Search

Background: In British Columbia, Canada, smoking is the most common modality of drug use among people who die of opioid toxicity. We aimed to assess oxygen saturation (SpO2) while people smoked opioids during a pilot study that introduced continuous pulse oximetry at overdose prevention services (OPS) sites. Methods: This was an observational cohort study, using a participatory design. We implemented our monitoring protocol from March to August 2021 at four OPS. We included adults (≥ 18 years) presenting to smoke opioids. A sensor taped to participants' fingers transmitted real-time SpO2 readings to a remote monitor viewed by OPS staff. Peer researchers collected baseline data and observed the timing of participants' inhalations. We analyzed SpO2 on a per-event basis. In mixed-effects logistic regression models, drop in minimum SpO2 ≤ 90% in the current minute was our main outcome variable. Inhalation in that same minute was our main predictor. We also examined inhalation in the previous minute, cumulative inhalations, inhalation rate, demographics, co-morbidities, and substance use variables. Results: We recorded 599 smoking events; 72.8% (436/599) had analyzable SpO2 data. Participants' mean age was 38.6 years (SD 11.3 years) and 73.1% were male. SpO2 was highly variable within and between individuals. Drop in SpO2 ≤ 90% was not significantly associated with inhalation in that same minute (OR: 1.2 [0.8–1.78], p = 0.261) or inhalation rate (OR 0.47 [0.20–1.10], p = 0.082). There was an association of SpO2 drop with six cumulative inhalations (OR 3.38 [1.04–11.03], p = 0.043); this was not maintained ≥ 7 inhalations. Demographics, co-morbidities, and drug use variables were non-contributory. Conclusions: Continuous pulse oximetry SpO2 monitoring is a safe adjunct to monitoring people who smoke opioids at OPS. Our data reflect challenges of real-world monitoring, indicating that greater supports are needed for frontline responders at OPS. Inconsistent association between inhalations and SpO2 suggests that complex factors (e.g., inhalation depth/duration, opioid tolerance, drug use setting) contribute to hypoxemia and overdose risk while people smoke opioids. [ABSTRACT FROM AUTHOR]

The authors discuss an article by Chandra and colleagues, published in the issue, which described the excess drug-related deaths attributable to the COVID-19 pandemic in the U.S. at a local scale. Topics include main factors proposed by Chandra and colleagues, a significant risk factor for illicit drug-related mortality, and the evolution of unregulated drug supply in British Columbia.

Background: Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment. Methods: One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques. Results: Fifteen family members/family of choice and 16 community-based organization staff members participated (n = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems. Conclusions: Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention. [ABSTRACT FROM AUTHOR]

Background: Global cases of overdose-related deaths attributed to synthetic opioids are reaching epidemic proportion in many jurisdictions. While the main focus of health agencies and the different levels of government has been to combat the cases linked to injection drug use, the deaths attributed to smoking illegal drugs have not gained the same attention. Moreover, little attention has been given to the role of people with past or current experiences of illegal drug use and how their social networks can mitigate the risk of a highly stigmatized behavior such as smoking illegal drugs. Methods: The study concerns the first social network research conducted via a community-based participatory action methodology in two distinct urban (Vancouver) and rural (Abbotsford) centers in British Columbia, Canada. The study will identify the influence of social networks on people who smoke illegal drugs (PWSID) and their adherence to interventions aimed at reducing harm. Through community consultations, members of the Vancouver Area Network of Drug Users and the British Columbia/Yukon Association of Drug War Survivors not only assisted with the design of this research project but also assisted with the data collection, management, protection and entry of demographic, and network information. Discussion: Many traditional qualitative and quantitative methods have not effectively engaged people who use drugs as researchers or collaborators due to stigma related to illegal drug use. The aim of this study is to recognize that everyone within the network of PWSID is a few steps away from harm. Therefore, we aim to reduce the harm associated with smoking of illegal drugs, especially for PWSID that are at the highest risk. At the same time, we hope that the social network research via a participatory community-based approach will mobilize PWSID in the process and offer a different method of knowledge construction from the traditional positivist approaches. [ABSTRACT FROM AUTHOR]

