Dynamics of overdose and non-overdose mortality among people living with HIV amidst the illicit drug toxicity crisis in British Columbia

ABSTRACT

We sought to characterize overdose and non-overdose mortality among PLWH amidst the illicit drug toxicity crisis in British Columbia, Canada. A population-based analysis of PLWH (age ≥19) in British Columbia accessing healthcare from April 1996 to March 2017 was conducted using data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort linkage. Underlying causes of deaths were stratified into overdose and non-overdose causes. We compared (bivariate analysis) health-related characteristics and prescription history between PLWH died of overdose and non-overdose causes between April 2009 and March 2017. Among 9,180 PLWH, we observed 962 deaths (142 [14.7%] overdoses; 820 [85.2%] other causes). Compared to those who died from other causes, those who died of overdose were significantly younger (median age [Q, Q3]: 46 years [42, 52] vs. 54 years [48, 63]); had an indication of chronic pain (35.9% vs. 27.1%) and hepatitis C virus (64.8% vs. 50.4%), but fewer experienced hospitalization in the year before death. PLWH who died were most likely to be prescribed with opioids (>50%) and least likely with opioid agonist therapy (<10%) in a year before death. These findings highlight the syndemic of substance use, HCV, and chronic pain, and how the crisis is unqiuely impacting females and younger people.

KEYWORDS:

• HIV
• substance use
• illicit drug toxicity crisis
• overdose deaths
• mortality

Acknowledgements

We would like to acknowledge with gratitude the people living with HIV and the health care practitioners in the province. We honour those we have lost due to the toxic drug crisis. We are grateful to the BC Ministry of Health of British Columbia for providing access to the administrative data and ongoing support. We also acknowledge the support of Scott Emerson and Amanda Yonkman and the STOP HIV/AIDS research group.

Disclaimer: All inferences, opinions, and conclusions drawn in this publication are those of the authors, and do not reflect the opinions or policies of the Data Stewards. The BC-CfE is prohibited from making individual-level data available publicly due to provisions in our service contracts, institutional policy, and ethical requirements. In order to facilitate research, we make such data available via individual data access requests. Some BC-CfE data are not available externally due to prohibitions in service contracts with our funders or data providers. Institutional policies stipulate that all external data requests require collaboration with a BC-CfE researcher. For more information or to make a request, please contact [email protected]. All data relevant to the analysis are included in the tables or supplementary materials. The underlying analytical codes are available from the authors on request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors contributions

KY, ND, and KS contributed to the research conceptualization, development, and design of methodology, data analysis, and data interpretation. KS oversaw project administration. KY was responsible for the original draft preparation and project coordination. MY, JT contributed to data cleaning, statistical analysis, and computer code implementation and statistical interpretation. AT, CS, N.GA, TM, VL, RB, RH, and JM contributed to the paper’s data interpretation and critical review. All authors contributed to manuscript development.

Ethics

The British Columbia Centre for Excellence in HIV/AIDS received approval for this study from the University of British Columbia Ethics Review Committee at St. Paul’s Hospital, Providence Health Care Site (H08-02095).

Additional information

Funding

This study was funded by the British Columbia Ministry of Health through the STOP HIV/AIDS program.