Factors Associated with Nonfatal Overdose During a Public Health Emergency

Abstract

Background: In 2016, in the Canadian province of British Columbia, the Provincial Health Officer declared drug-related overdose deaths a public health emergency. Objectives: In this study, we examine factors associated with recent non-fatal overdose during a time of unprecedented rates of overdose and increasing involvement of fentanyl and fentanyl derivatives in overdose deaths. Methods: Between June and September 2016, a cross-sectional survey was conducted among people who inject drugs (PWID) in Victoria, British Columbia, Canada. Bivariable and multivariable logistic regression analyses were used to examine factors associated with recent non-fatal overdose. Results: A total of 187 PWID were included in the present study, of whom 56 (29.9%) reported having overdosed in the previous 6 months. In multivariable analyses, fentanyl injection (Adjusted Odds Ratio [AOR] = 2.60; 95% confidence interval [CI]: (1.08 – 6.27) and public injection (AOR = 2.20; 95% CI: 1.09 – 4.43) were positively associated with recent non-fatal overdose. Conclusions: Fentanyl injection and public injection were associated with an increased likelihood of non-fatal overdose. These findings underscore the need for drug checking, safer sources of opioids and safer injecting interventions as part of overdose prevention strategies.

Keywords:

• Fentanyl
• illicit drugs
• injection drug users
• nonfatal overdose

Acknowledgments

The authors thank the study participants as well as the agencies and their staff that facilitated data collection within their sites.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

The study was supported by funding from the University of Victoria’s Internal Research Project Grant, Centre for Addictions Research of BC, YES2SCS, the Ontario HIV Treatment Network, as well as funding from the Canadian Institute for Health Research (CIHR) Centre for REACH in HIV/AIDS, Bernie Pauly’s University of Victoria Community Engaged Scholar Fund, and Thomas Kerr’s Foundation Grant (FDN-148476). Mary Clare Kennedy is supported by a Social Sciences and Humanities Research Council Doctoral Fellowship and a Mitacs Accelerate Award from Mitacs Canada.