Background: Despite the epidemic of nonmedical analgesic use (NMAU) in North America, there is a scarcity of research quantifying the effect of pain on NMAU. Aims: This study sought to investigate the relationship between NMAU and functional pain interference, defined as the perceived level of interference in performing activities of daily living due to pain, in a population-based sample of the general Canadian population. Methods: Data from the 2012 Canadian Community Health Survey (CCHS)–Mental Health, a nationally representative cross-sectional survey, were used to conduct bivariable and multivariable logistic regression analyses. Results: The weighted prevalences of pain and NMAU were 20.6% and 6.6%, respectively. After adjusting for age, sex, education, culture/race, and chronic mental health diagnosis, a dose–response relationship was observed between higher functional pain interference and increased odds of NMAU, ranging from 1.61 (95% confidence interval [CI], 1.22–2.12) to 2.98 (95% CI, 2.21–4.01) from the lowest to the highest levels of functional pain interference. Elevated odds of NMAU were also observed among younger respondents aged 20–29 years and 15–19 years, respondents with a chronic mental illness diagnosis, and males. Secondary analyses revealed that the dose–response relationship between greater function pain interference and increased odds of NMAU persisted within subgroups with and without mental illness, as well as within subgroups aged 40 to 69. Conclusions: These findings highlight the potential role of pain on increasing NMAU and the need for targeted strategies to reduce harms of NMAU among high-risk subgroups such as young adults. [ABSTRACT FROM AUTHOR]

Objectives: Although take-home naloxone (THN) programs are integral in strategies to prevent overdose deaths among opioid users, the uptake of THN among people who use drugs (PWUD) (including non-opioid users) is unknown. The objectives of this study were to determine awareness, possession, and use of THN among PWUD in Vancouver, Canada, and identify barriers to adopting this strategy. Methods: From December 1, 2014, to May 29, 2015, participants in 2 prospective cohort studies of PWUD in Vancouver completed a standardized questionnaire, which asked about awareness, possession, and use of THN; sociodemographic characteristics; and drug use patterns. We conducted multivariable logistic regression analyses to determine factors independently associated with awareness and possession of THN. Results: Of 1137 PWUD, 727 (64%) reported at least 1 previous overdose ever, and 220 (19%) had witnessed an overdose in the previous 6 months. Although 769 (68%) participants overall reported awareness of THN, only 88 of 392 (22%) opioid users had a THN kit, 18 (20%) of whom had previously administered naloxone. Factors that were positively associated with awareness of THN included witnessing an overdose in the previous 6 months (adjusted odds ratio [aOR] = 2.23; 95% confidence interval [CI], 1.49-3.34; P <.001), possession of THN (aOR = 1.85; 95% CI, 1.11-3.06; P = .02), younger age (aOR = 1.02; 95% CI, 1.01-1.04; P = .003), white race (aOR = 1.67; 95% CI, 1.27-2.19; P <.001), hepatitis C infection (aOR = 1.63; 95% CI, 1.13-2.36; P = .01), residing in Vancouver's Downtown Eastside neighborhood (aOR = 1.93; 95% CI, 1.47-2.53; P < .001), and at least daily heroin injection (aOR = 1.69; 95% CI, 1.09-2.62; P < .02). Conclusion: Efforts to improve knowledge of and participation in the THN program may contribute to reduced opioid overdose mortality in Vancouver. [ABSTRACT FROM AUTHOR]

Background: The prevalence of reported allergic diseases is higher in North-America than in other countries around the world. Further, certain types of allergies are more common in some geographic regions or amongst different ethnic populations. This phenomenon has not been well studied amongst the Persian population in the Canadian context; therefore, the current study aimed to compare the prevalence of perceived and diagnosed non-food and food allergies, and food intolerance between Canadians of Persian descent (CPD) and Canadians of European descent (CED), within a sample population of British Columbia residents, their family members and close friends. Methods: Participants were recruited via convenience and snowball sampling, and information about allergy history was collected through in-person and telephone interviews. The prevalence of perceived and diagnosed allergies and food intolerances were compared between CPD and CED. In total, data was reported about 4,404 individuals. Results: The prevalence of all perceived allergies was significantly higher amongst CED compared to CPD [RR (95%CI) = 2.33 (1.6, 3.3)]. A similar pattern was observed for diagnosed food and nut allergy. As well, no cases of perceived or diagnosed food intolerance were reported amongst Persians in the study population. Conclusion: In conclusion, these findings have clinical implications for the treatment and prevention of allergies and food intolerance in BC and Canada. The disproportionate effect of allergies and food intolerance on Canadians of European descent warrants the implementation of targeted public health prevention measures. The genitival and environmental reasons for lack of food intolerance in Canadians of Persian descent should also be investigated. [ABSTRACT FROM AUTHOR]

