Sector News

  1. International Overdose Awareness Day – August 31st

    “Time to Remember. Time to Act” International Overdose Awareness Day (IOAD) is a global event held on August 31st each year and aims to raise awareness of overdose and reduce the stigma of a drug-related death. It also acknowledges the grief felt by families and friends remembering those who have met with death or permanent injury as a result of drug overdose.

    International Overdose Awareness Day spreads the message that the tragedy of overdose death is preventable. The silver badge or the purple wristband are symbols of awareness of overdose and its effects. Wearing these reinforces the infinite value of each human being, and helps to nullify presumption, prejudice and stigma towards people who use drugs.

    To learn more, visit:  International Overdose Awareness Day

  2. Posted in:

    World Hepatitis Day – July 28th

    Friday, July 28, 2017 marks World Hepatitis Day. This initiative is in response to the May 2016 World Health Assembly’s where 194 governments  adopted the World Health Organization’s Global Strategy on Viral Hepatitis, which includes a goal of eliminating hepatitis B and C in the next 13 years.

    Last year’s theme was “NOhep” while this year’s theme is “Show Your Face.” This campaign invites you to share a photo of yourself accompanied by your own personal “I AM” message to help put a human face to the elimination of viral hepatitis.

  3. Methadone Injection in a Canadian Context

    Background

    • According to the Substance Abuse and Mental Health Services Administration (2012), 669,000 people used heroin in the previous year in the United States. As well, the number of heroin users increased every year for five years in a row.

    • Although methadone is an effective treatment for patients with opioid use disorder and chronic pain, fatalities have continued to rise due to illicit methadone use.

    • The authors aimed to look at the factors associated with methadone injection in an urban Canadian setting where access to methadone prescribed through primary care physicians is common.

    Approach

    The authors used two prospective cohorts of individuals who use drugs in Vancouver (Vancouver Injection Drug Users Study (VIDUS), and AIDS Care Cohort).

    Findings

    • Approximately 7% of participants injected methadone over the study period. The authors found this behaviour to be associated with socioeconomic vulnerability and other addictions.

    • Methadone injection was not associated with enrolment in a methadone program. Interestingly, the findings of this study contrast with other studies, which propose that enrolment in a methadone maintenance program is associated with injection of methadone. Due to this, the authors suggest that these individuals may represent a sub-population of PWID “for whom evidence-based addiction treatment services remain out of reach.”

    • The rates of diversion (transfer of legally prescribed drugs from the patient to another person for illicit use) show a need to implement tools that enhance the flexibility of program rules for patients at low risk of diversion. , while at the same time ensuring that patients at risk of selling their medication ingest their medication at the time it is provided.

    • However, the authors also note that PWID may be purchasing and using street methadone as a means to reduce their heroin consumption and self-treat opioid withdrawal symptoms.

    Conclusion

    The injection of methadone is associated with several other high-risk behaviors. Due to this, access to methadone programs should be optimized while also making efforts to limit diversion of methadone to the street.

    Tucker, D., Milloy, M.J., Hayashi, K., Nguyen, P., Kerr, T., and Wood, K. (2015). Factors Associated with Illicit Methadone Injecting in a Canadian Setting. The American Journal on Addictions. 24:532-537.

  4. Posted in:

    Declines in Assisted Injection

    Background

    • Research shows that those who get assistance injecting are an especially vulnerable subgroup of people who inject drugs (PWID).
    • However, an injection by another person is common amongst PWID. A previous study found that 41% of PWID in a Canadian city reported assisted injecting within the last 6 months.
    • Those who receive assisted injection are at significant risk of several negative health outcomes. Usually people who help others inject use the same syringe. As well, there is an association between requiring help with injection and syringe sharing, which puts theses individuals at a great risk for blood-borne illnesses.
    • Assisted injecting is strongly associated with HIV and HCV.
    • A previous Canadian study found that those who get assistance with injecting are at over twice the risk of acquiring HIV.
    • Women who inject drugs may be more likely than males to require assistance with injection. Although the reasons for injection assistance may be gendered, other reasons for assisted injecting include a lack of viable veins, reliance upon jugular injection, being in withdrawal, and a lack of knowledge of how to inject.

