort of people aged 18-65 years with recent history of injection drug use (PWID).

Responding to an evolving crisis: Meeting the needs of a growing population who smoke their unregulated substances.

Jurisdictions across Canada are experiencing high and increasing numbers of drug toxicity (overdose) deaths. To effectively respond to this crisis, a recognition and adaptation to shifting substance use patterns is needed. People may use one or more modes of consumption (e.

"Before medically advised" hospital discharge and the risk of subsequent drug overdose: A case-crossover analysis.

Background: Patient-initiated or "before medically advised" (BMA) hospital discharge is more common among people who use drugs. Transitions of care can be destabilizing and might increase the risk of subsequent illicit drug overdose.

Objectives: This study sought to evaluate whether BMA discharge is associated with an increased risk of subsequent drug overdose (primary objective) and whether physician-advised discharge is associated with an increased risk of subsequent drug overdose (secondary objective).

"Before medically advised" departure from hospital and subsequent drug overdose: a population-based cohort study.

Background: A substantial number of hospital admissions end in patient-initiated departure before medical treatment is complete. Whether "before medically advised" (BMA) discharge increases the risk of subsequent drug overdose remains uncertain.

Methods: We performed a retrospective cohort study using administrative health data from a 20% random sample of residents of British Columbia, Canada.

Awareness and knowledge of drug decriminalization among people who use drugs in British Columbia: a multi-method pre-implementation study.

Background: In January 2023, British Columbia implemented a three-year exemption to Controlled Drugs and Substances Act, as granted by the federal government of Canada, to decriminalize the personal possession of small amounts of certain illegal drugs. This decriminalization policy, the first in Canada, was announced in response to the overdose emergency in British Columbia as a public health intervention that could help curb overdose deaths by reducing the impact of criminalization and increasing access to health and social services through stigma reduction.

Methods: The current multi-method study examines people who use drugs' awareness and knowledge of British Columbia's decriminalization model through cross-sectional quantitative surveys and qualitative interviews among people who use drugs from September-November 2022, immediately prior to the implementation of decriminalization.

Effect of Risk Mitigation Guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study.

Objective: To determine the effect of opioid and stimulant Risk Mitigation Guidance (RMG) dispensations on mortality and acute care visits during the dual public health emergencies of overdose and covid-19.

Design: Population based retrospective cohort study.

Setting: British Columbia, Canada.

Factors associated with obtaining prescribed safer supply among people accessing harm reduction services: findings from a cross-sectional survey.

Background: With growing rates of unregulated drug toxicity death and concerns regarding COVID-19 transmission among people who use drugs, in March 2020, prescribed safer supply guidance was released in British Columbia. This study describes demographic and substance use characteristics associated with obtaining prescribed safer supply and examines the association between last 6-month harm reduction service access and obtaining prescribed safer supply.

Methods: Data come from the 2021 Harm Reduction Client Survey administered at 17 harm reduction sites across British Columbia.

Preferred stimulant safer supply and associations with methamphetamine preference among people who use stimulants in British Columbia: Findings from a 2021 cross-sectional survey.

Background: As safer supply programs expand in Canada, stimulant safer supply is often overlooked despite the harms and criminalization faced by people who use stimulants.

Methods: The 2021 Harm Reduction Client Survey was administered at 17 harm reduction sites around British Columbia, Canada. The survey included a question about what specific substance participants would want to receive as stimulant safer supply.

Police officers' knowledge, understanding and implementation of the Good Samaritan Drug Overdose Act in BC, Canada.

Introduction: In May 2017, the Good Samaritan Drug Overdose Act (GSDOA) was enacted in Canada - amending the Controlled Drugs and Substances Act. For people present at an overdose, the GSDOA offers legal protection from simple drug possession as well as breach of charges related to simple possession including probation, pre-trial release, conditional sentences, and parole. It is unclear if the GSDOA has been fully implemented by police officers.

Prescription-related risk factors for opioid-related overdoses in the era of fentanyl contamination of illicit drug supply: A retrospective case-control study.

We sought to quantify the association between clinical, physiological, and contextual factors and opioid-related overdose, specifically focusing on current and past use of select prescription medications. We conducted a case-control study of individuals who experienced a non-fatal opioid-related overdose between January 2015 and November 2016 in British Columbia, Canada. We matched 8,831 cases to 44,155 controls on birth year, sex, and local health area of residence and examined 5-year prescribing history for opioids for pain, medications for opioid use disorder (MOUD), benzodiazepines/z-drugs, and other psychoactive medications.