Background: OxyContin was delisted from Canadian provincial drug formularies in March 2012 and replaced with a reformulated tamper-resistant form of oxycodone (i.e., OxyNeo). We assessed if delisting of OxyContin was associated with changes in the use of unregulated opioids and other substances among people who use opioids (PWUO).Methods: Data were derived from two prospective cohort studies of people who use drugs in Vancouver, BC, Canada from 2006 to 2018. PWUO who had at least one follow-up visit before and after delisting of OxyContin were included. Outcomes of interest were self-reported regular (i.e., at least weekly) use of heroin, non-prescribed prescription opioids, cannabis, methamphetamine, crack cocaine, and powder cocaine during the previous six months. Using quasi-experimental interrupted time series, we fit generalized least squares models to assess participants' immediate and long-term substance use practices after the policy change.Results: We analyzed data from 1014 participants who contributed to 17457 visits during the study. Following the delisting of OxyContin, heroin use increased immediately by 5.17% (95% confidence intervals [CI]: 0.68 to 9.67) and over time by 0.47% (0.35 to 0.58) per month. Non-prescribed prescription opioid use increased immediately by 1.80% (0.10 to 3.50) and over time by 0.16% (0.12 to 0.19) per month. Cannabis use increased immediately by 4.37% (0.88 to 7.87) and over time by 0.11% (0.02 to 0.19) per month. Methamphetamine use did not increase immediately but increased over time by 0.10% (0.01 to 0.18) per month. Crack cocaine use decreased immediately by 6.13% (-10.94 to -1.69) but not significantly over time. Lastly, powder cocaine use did not increase immediately or over time.Conclusions: Delisting of OxyContin in BC was not associated with a reduction in unregulated opioid use among PWUO. Our findings point to a shift in substance use patterns of PWUO post-intervention and further highlight the unintended consequences of supply-reduction interventions in addressing the opioid epidemic. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 52-year-old man with fentanyl-induced muscle rigidity. Topics discussed include fentanyl-induced muscle rigidity caused by the injection of illicit fentanyl; signs of fentanyl-induced muscle rigidity such as jaw clenching and chest rigidity; and need for immediate intervention in the case of fentanyl-induced muscle rigidity.

Background: Drug-induced agranulocytosis is a recognized adverse drug event associated with serious infectious complications. Levamisole is an antihelminthic and immunomodulator withdrawn from North American markets in 2005 after reports of agranulocytosis. Previous studies of levamisole, suggest that the human leukocyte antigen (HLA)-B27 confers a genetic predisposition to this adverse drug event. Since 2009, emergency room visits due to agranulocytosis in individuals consuming levamisole-adulterated crack-cocaine have increased. Methods: We performed a case-control study using a genotyping assay and novel gene chip to test the association between cocaine-associated agranulocytosis (CAA) and HLA-B27 and to identify pharmacokinetic and pharmacody-namic gene variants associated with the phenotype. Results: Fifty-one CAA cases were identified through a provincial physician reporting system between 2008 and 2011. We examined eight of these cases and 26 matched controls. Genotyping revealed a significant association between HLA-B27 and CAA (odds ratio [OR] 9.2,95% confidence interval [Cl], 1.54-54.6). We also observed a similar association with the HLA-B27 tag single nucleotide polymorphism rs4349859 (OR 9.2,95% Cl 1.5-54.6) and rsi 3202464 (OR 6.7,95% Cl 1.1-41). Further associations were identified with variants in the ARBCC12 (OR 10.0,95% Cl 2.7-36.8) and CYP11A1 (OR 7.4,95% Cl 2.1-26.6) genes, while a novel protective association was observed with variants in the ARDB1 gene (OR 0.06, 95% Cl 0.007-0.46). Conclusions: We confirmed the association of HLA-B27 with CAA and identified additional susceptibility variants. Health care providers should inform people who are identified as having CAA that it is genetically determined and can recur with continued cocaine use. The severity of infections and subsequent hospitalization, and the risk of recurrence may prompt health-promoting behaviour changes of the affected individuals. These genetic associations warrant the attention of public health and knowledge translation efforts to highlight the implications for susceptibility to this severe adverse drug event. [ABSTRACT FROM AUTHOR]