    Approach

    The authors conducted a gender-based analysis among 1119 people who inject drugs (PWID) in Vancouver to look at trends in the rates of requiring assistance with injection.

    Findings

    • The authors found that rates of assisted injection in last 6 months declined between 2006 and 2014 for both males (21.9 to 13.8 %) and females (37.0 to 25.6 %).
    • However, syringe borrowing remained positively associated with assisted injecting females and in more recent years among males.
    • For women, daily heroin injection, anxiousness and dope sickness emerged as reasons for requiring injection assistance.
    • The most frequently listed reasons for assisted injecting were similar between males and females. The reasons included: jugular injection; bad veins/no veins; and being anxious/dope sick.
    • The amount of both men and women who reported a lack of injection technique as a reason for assisted injection decreased in recent years.
    • However, rates of assisted injection continue to be high despite the decline shown in this study. This is particularly true for females as they have higher rates of assisted injecting in comparison to males.
    • A troubling finding is that the association between assisted injecting and syringe borrowing seems to have strengthened in recent years.
    • For both men and women, injecting in public was continually associated with assisted injecting.

    Conclusion

    The rates of assisted injection among people who inject drugs is declining. Possibly, this may be related to increased awareness of the risks associated with assisted injecting due to improved access to harm reduction information and interventions. However, it is important to recognize that, overall, assisted injecting remains high, particularly among women.

    Pedersen, J.S., Dong, H., Small, W., Wood, E., Nguyen, P., Kerr, T., and Hayashi, K. (2016).Declining trends in the rates of assisted injecting: a prospective cohort study. Harm Reduction Journal. 13:2.

  5. Naloxone as Treatment for Opioid Overdose

    Summary

    • Between 1999 and 2012, opioid-related deaths over tripled from 1.4 to 5.1 per 100,000.
    • Opioid painkillers are the most common prescription medication related to overdose deaths.
    • A drug called naloxone can treat opioid overdoses. Administration of the treatment is easy because it can be sprayed into an unconscious person’s nose, does not require intravenous access, and reduces needle prick risks.
    • Many states have reduced restrictions of naloxone use by emergency responders and have developed programs for naloxone distribution to opioid abusers in order to reduce opioid-associated mortality. There are at least 188 programs that currently distribute naloxone throughout the U.S.
    • Over 10,000 successful opioid overdose reversals were reported between 1996 and 2010 by naloxone distribution programs. This shows that naloxone can prevent overdose death when administered by bystanders with limited training.
    • Amended laws in 30 states now make it easier for medical professionals to prescribe and dispense naloxone, and for bystanders to administer it, by removing or reducing liability if something goes wrong.
    • Good Samaritan Laws allow bystanders to call 911 to report an overdose without fear of arrest (Law Atlas The Policy Surveillance Portal, 2015).
    • A community-based prevention program, Project Lazarus, partnered with local physicians and provided naloxone as part of their routine medical care to both suspected opioid abusers and pain patients who were at high risk for overdose. They also provided enhanced education for prescribing physicians. In that program, opioid-associated deaths decreased by 50% in one year.

    In the last two decades, opioid prescribing has increased considerably in the U.S. This is partly due to significant changes in clinical practice guidelines for improved pain control. This may have lead to broader opioid prescribing for chronic pain leading to increased availability of opioids, and increased marketing of opioids. Naloxone is a therapeutic drug used for opioid overdose reversal currently used by first responders and hospitals. Overall, naloxone distribution and training programs have shown to be effective in reducing opioid associated mortality.

    Coe, M.A., and Walsh, S.L. (2015).Distribution of naloxone for overdose prevention to chronic pain patients. Preventative Medicine. 80:41-43.

  6. Good News for Good Samaritans!

    The Good Samaritan Overdose Act is now law in Canada.

    This will help to save lives.  To learn more, see News Release from Health Canada.

  7. Perceived Risk of Opioid Overdose

    Background

    Globally, opioid use is on the rise. Opioid dependence is estimated as the largest contributor to the global burden of disease from drug dependence. In the United Stated, over 25 million people began using nonmedical opioids between 2002 and 2011. During this time, the drug-poisoning mortality rate more than doubled.

