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.
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.
The authors surveyed 172 opioid users in San Francisco to assess predictors of risk perception for opioid overdose.
• 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.
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.
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.
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.
INSTI Rapid HIV and OraQuick Rapid tests were used to determine HIV and HCV status. Additional data was acquired through questionnaires.
HCV + (pos) Characteristics
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.
“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.
Risk environments =‘‘spaces – whether social or physical – in which a variety of factors interact to increase the chances of harm occurring’’ (Rhodes, 2009).
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.
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.
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
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.
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.
Steroids, properly called Anabolic–androgenic steroids (AAS), are commonly used drugs in some populations of young men. Several studies have found an association between illicit drugs, such as heroin and other opiates, with steroid use. There are various possible explanations for the connection between steroid use and illicit drug use:
In an urban area in the North East of England, the authors used several focus groups (total of 30 participants) to look at the socio-cultural links to steroid use (AAS) and the link between steroid use and heroin.
Hiding weight loss
Other studies also, have found that steroids were used for reasons such as “to feel brave” and as an attempt to hide the effects of heroin.
There are important socio-cultural reasons for the association between heroin and AAS use, which include the need to function through intimidation, and to hide the stigma associated with heroin use. It is important to note that most steroid users do not use heroin and most heroin users do not use steroids. Further research could focus on determining which heroin users are at risk of using steroids and of those who use them, investigating who is at the greatest risk for developing dependence on steroids.
Cornforda, C.S., Keanb, J., and Nash, A. (2014). Anabolic–androgenic steroids and heroin use: A qualitative study exploring the connection. Journal of International Drug Policy. Vol. 25, Issue, 5. Pp. 928-930.
On February 21, 2017, a first national Day of Action will be held across Canada to demand different levels of government take meaningful and concrete action to address the opioid overdose epidemic devastating communities across the country. The demands include an end to the war on drugs, the removal of barriers to health care including immediate improved access to naloxone and opiate substitution therapy, and the implementation of policies that are informed by real life experiences of people who use drugs. Actions are taking place in Vancouver, Victoria, Edmonton, Ottawa, Toronto, Montreal, Halifax and other communities across Canada.
Local organizations are seeking endorsements for their lists of demands. To sign on to the demands, or to find out more information about the actions taking place closer to you, visit https://www.facebook.com/events/371308773235925/?active_tab=about or contact firstname.lastname@example.org.
Hepatitis C virus (HCV) infection prevalence is high among people who inject drugs (PWID) and is a major cause of morbidity and mortality among this population. Due to concerns that HCV treatment may increase injecting risk behaviours among people who inject drugs (PWID) the authors compared recent (past month) injecting risk behaviours between PWID who received and did not receive HCV treatment.
Hepatitis C virus assessment and treatment for people who inject drugs should be enhanced due to its effectiveness as it does not lead to increases in injection risk behaviours and has already been shown to be safe and effective for PWID populations.
Alavi, M., Spelman, T., & Matthews, G.V. (2015). Injecting risk behaviours following treatment for hepatitis C virus infection among people who inject drugs: The Australian Trial in Acute Hepatitis C. International Journal of Drug Policy. Vol. 26. Issue 10, pp. 976-983.
Health care providers and governments across the globe are faced with an urgent task to improve health outcomes for PWID, specifically reducing increasing rates of HIV and HCV transmission.
The authors assess needle exchange programs (NSPs), opioid substitution therapy (ORT), and antiretroviral therapy (ART) in isolation and then in combination.
Effectiveness and Cost-effectiveness of needle syringe programs (NSPs)
Effectiveness and Cost effectiveness of opioid substitution therapy (OST)
Effectiveness and Cost effectiveness of antiretroviral therapy ART
Effectiveness and Cost effectiveness of combination strategies
Harm reduction interventions are good value for the money invested and improve health outcomes for PWID, as well as, the broader population. Currently, coverage of harm reduction programs is too low across almost all global regions. Although scaling up is costly, it is worthwhile not only for the societal benefits, but also for the significant returns on investment for governments.
Wilson, D.P., Donald, B., Shattock, A.J., Wilson, D., and Fraser-Hunt, N. (2015). The cost-effectiveness of harm reduction. International Journal of Drug Policy. Vol. 26, pp. S5-S11.
Timely notification of HCV test results is a key opportunity for risk behavior reduction counseling. In addition, there is need to expand post-test counseling services and monitoring in order to address post-diagnosis alcohol use.
Spelman, T., Morris, M.D., and Zang, G. (2015). A longitudinal study of hepatitis C virus testing and infection status notification on behavior change in people who inject drugs. J Epidemiol Community Health. 69(8): 745–752.