Background: Immunization offers the best protection from influenza infection. Little evidence describes disparities in immunization uptake among low-income individuals. Higher rates of chronic disease put this population at increased risk of influenza-related complications. This analysis examines if the type of main source of household income in low-income groups affects influenza immunization uptake. We hypothesized that individuals on social assistance have less access to immunization compared to those with employment earnings or seniors’ benefits. Methods: Data was obtained from the Canadian Community Health Survey annual component 2009-2010. A total of 10,373 low-income respondents (<20,000$ Canadian per annum) were included. Logistic regression, stratified according to type of provincial publicly funded immunization program, was used to examine the association between influenza immunization (in the last 12 months) and main source of household income (employment earnings; social assistance as a combination of employment insurance or worker’s compensation or welfare; or seniors’ benefits). Results: Overall, 32.5% of respondents reported receiving influenza immunization. In multivariable analysis of universal publicly funded influenza immunization programs, those reporting social assistance (AOR 1.24, 95% CI 1.02-1.51) or seniors’ benefits (AOR 1.56, 95% CI 1.23-1.98) were more likely to be immunized compared to those reporting employment earnings. Similar results were observed for high-risk programs. Conclusions: Among the low-income sample, overall influenza immunization coverage is low. Those receiving social assistance or seniors’ benefits may have been targeted due to higher rates of chronic disease. Programs reaching the workforce may be important to attain broader coverage. However, CCHS data was collected during the H1N1 pandemic influenza, thus results may not be generalizable to influenza immunization in non-pandemic years. [ABSTRACT FROM AUTHOR]

Abstract: Background: Injection drug use has been identified as a key source of morbidity and mortality, primarily from overdose and the transmission of blood-borne diseases such as HIV. Experts have therefore called for the prioritization of resources toward the prevention of injection drug use. However, these strategies have not been systematically assessed. Methods: PRISMA guidelines were used to systematically review and extract findings from the peer-reviewed literature evaluating the effectiveness of interventions to prevent injecting initiation. We searched 10 English language electronic databases (PubMed, PsycINFO, EMBASE, Cochrane CENTRAL, CINAHL, Web of Science, TOXNET, AIDSLINE, AMED and ERIC), the Internet (Google, Google Scholar), and article reference lists, from database inception to June 1st, 2012. Results: Overall, out of 384 studies identified in the initial search, eight met the inclusion criteria. Studies evaluated four different types of interventions: social marketing, peer-based behavior modification, treatment, and drug law enforcement. Four studies observed a significant effect of the intervention on reducing rates of injecting initiation. Peer-based behavior modification and addiction treatment interventions were found to be most effective. Two of three studies assessing the impact of drug law enforcement on patterns of injecting initiation found no impact on injecting initiation, while one study reported inconclusive results. Conclusion: There exists a limited scientific literature on strategies to prevent injecting initiation. Resources should be allocated toward increased research and development of effective interventions to prevent this phenomenon. [Copyright &y& Elsevier]

Objective: Previous work shows that many medical professionals hold stigmatizing attitudes towards individuals with mental illness. Medical professionals' stigmatizing attitudes have been associated with the decreased use of needed healthcare services among individuals with mental illness, which can exacerbate the effects and symptoms of the illness on the individual. Medical professionals' attitudes are perhaps best modified early in their training. Thus, we aimed to determine whether a novel intervention could reduce medical students' stigmatizing attitudes towards individuals with mental illness. Methods: Students attended a presentation about a program that trains individuals with mental illness to perform stand-up comedy, and then interacted with the comedians in small groups. Immediately before (T1) and after (T2) the intervention, participants self-rated their comfort with asking patients about mental illness, and completed scales measuring two aspects of stigma: stereotype endorsement, and broad negative attitudes towards people with mental illness. Results: T1 and T2 questionnaires were returned by 49 students. At T2, 52% reported feeling more comfortable asking patients about a history of mental illness. There was no change in broad attitudes towards mental illness, but endorsement of negative stereotypes about mental illness decreased significantly from T1 to T2. Conclusions: These pilot data warrant further investigation of the effects of this novel intervention. [ABSTRACT FROM AUTHOR]