    Method

    The authors surveyed 172 opioid users in San Francisco to assess predictors of risk perception for opioid overdose.

    Findings

    • Older individuals and those who injected more frequently were less likely to see themselves at a high risk for opioid overdose. However, the literature indicates that those who are older are actually more likely to die from overdose.
    • Those who injected more frequently were less likely to perceive themselves as high risk for overdose.
    • Interestingly, although concurrent use of opioids and alcohol was associated with a high-perceived risk of overdose, concurrent use of opioids and benzodiazepines or cocaine was not. Yet previous research shows that concurrent use of these substances is linked to opioid overdose.
    • Participants who experienced a past overdose, used heroin and mixed opioids and alcohol more frequently were more likely to see themselves as high risk for overdose. This finding is consistent with the literature, which shows previous overdose to be the strongest predictor of overdose and overdose death.
    • HCV positive participants were more likely perceive themselves at high risk for overdose. However this association was not found amongst HIV positive participants, despite the risks. This suggests a gap in risk perception amongst this particular population.

    Conclusion

    There are gaps in awareness between real overdose risk factors and perceived overdose risk amongst opioid users. The authors highlight the need for educational interventions.

    Rowena, C., Santos, G.M., Behar, E., and Coffin P.O. (2016). Correlates of overdose risk perception among illicit opioid users. Drug and Alcohol Dependence. 159: 234-239.

  8. Posted in:

    HCV Among People Who Inject Drugs in Rural Puerto Rico

    Background

    Although we know that the microbial differences between HIV and HCV have an impact on prevalence, how drugs are obtained and used may also influence prevalence. Recent studies show Puerto Rico has one of the highest HCV prevalence rates in the world.

    Aim

    The authors looked risk factors of 315 rural Puerto Rican people who inject drugs (PWID) and also compared the behaviours of HCV negative and HCV positive participants.

    Method

    INSTI Rapid HIV and OraQuick Rapid tests were used to determine HIV and HCV status. Additional data was acquired through questionnaires.

    Findings

    • Over three quarters (78.4%) of the participants were positive for HCV and significantly fewer (6.0%) were HIV positive.
    • All HIV positive individuals were also infected with HCV.
    • Both HCV positive and HCV negative reported the same frequency of injection drug use during the last year.
    • Each additional person who used equipment before the participant was associated with an increase 18% increase in the odds of being HCV + positive.
    • Frequency of injection with a used cooker was over twice as common as injection with a used needle.

    HCV + (pos) Characteristics

    • 3 years older (than HCV negative)
    • Began injecting at a younger age (20.7 vs 26.3)
    • Injected for 9.4 more years than HCV negative group
    • Used cookers, cotton and water after an average of 2 or more people

    Conclusion

    This adds to current research showing that a notable proportion of HCV infections are due to cooker or cotton sharing.

    Abadie, R., Welch-Lazoritz, M., Gelepi-Acosta, C., Reyes, J.C., and Dombrowski, K. (2016). Understanding differences in HIV/HCV prevalence according to differentiated risk behaviors in a sample of PWID in rural Puerto Rico. Harm Reduction Journal. 13:10-13.

  9. Deindustrialization and Overdose Risk

    Background

    “In 2013, more Americans died from overdoses than car crashes” – Hilary Clinton in 2015 on the growing need to address the epidemic of drug overdose.

    • Opiate- and opioid-type drugs have been associated with a rising proportion of overdose deaths – from over 38% in 2004 to just under 52% in 2013 in the United States.
    • The initial rise in mortality was due to an in crease in prescription opioid (PO) abuse, but more recent data shows that heroin use has risen in popularity partly due to the attempts to control prescription drug misuse.
    • In 2008, heroin represented approximately 30% of overdose deaths. By 2014, heroin accounted for 61%, making it the most prevalent substance associated with overdose deaths.
    • Recent research has considered how the shifting dynamics of the U.S. illicit drug market have heightened overdose risk in places newly supplied with cheaper, more potent Colombian heroin.

