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Additional file 1. PDF document containing the following supplementary figures & tables: Figure S1. Satisfaction with adaptations made by pharmacy/medical team to deliver OAT during the health emergency; Figure S2. Anticipated outcomes of the COVID-19 pandemic based on a rapid review of select "Big Events", as reported in Zolopa et al 2021; Table S1. Changes in income sources; Table S2. Access to drug/alcohol treatment and harm reduction during the health emergency.

Following cannabis legalization, some Canadian provinces created government-operated stores (e.g. Société québécoise du cannabis, SQDC) to distribute and sale cannabis and protect public health. However, little information exists on cannabis-related harms as a function of supply source. This study analyses data from the Quebec cannabis survey conducted between February 11th and June 9th 2019 in 1836 adult (>18 years old) cannabis users. Binary logistic regressions were used to evaluate the association between seven vulnerability markers to cannabis-related harms and supply source. Individuals who bought their cannabis at the SQDC (46%) had similar profile compared with individuals who bought their cannabis elsewhere (54%) in terms of psychological distress (adjusted odds ratio [aOR]=1.0; 95% confidence interval [CI]=0.3-3.8, p=0.991), risky motor driving (aOR=0.9, 95% CI=0.3-3.4, p=0.913), other substance co-use (aOR=0.8, 95% CI=0.2-3.9, p=0.765), problematic cannabis use (aOR=0.5, 95% CI=0.1-1.6, p=0.230), use to deal with negative affect (aOR=0.6, 95% CI=0.2-2.5, p=0.499) and cannabis use frequency (aOR=0.5, 95% CI=0.1-1.7, p=0.238). However, individuals who did not bought their cannabis at the SQDC had increased odds of ignoring the cannabinoid content of their cannabis product compared with those who bought their cannabis from SQDC (aOR=4.1, 95% CI=1.1-15.4, p=0.035). This result is coherent with SQDC's objective to inform cannabis users on their products, including the content and ratio of cannabinoids. More research is needed to see if this lower vulnerability marker translates into fewer negative consequences from cannabis use.Poster presented at the 22nd congress of students, fellows and residents of the Research Centre of the Centre hospitalier de l'Université de Montréal, Montreal (Canada), May 5-6 2021.

AimsTo summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs.DesignSystematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting health-care utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525).Setting and participantsPeople who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4-methyl​enedioxy​methamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services.MeasurementsPrimary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED).FindingsNinety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI)=114-201] and 41 (95% CI=30-57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.ConclusionsPeople who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

Table S1. ICD-10 codes used to define cause-specific mortality and hospital admissions among people with an HBV and HCV notification, NSW 1993-2012, n = 150,403. Table S2. Cause-specific mortality among people with an HBV and HCV notification, NSW 1993-2012, by ICD-10 chapter, n = 150,403. Table S3. Unadjusted analysis of factors associated with liver-related mortality among people with an HBV notification, NSW 1993-2012, n = 57,929. Table S4. Unadjusted analysis of factors associated with liver-related mortality among people with an HCV notification, NSW 1993-2012, n = 96,250. Table S5. Other cause-related mortality among people with an HBV and HCV notification, NSW 1993-2012, by ICD-10 chapter and year of birth, n = 150,403. Table S6. Adjusted analysis of factors associated with liver-related mortality among people with an HBV and HCV notification, NSW 1993-2012, n = 150,403. (DOCX 50 kb)

Sex and age distributions of people who inject drugs observed in routinely collected and survey data, 2014, and summary proportions obtained by random effects meta-analysis. Sex and age distributions observed in the National Opioid Pharmacotherapy Statistical Annual Data Collection, Australian Bureau of Statistics Causes of Death data, Australian Needle and Syringe Program Survey, and Illicit Drug Reporting System, and summary proportions used to disaggregate the national estimate of people who inject drugs by sex and age. (PDF 73 kb)