Background: Substance use disorder (SUD) has become increasingly prevalent worldwide, this study investigated the associations of SUD and alcohol, cannabis, opioid, or stimulant use disorder with cardiovascular disease (CVD) and 11 major CVD subtypes.Methods: This study was based on a 20% random sample of residents in British Columbia, Canada, who were aged 18 - 80 years at baseline on January 1, 2015. Using linked administrative health data during 2010 - 2014, we identified people with various SUDs and prevalent CVDs at baseline, and examined the cross-sectional associations between SUDs and CVDs. After excluding people with CVDs at baseline, we followed the cohort for 4 years to identify people who developed incident CVDs, and examined the longitudinal associations between SUDs and CVDs.Results: The cross-sectional analysis at baseline included 778,771 people (mean age 45 years, 50% male), 13,279 (1.7%) had SUD, and 41,573 (5.3%) had prevalent CVD. After adjusting for covariates, people with SUD were 2.7 (95% confidence interval [CI], 2.5 - 2.8) times more likely than people without SUD to have prevalent CVD. The longitudinal analysis included 617,863 people, 17,360 (2.8%) developed incident CVD during the follow-up period. After adjusting for covariates, people with SUD were 1.7 (95% CI, 1.6 - 1.9) times more likely than people without SUD to develop incident CVD. The cross-sectional and longitudinal associations were more pronounced for people with opioid or stimulant use disorder.Conclusions: People with SUD are more likely to have prevalent CVD and develop incident CVD compared with people without SUD. [ABSTRACT FROM AUTHOR]

Several recent collaborations between correctional facilities and community health organizations and community education organizations have enabled incarcerated women to access health and education programs that are also available in the community. In addition, health educational programs initiated by incarcerated women themselves illustrate that incarceration provides opportunities to engage hard-to-reach women in health and educational community-based programs with potential long-term healing benefits. [ABSTRACT FROM AUTHOR]

About 10% of the prison population in British Columbia is women; the annual number of provincial admissions for women may be as high as 3700. Consistent with the rest of Canada, Aboriginal people are overrepresented in the criminal justice system. There is a greater prevalence of bloodborne infections in incarcerated women. Women in prison tend to be of childbearing age, and the problem of separation from their children is inadequately dealt with in our current system. Continuity of health care delivery as women revolve from the community to prison and back to the community is essential for improved health outcomes. Incarcerated women share their ideas regarding their health goals and recidivism. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Crack cocaine pipe sharing is associated with various health-related harms, including hepatitis C transmission. Although difficulty accessing crack pipes has been found to predict pipe sharing, little is known about the factors that limit pipe access in settings where pipes are provided at no cost, albeit in limited capacity. Therefore, we investigated crack pipe access among people who use drugs in Vancouver, Canada. Design and Methods. Data were collected through two Canadian prospective cohort studies. Generalised estimating equations with logit link for binary outcomes were used to identify factors associated with difficulty accessing crack pipes. Results. Among 914 participants who reported using crack cocaine, 33% reported difficulty accessing crack pipes. In multivariate analyses, factors independently associated with difficulty accessing crack pipes included: sex work involvement [adjusted odds ratio (AOR) = 1.57; 95% confidence interval (CI): 1.03-2.39], having shared a crack pipe (AOR = 1.69; 95% CI: 1.32-2.16), police presence where one buys/uses drugs (AOR = 1.47; 95% CI: 1.10-1.95), difficulty accessing services (AOR = 1.74; 95% CI: 1.31-2.32) and health problems associated with crack use (AOR = 1.37; 95% CI: 1.04-1.79). Reasons given for difficulty accessing pipes included sources being closed (48.2%) and no one around selling pipes (18.1%). Discussion and Conclusions. A substantial proportion of people who smoke crack cocaine report difficulty accessing crack pipes in a setting where pipes are available at no cost but in limited quantity. These findings indicate the need for enhanced efforts to distribute crack pipes and address barriers to pipe access.[Ti L, Buxton J, Wood E, Shannon K, Zhang R, Montaner J, Kerr T. Factors associated with difficulty accessing crack cocaine pipes in a Canadian setting. Drug Alcohol Rev 2012;31:890-896] [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the rationale, methodology, and progress of risk perceptions of laboratory workers in relation to existing prion disease infection control policies in Canadian medical laboratories. This study developed a Web survey that investigated the knowledge, behavior, and attitudes of laboratory staff in order to (1) identify strengths, weaknesses, and gaps of current prion infection prevention and control guidelines and (2) inform the development of national medical lab specific guidelines. The use of qualitative methods to develop a relevant survey is described and future research activities are outlined. Preliminary, qualitative data indicate that, among laboratory staff, there is a high degree of perceived susceptibility toward prion transmission in medical laboratories. Significant barriers to following existing prion infection control guidelines are reported with few benefits of following these guidelines. As a result, laboratories take precautions above those that are required when processing suspect prion-infected specimens, which may result in testing delays. A focused survey for laboratory staff that addresses these issues will provide insight on the necessary steps that will ensure safe and efficient diagnostic testing for suspect prion specimens. [ABSTRACT FROM AUTHOR]

