Aims To compare the change in illicit opioid users’ risk of fatal drug-related poisoning (DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support, and investigate the modifying effect of patient characteristics, criminal justice system (CJS) referral and treatment completion. Design National data linkage cohort study of the English National Drug Treatment Monitoring System and the Office for National Statistics national mortality database. Data were analysed using survival methods. SettingAll services in England that provide publicly funded, structured treatment for illicit opioid users. Participants Adults treated for opioid dependence during April 2005 to March 2009: 151 983 individuals; 69% male; median age 32.6 with 442 950 person-years of observation.
Measurements The outcome was fatal DRP occurring during periods in or out of treatment, with adjustment for age, gender, substances used, injecting status and CJS referral.
Findings There were 1499 DRP deaths [3.4 per 1000 person-years, 95% confidence interval (CI) = 3.2–3.6]. DRP risk increased while patients were not enrolled in any treatment [adjusted hazard ratio (aHR) = 1.73, 95% CI = 1.55–1.92]. Risk when enrolled only in a psychological intervention was double that during OAP (aHR = 2.07, 95% CI = 1.75–2.46). The increased risk when out of treatment was greater for men (aHR = 1.88, 95% CI = 1.67–2.12), illicit drug injectors (aHR = 2.27, 95% CI = 1.97–2.62) and those reporting problematic alcohol use (aHR = 2.37, 95% CI = 1.90–2.98). Conclusions Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.
International Journal of Drug Policy 2015:26(12);1183-1188 Abstract
BackgroundThe epidemic of drug-related mortality continues to endure. The most common cause of death associated with drugs is overdose and opioids are consistently the substances most prominently involved. As well as efforts to control the availability of illicit drugs and increase engagement in treatment services, the use of naloxone for peer administration has increasingly been championed as a mechanism for addressing the DRD epidemic. Despite increasing adoption and use of take-home naloxone (THN) as a primary response to DRD internationally the evidence base remains limited.MethodsA systematic review and descriptive meta-analysis of the international THN literature was undertaken to determine an effect size for THN programmes. For each study, a proportion of use (PoU) was calculated using the number of ‘peer administered uses’ and the ‘total number of participant/clients’ trained and supplied with naloxone with a specific focus on people who use drugs (PWUD). This was constrained to a three month period as the lowest common denominator. As a percentage this gives the three month rate of use (per 100 participants). Results From twenty-five identified THN evaluations, nine studies allowed a PoU to be determined. Overall, the model shows a range of 5.2–13.1 (point estimate 9.2) naloxone uses every three months for every 100 PWUD trained.
Conclusion Our model estimates that around 9% of naloxone kits distributed are likely to be used for peer administration within the first three months of supply for every 100 PWUD trained. Future evaluations should directly compare different training structures to test relative effectiveness and use a series of fixed time periods (3, 6 and 12 months) to determine whether time since training affects rate of naloxone use.
56. Trends in recreational poisoning in Newcastle, Australia, between 1996 and 2013
Kate M. Chitty, Nicholas J. Osborne, Rose Cairns, Andrew H. Dawson, Nicholas A. Buckley
Drug and Alcohol Dependence 2016:159;17-25 Abstract
Background Poisoning that occurs as the result using alcohol or drugs for recreational purposes or to induce rewarding psychoactive effects (“recreational poisoning”) represents significant harm attributed to drug use. There has been limited focus on recreational poisoning separately from hospital admissions for general harms related to alcohol or drug use. This study aims to detail the drug trends and patient population represented in recreational poisonings in Newcastle, Australia. Methods Naturalistic analysis of consecutive hospital presentations following poisoning between January, 1996 and December, 2013 was conducted using data from the Hunter Area Toxicology Ser-vice (HATS). 13805 patient records were included (aged 18–98), 1209 (8.8%) of those were recreational poisonings. Results Compared to non-recreational poisonings, recreational poisonings were more likely to occur in males than females (OR = 2.87, 95% CI: 2.44–3.40, p < 0.001) and in patients under the age of 30 compared to their older counterparts (OR = 1.58, 95% CI: 1.35–1.85, p < 0.001). Hospital presentations for recreational poisonings were more likely to occur between 0300 and 0600 h than 0900–1700 h (OR = 3.07, 95% CI: 2.29–4.11, p < 0.001) and more likely to occur on the weekend than on a Monday. Overall, recreational poisoning admissions declined over time. Conclusions Overall, the trends reported in this analysis reflect general use and availability of alcohol and illicit substances in Australia over the time period. Looking at specific sub-types of alcohol and drug-related harm, like poisoning, is important for service planning and government initiatives.
57. Correlates of overdose risk perception among illicit opioid users
Christopher Rowe, Glenn-Milo Santos, Emily Behar, Philip O. Coffin
Drug and Alcohol Dependence 2016:159;234-239 Abstract
Background Opioid-related mortality continues to increase in the United States. The current study assesses demographic and behavioral predictors of perceived overdose risk among individuals who use opioids illicitly. By examining these correlates in the context of established overdose risk factors, we aim to assess whether characteristics and behaviors that have been associated with actual overdose risk translate to higher perception of risk.Methods We conducted a cross-sectional survey of 172 adult illicit opioid users in San Francisco, CA and used multivariable logistic regression to identify predictors of perception of high risk for opioid overdose.Results Age (aOR = 0.96, 95%CI = 0.93–1.00) and number of injection days per month (0.91, 0.86–0.97) were associated with a lower odds of perceived high overdose risk. There was no independent association between use of opioid analgesics, concurrent use of opioids and benzodiazepines or cocaine, or HIV status and overdose risk perception.Conclusions Opioid users who injected more frequently and those who were older were less likely to perceive themselves as being at risk of overdose, notwithstanding that those who inject more are at higher risk of overdose and those who are older are at higher risk overdose mortality. In addition, despite being established overdose risk factors, there was no relationship between use of opioid analgesics, concurrent use of opioids and cocaine or benzodiazepines, or self-reported HIV status and overdose risk perception. These findings highlight key populations of opioid users and established risk factors that may merit focused attention as part of education-based overdose prevention and opioid management strategies.