Heroin dependence is a chronic condition associated with significant health and social harms. The most effective treatment for heroin dependence is opioid substitution treatment (OST), in which long-acting opioid medications such as methadone or buprenorphine are prescribed with the goal of reducing heroin use and associated harms. Internationally, OST is rarely available in prisons, despite the high proportion of heroin users among prisoners. Furthermore, limited research attention has been given to examining how prison-based OST can reduce the harms of heroin dependence. This thesis reports on two systematic literature reviews and four data linkage studies on the effects of prison-based and post-release OST. The first systematic review found that there is good evidence that prison OST reduces heroin use and needle and syringe sharing among prison inmates. The second review found that the evidence relating to the effects of prison OST on post-release outcomes is inconsistent and has limitations. As such, four data linkage studies were undertaken to assess incarceration, offending and mortality outcomes for a cohort of 375 male heroin users recruited in prisons in New South Wales (NSW), Australia, in 1996-7. Data were linked for the nearly ten-year period 1 June 1997 – 31 December 2006. The first data linkage study assessed whether the baseline data for the cohort could be linked to other databases with sufficient sensitivity and specificity to obtain reliable and valid results regarding episodes of OST. Results showed that maximum sensitivity and specificity were achieved when participants’ aliases were included as identifiers during the linkage process, and that enrolment in OST during the observation period had been reliably ascertained by linkage. The second data linkage study demonstrated that exposure to OST while in prison did not in itself reduce risk of re-incarceration; rather, it was continuation of treatment as the individual returned to the community that reduced the risk of returning to prison. Among participants who remained in OST post-release, risk of re-incarceration was, on average, 80% that of participants not in OST. The third study, assessing re-offending, did not find a relationship between OST exposure and criminal convictions; however, there were indications of bias in the analysis as a result of informative censoring. The fourth data linkage study analysed mortality outcomes for the cohort. Participant mortality was six times that seen in the age-, sex- and calendar-adjusted NSW population, but was moderated while in OST and while in prison. Although mortality was elevated in the 28 days immediately after release from prison in comparison to all other time at liberty, this difference was not statistically significant; a larger sample size may have resulted in a significant finding in this regard. Although OST has been studied extensively, few studies have employed data linkage to examine long-term treatment outcomes, particularly in relation to treatment participation while in prison. The evidence presented in this thesis provides support for the provision of OST in prisons, and for programs that facilitate prisoners’ access to post-release OST. Integration of prisoner healthcare into public health systems may assist in improving continuity of OST as well as general standards of care. Future research should explore how the duration of pre-release treatment affects post-release outcomes and how OST can be combined with therapeutic approaches that address other risk factors for offending. Further follow-ups of the cohort would provide insights into the course and consequences of heroin use in Australia.

Table S1. ICD-10 codes used to define cause-specific mortality and hospital admissions among people with an HBV and HCV notification, NSW 1993-2012, n = 150,403. Table S2. Cause-specific mortality among people with an HBV and HCV notification, NSW 1993-2012, by ICD-10 chapter, n = 150,403. Table S3. Unadjusted analysis of factors associated with liver-related mortality among people with an HBV notification, NSW 1993-2012, n = 57,929. Table S4. Unadjusted analysis of factors associated with liver-related mortality among people with an HCV notification, NSW 1993-2012, n = 96,250. Table S5. Other cause-related mortality among people with an HBV and HCV notification, NSW 1993-2012, by ICD-10 chapter and year of birth, n = 150,403. Table S6. Adjusted analysis of factors associated with liver-related mortality among people with an HBV and HCV notification, NSW 1993-2012, n = 150,403. (DOCX 50 kb)

usc Background: HCV transmission remains high in prisons globally. Understanding injecting risk behaviours in prisons is crucial to effectively develop and implement HCV prevention programs in this setting including treatment as prevention. Methods: HITS-p is a cohort study which enrolled people with a history of injecting drug use in prisons in NSW, Australia from 2005 to 2013. Participants completed an interview at enrolment and follow-up visits to determine injecting behaviours. Generalized estimating equation (GEE) and logistic regression methods were used to assess injecting risk behaviours prior to and following prison entry and to investigate injecting risk behaviours in prison. Results: Overall, 499 participants with a history of injecting drug use were included (median age, 26 years; 65% male). Participants were significantly less likely to inject drugs following incarceration. Among injectors, participants were less likely to inject ≥weekly but more likely to share a needle/syringe. At enrolment, the proportion reporting any injecting, ≥weekly injecting, and needle/syringe sharing in prison was highest among younger individuals. Younger age was associated with both re-initiation and continuation of injecting drug use following prison entry. Among those continuously imprisoned, younger age was associated with increased odds of any injecting, ≥weekly injecting, and sharing a needle/syringe. Conclusions: Upon entry to prison, injecting drug use decreased but syringe sharing increased among injectors. Younger individuals are most likely to exhibit high-risk injecting behaviours in prison. These data highlight the need for improved HCV prevention strategies (including improved needle/syringe access and scale up of HCV therapy) for those at increased risk of HCV transmission in prison, including younger individuals. Refereed/Peer-reviewed