An association between leukoencephalopathy, a disease of the white matter of the brain, and smoking heroin is well recognized. This paper describes 27 cases of leukoencephalopathy identified in two cities in British Columbia, Canada 2001-2006; the largest number of geographically and temporally defined reported cases in North America. Twenty cases of leukoencephalopathy were identified in and around Vancouver with onset dates December 2001 to July 2003; seven further cases were identified in Victoria September 2005-August 2006. Twenty (74%) of all cases were male, two couples were reported and eleven cases (55%) had Asian ethnicity. One case reported smoking heroin on a single occasion and developed mild symptoms; all other cases were hospitalized. Thirteen (48%) cases died; all had smoked heroin for a minimum of 3 years. Testing of one available heroin sample identified no substance other than common cutting agents. Although a specific etiology was not identified our study supports the theory of an intermittent exposure to a toxic agent added to the heroin or a combustion by-product. It also suggests a dose response effect rather than genetic predisposition. Collaboration with public health, health professionals, law enforcement and persons who use illegal drugs, will facilitate the early identification of cases to enable timely and complete follow-up including obtaining samples. Testing of implicated heroin samples may allow identification of the contaminant and therefore prevent further cases. It is therefore important to ensure key stakeholders are aware of our findings. [ABSTRACT FROM AUTHOR]

Background: The health risks of crack cocaine smoking in public settings have not been well described. We sought to identify factors associated with public crack smoking, and assess the potential for a supervised inhalation facility to reduce engagement in this behavior, in a setting planning to evaluate a medically supervised crack cocaine smoking facility. Methods: Data for this study were derived from a Canadian prospective cohort of injection drug users. Using multivariate logistic regression we identified factors associated with smoking crack cocaine in public areas. Among public crack smokers we then identified factors associated with willingness to use a supervised inhalation facility. Results: Among our sample of 623 people who reported crack smoking, 61% reported recently using in public locations. In multivariate analysis, factors independently associated with public crack smoking included: daily crack cocaine smoking; daily heroin injection; having encounters with police; and engaging in drug dealing. In sub analysis, 71% of public crack smokers reported willingness to use a supervised inhalation facility. Factors independently associated with willingness include: female gender, engaging in risky pipe sharing; and having encounters with police. Conclusion: We found a high prevalence of public crack smoking locally, and this behavior was independently associated with encounters with police. However, a majority of public crack smokers reported being willing to use a supervised inhalation facility, and individuals who had recent encounters with police were more likely to report willingness. These findings suggest that supervised inhalation facilities offer potential to reduce street-disorder and reduce encounters with police. [ABSTRACT FROM AUTHOR]