Comparison of rates of opioid withdrawal symptoms and reversal of opioid toxicity in patients treated with two naloxone dosing regimens: a retrospective cohort study.

Introduction: When managing opioid overdose (OD) patients, the optimal naloxone regimen should rapidly reverse respiratory depression while avoiding opioid withdrawal. Published naloxone administration guidelines have not been empirically validated and most were developed before fentanyl OD was common. In this study, rates of opioid withdrawal symptoms (OW) and reversal of opioid toxicity in patients treated with two naloxone dosing regimens were evaluated.

Known fentanyl use among clients of harm reduction sites in British Columbia, Canada.

Background: North America is in the midst of an opioid overdose epidemic and it is commonly suggested that exposure to fentanyl is unknown. Using a provincial survey of harm reduction site clients, we aimed to characterize known and unknown fentanyl use and their correlates among people who use drugs in British Columbia, Canada.

Methods: We recruited 486 clients who were >18 years old and 316 agreed to provide a urine sample for substance use testing.

Correlates of take-home naloxone kit possession among people who use drugs in British Columbia: A cross-sectional analysis.

Introduction: In response to North America's opioid crisis, access to naloxone has increased. However, our understanding of the correlates of possessing a naloxone kit is limited. This study seeks to determine the prevalence and correlates of kit possession among people who use drugs (PWUD) in British Columbia (BC) Canada.

Naloxone urban legends and the opioid crisis: what is the role of public health?

As the overdose crisis in North America continues to deepen, public health leaders find themselves responding to sensational media stories, many of which carry forms and themes that mark them as urban legends.This article analyzes one set of media accounts - stories of misuse of naloxone, an opioid overdose antidote distributed to people who use drugs - through the lens of social science scholarship on urban legends. We suggest that these stories have met a public need to feel a sense of safety in uncertain times, but function to reinforce societal views of people who use drugs as undeserving of support and resources.

Effects of the new prescribing standards in British Columbia on consumption of opioids and benzodiazepines and drugs.

Objective: To evaluate the effects of the 2016 College of Physicians and Surgeons of British Columbia's (CPSBC's) opioid and benzodiazepine and drug prescribing standards on the use of these medications in British Columbia.

Design: Interrupted time-series analysis of community-prescribing records over a 30-month period: January 2015 to June 2017.

Setting: British Columbia.

Correlates of seeking emergency medical help in the event of an overdose in British Columbia, Canada: Findings from the Take Home Naloxone program.

Background: British Columbia (BC), Canada, is experiencing an unprecedented number of opioid overdoses mainly due to the contamination of illicit drugs with fentanyl and its analogues. Reluctance to seek emergency medical help (i.e.

Patterns and history of prescription drug use among opioid-related drug overdose cases in British Columbia, Canada, 2015-2016.

Background: British Columbia is the epicenter of the current fentanyl-related overdose crisis in Canada. Our study characterizes prescribing histories of people who had an opioid-related overdose compared to matched controls.

Methods: We examined linked administrative data for individuals who overdosed between January 1, 2015 and November 30, 2016.

Patterns of health care utilization among people who overdosed from illegal drugs: a descriptive analysis using the BC Provincial Overdose Cohort.

Introduction: British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs.

Methods: The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016.

Perceived harms and harm reduction strategies among people who drink non-beverage alcohol: Community-based qualitative research in Vancouver, Canada.

Background: There has been increasing interest in harm reduction initiatives for street-involved people who drink alcohol, including non-beverage alcohol such as mouthwash and hand sanitizer. Limited evidence exists to guide these initiatives, and a particular gap is in research that prioritizes the experiences and perspectives of drinkers themselves. This research was conducted to explore the harms of what participants termed "illicit drinking" as perceived by people who engage in it, to characterize the steps this population takes to reduce harms, and to identify additional interventions that may be of benefit.

Results of a participatory needs assessment demonstrate an opportunity to involve people who use alcohol in drug user activism and harm reduction.

Background: Drug users' organizations have made progress in recent years in advocating for the health and human rights of people who use illicit drugs but have historically not emphasized the needs of people who drink alcohol.

Methods: This paper reports on a qualitative participatory needs assessment with people who use illicit substances in British Columbia, Canada. We held workshops in 17 communities; these were facilitated by people who use illicit drugs, recorded with ethnographic fieldnotes, and analyzed using critical theory.