    Study Setting

    • Small cities across the Monongahela River Valley have lost ‘‘90 percent of everything’’ – residents, jobs, and businesses – over the past three decades
    • According to the Allegheny County Medical Examiner (ACME), fatal overdoses nearly tripled from 2000 to 2014, from 109 to 307.
    • Case-level mortality data from Allegheny County shows an obvious spatial association between deadly overdose and poverty, with the highest fatality rates clustered in the region’s deindustrialized communities and Pittsburgh’s inner-city neighbourhoods.

    Risk environments =‘‘spaces – whether social or physical – in which a variety of factors interact to increase the chances of harm occurring’’ (Rhodes, 2009).

    Approach

    In a survey, participants described their own most recent overdose event and/or the last overdose they had personally witnessed. They were also asked to speculate upon the roots of the local overdose epidemic, while suggesting possible remedies.

    Findings

    • Participants viewed overdose and addiction as part of life in a poor city.
    • Participants lacked access to prevention education and free naloxone (for treating overdoses) from the county needle exchange program due to transportation barriers.
    • Several participants sold heroin in order to support their own drug use and many feared the criminal consequences of a buyer having a fatal overdose.

    Conclusion

    The authors suggest that the road into drug use is shaped by a deindustrialized context. Lack of opportunity, social support, and hope are met by the expanding illicit drug market, which offers both employment and recreation. Due to this, policy makers should be aware of the underlying factors and future overdose interventions should take into account that drug-related risks are complex and multifaceted when designing accessible programs for low/no-income individuals.

    McLean, K. (2015). ‘‘There’s nothing here’’: Deindustrialization as risk environment for overdose. International Journal of Drug Policy. Vol. 29. Pp. 19-26.

    Rhodes, T. (2009). Risk environments and drug harms: A social science for harm reduction approach. International Journal of Drug Policy. 20: 193–201.

  10. Posted in:

    Recommendations for HCV Infection Management

    Background

    • Hepatitis C virus (HCV) infection in high income countries ranges from 50%-80% among people who inject drugs (PWID) and epidemics are also beginning to emerge in middle and low income countries among their PWID populations.
    • Among people who inject drugs, the rates of advanced liver disease complications, related healthcare costs, and liver associated morbidity and mortality are all on the rise.
    • Despite the increased burden of liver disease, treatment uptake and completion remains very low.

    Approach

    The authors make recommendations based on scientific research and expert opinion, which are updated to be in line with international guidelines.

    Summery of some of the recommendations:

    Impact of drug use on treatment adherence and sustained virologic response (SVR) 

    If one receives approximately 80% of scheduled treatments he is generally considered to be adhering to the to HCV therapy however, this does not distinguish between missed doses and the stopping of treatment.

    In addition, studies have found that lower education and unstable housing are associated with adherence and treatment completion. Other factors associated with low SVR among PWID, include low social functioning, a history of untreated depression, and continued drug use during treatment

    • Adherence assessments should consider missed doses and treatment discontinuation
    • Individuals should be counselled on the importance of adherence in attaining an SVR
    • A history of IDU and recent drug use at treatment initiation are not associated with reduced SVR and decisions to treat should be made on a case-by-case basis
    • Those with ongoing social issues, history of psychiatric disease and those with more frequent drug use during therapy are at risk of lower adherence and SVR and should be to be monitored closely.

    Treatment management recommendations

    Several models have shown that HCV treatment can be delivered successfully to PWID whether it be within a general hospital, drug detoxification clinics, opioid substitution therapy clinics, prisons or a community-based clinics.

    • HCV treatment for PWID should be looked at on a case by case basis and delivered by a multidisciplinary team
    • Access to harm reduction programs, social work and social support services should be a component of HCV clinical management
    • Peer-based support should be evaluated to improve HCV clinical management

    Conclusions

    Although there are number of barriers to care for people who inject drugs (PWID), research has shown hepatitis C virus (HCV) treatment to be safe and effective. Enhancement of HCV assessment and treatment strategies is greatly needed due to the burden of HCV-related disease.

    Grebely, J.A., Robaeys, G., Bruggmann, P., Aghemo, A, Backmund, M., and Bruneau, J. (2015).

    Recommendations for the management of hepatitis C virus infection among people who inject drugs. International Journal of Drug Policy. Vol. 26. Pp 1028-1039.