Background: As HIV and hepatitis C (HCV) share some modes of transmission co-infection is not uncommon. This study used a population-based sample of HIV and HCV tested individuals to determine the prevalence of HIV/HCV co-infection, the sequence of virus diagnoses, and demographic and associated risk factors.Methods: Positive cases of HIV were linked to the combined laboratory database (of negative and positive HCV antibody results) and HCV reported cases in British Columbia (BC).Results: Of 4,598 HIV cases with personal identifiers, 3,219 (70%) were linked to the combined HCV database, 1,700 (53%) of these were anti-HCV positive. HCV was diagnosed first in 52% of co-infected cases (median time to HIV identification 3 1/2 years). HIV and HCV was diagnosed within a two week window in 26% of cases. Among individuals who were diagnosed with HIV infection at baseline, subsequent diagnoses of HCV infection was independently associated with: i) intravenous drug use (IDU) in males and females, Hazard Ratio (HR) = 6.64 (95% CI: 4.86-9.07) and 9.76 (95% CI: 5.76-16.54) respectively; ii) reported Aboriginal ethnicity in females HR = 2.09 (95% CI: 1.34-3.27) and iii) males not identified as men-who-have-sex-with-men (MSM), HR = 2.99 (95% CI: 2.09-4.27).Identification of HCV first compared to HIV first was independently associated with IDU in males and females OR = 2.83 (95% CI: 1.84-4.37) and 2.25 (95% CI: 1.15-4.39) respectively, but not Aboriginal ethnicity or MSM. HIV was identified first in 22%, with median time to HCV identification of 15 months;Conclusion: The ability to link BC public health and laboratory HIV and HCV information provided a unique opportunity to explore demographic and risk factors associated with HIV/HCV co-infection. Over half of persons with HIV infection who were tested for HCV were anti-HCV positive; half of these had HCV diagnosed first with HIV identification a median 3.5 years later. This highlights the importance of public health follow-up and harm reduction measures for people identified with HCV to prevent subsequent HIV infection. [ABSTRACT FROM AUTHOR]

The Canadian Community Epidemiology Network on Drug Use (CCENDU) Vancouver-site committee is comprised of representatives from national/provincial/local health and enforcement agencies. It collects, collates and interprets recent local data relating to major drug use to produce regular reports exploring Vancouver data with provincial and national comparisons. Meetings of committee members allow identification of current concerns, inform the data and broaden the context for the members. The seventh Vancouver site report since 1996 was published in July 2007. Data trends are explored with input from committee members; changes in data collection and definitions are clarified. The committee strives to share the knowledge with health authorities, policy makers, agencies and the public. [ABSTRACT FROM AUTHOR]

Despite various national and provincial tobacco, alcohol, and illicit drug surveys in Canada, tracking trends and patterns of use is difficult. These surveys often target specific populations and are prone to sampling or respondent bias. This article describes a feasibility study to provide alcohol-, illicit drug- and tobacco-related morbidity using hospital separation data. Hospital episodes for diseases and conditions wholly or partially attributable to alcohol, illicit drugs, and tobacco by health authority, age group, sex, and specific ICD-10 codes for British Columbia (BC) were obtained. The most responsible diagnosis statistics were combined with aetiologic fractions for each ICD-10 code to estimate the total burden of substance use by health authority. Hospital admissions attributable to alcohol and tobacco each cause approximately 3 and 5 times respectively, that attributable to illicit drugs. The on going analysis of morbidity data will be used to inform the health authorities, and to assist policy makers in creating and evaluating policies. [ABSTRACT FROM AUTHOR]

This pilot project is a province-wide and nationally-supported collaboration intended to add value to existing monitoring and surveillance exercises that currently exist and are being developed in Canada. The fundamental aim is to create a system that generates a timely flow of data on hazardous patterns of substance use and related harms so as to inform public debate, to support effective policy, and to facilitate policy-relevant epidemiological research. Pilot and feasibility exercises have been conducted in relation to developing consistent questions in surveys of general and special populations, treatment system data, data on the contents of drugs seized by police, interviews with police, rates of alcohol and other drug mortality and morbidity, alcohol sales data, and data from the emergency departments. Wherever possible, links with the equivalent national data collection processes have been established to create consistencies. This article provides a general overview of the BC pilot monitoring system and discusses some potential advantages of planning and designing a comprehensive system with built-in consistencies across data collection elements. [ABSTRACT FROM AUTHOR]

The article focuses on the long term effectiveness and scheduling of Hepatitis B Virus (HBV) immunization programs for infants and adolescents. It notes the most appropriate timing of vaccination for the immunization against HBV as discussed by the Vaccine advisory bodies. It suggests that HBV immunization vaccines should be given to infants to reduce risk of cirrhosis and hepatocellular carcinoma which occur up to 90% of infants and 1% to 5% of adults. Among the 193 member countries of the World Health Organization (WHO), 171 had implemented the vaccination of hepatitis B to infants as recommended by the Expanded Programme on Immunization in 2007.

