Effect of witnessing an overdose on the use of drug checking services among people who use illicit drugs in Vancouver, Canada

ABSTRACT

Background

Since 2013, fentanyl-contaminated drugs have been driving North America’s opioid-overdose epidemic. Drug checking, which enables people who use illicit drugs (PWUD) to test and receive feedback regarding the contents of their drugs, is being considered as a potential tool to address the toxic drug supply. While some PWUD witness overdoses, little is known about the impact of these experiences on subsequent risk reduction practices.

Objective

The purpose of this study was to examine the effect of witnessing an overdose on drug checking service use.

Methods

Data were derived from prospective cohorts of PWUD in Vancouver, Canada, a setting with a community-wide fentanyl overdose crisis, between June 1, 2018 and December 1, 2018. Multivariable logistic regression was used to estimate the effect of witnessing an overdose on drug checking service use.

Results

1,426 participants were eligible for the study, including 530 females; 767 (53.8%) participants reported witnessing an overdose and 196 (13.7%) reported using drug checking services in the last 6 months. In multivariable analyses, after adjusting for a range of confounders including the use of fentanyl, witnessing an overdose was positively associated with drug checking service use (adjusted odds ratio = 2.32; 95% confidence interval: 1.57–3.49).

Conclusion

Our findings suggest that witnessing an overdose may motivate PWUD to use drug checking services. Given that only a small proportion of PWUD in the study reported using drug checking services, our findings highlight the need to continue to scale-up a range of overdose prevention interventions.

KEYWORDS:

• Overdose
• drug checking
• illicit drugs
• opioids
• fentanyl
• Vancouver

Acknowledgements

The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff.

Disclosure of interest

The authors report no conflicts of interest.

Additional information

Funding

The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff. The study was supported by the US National Institutes of Health [VIDUS: U01DA038886]; [ACCESS: R01DA021525]; and [ARYS: U01DA038886]. Dr. Kora DeBeck is supported by a MSFHR/St. Paul’s Hospital Foundation–Providence Health Care Career Scholar Award and a Canadian Institutes of Health Research New Investigator Award. Dr. Lianping Ti is supported by a MSFHR Scholar Award. Dr. Kanna Hayashi is supported by a CIHR New Investigator Award [MSH-141971], a MSFHR Scholar Award, and the St. Paul’s Foundation. Dr. M-J Milloy is supported by a CIHR New Investigator Award, a MSFHR Scholar Award and the US NIH [U01DA021525]. Dr. M-J Milloy’s institution has received an unstructured gift from NG Biomed Ltd., to support his research. He is the Canopy Growth professor of cannabis science at the University of British Columbia, a position established through arms’ length gifts to the university from Canopy Growth Corporation, a licensed producer of cannabis in Canada, and the Government of British Columbia’s Ministry of Mental Health and Addictions. Tara Beaulieu is supported by a University of British Columbia Doctoral Fellowship. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine which supports Dr. Evan Wood.