Background: Illicit drug overdose deaths (IDD) relate to individual drug dose and context of use, including use with other drugs and alcohol. IDD peaked in British Columbia (BC) in 1998 with 417 deaths, and continues to be a public health problem. The objective of this study was to examine IDD in 2006 in BC by place of residence, injury and death, decedents' age and sex and substances identified. Methods: IDD data was obtained through the BC Coroners Office and entered into SPSS (version 14). Fisher's exact and Pearson's ?2 were used for categorical data; Mann-Whitney U-test for continuous variables. Rates were calculated using 2006 population estimates. Results: We identified 223 IDD in BC; 54 (24%) occurred in Vancouver. Vancouver decedents (compared to those occurring outside Vancouver) were older (mean age 43.9 vs. 39.2 years; p < 0.01) and more likely to be male (90.7% vs. 77.5%; p = 0.03). Provincially Aboriginal ethnicity was reported for 19 deaths; 13 (30.2%) of 43 females and 6 (3.3%) of 180 males (p = < 0.001). Cocaine was identified in 80.3%, opiates 59.6%, methadone 13.9%, methamphetamine/ amphetamine 6.3%, and alcohol in 22.9% of deaths. Poly-substance use was common, 2 substances were identified in 43.8% and 3 or more in 34.5% of deaths. Opiates were more frequently identified in Vancouver compared to outside Vancouver (74.1% vs. 55.0%) p = 0.015. Conclusion: Collaboration with the Coroner's office allowed us to analyze IDD in detail including place of death; cocaine, opiates and poly-substance use were commonly identified. Poly-substance use should be explored further to inform public health interventions. [ABSTRACT FROM AUTHOR]

Background: While incarceration has consistently been associated with a higher risk of HIV infection for individuals who use injection drugs (IDU), the effect of incarceration on the postrelease risk environment remains poorly described. We sought to assess the impact of incarceration on risk factors for HIV infection after release from prison in a sample of active IDU in Vancouver, Canada. Methods: Using a prospective cohort of community-recruited IDU followed from May 1, 1996 to November 30, 2005, we examined contingency tables and performed linear growth curve analyses to assess changes in the prevalence of independent risk factors for HIV infection from before to after a period of incarceration among participants reporting incarceration and a matched control group. Results: Of the 1603 participants followed-up over the study period, 147 (9.2%) were eligible for an analysis of post-incarceration risk behaviours and 742 (46.3%) were used as matched controls. Significant differences were found in one or both groups for the prevalence of frequent cocaine injection, requiring help injecting, binge drug use, residence in the HIV outbreak epicentre, sex-trade participation and syringe sharing (all p < 0.05) after incarceration. In linear growth curve adjusted for age, gender and ethnicity, syringe sharing was significantly more common in those recently released from prison (p = 0.03) than in the control group. Conclusion: In a sample of Canadian IDU, we did not observe any effect of incarceration on the prevalence of several behaviours that are risk factors for HIV infection, including intensity of drug use or participation in the sex trade. However, those recently released from prison were more likely to report syringe sharing that those in a matched control group. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence indicates that illicit drug overdoses are increasing throughout the COVID-19 pandemic. There is a paucity of evidence on the causative pathways for this trend, but expert opinions, commentaries, and some reviews offer theoretical underpinnings.Methods: In this rapid review, we collate the available published evidence, expert opinions, commentaries, and reviews on the unintended pathways between COVID-19 public health responses and increasing illicit drug overdoses. Using tenets of thematic analyses and grounded theory, we also offer a visual conceptual framework for these unintended pathways.Results: Our framework focuses on five particular public health responses, namely social isolation/physical distancing/quarantine; staff/resource reallocations and reductions; closures of businesses and other places of employment; border closures and transportation restrictions; and the early release of people from prisons. As argued in the literature reviewed here, these public health responses have unintentionally created increased overdose risks by producing high risk use scenarios; increased risks of relapsing; disrupted addictions services and treatment; an increasingly toxic supply of drugs; and the risk of using with lowered tolerance.Conclusions: Health care systems should respond to these pathways to mitigate the unintended consequences. Furthermore, the COVID-19 pandemic may represent an opportunity to enact proactive, progressive, and innovative solutions to an overdose crisis that will surely outlast the current pandemic. [ABSTRACT FROM AUTHOR]

Introduction: The literature identifies significant inequalities in the health status of rural and Aboriginal populations, compared with the general population. Providing rural primary care physicians with public health skills could help address this issue since the patterns of mortality and morbidity suggest that prevention and health promotion play an important role. However, we were unable to identify any community needs assessment for such professionals with dual skills that had been performed in Canada. Methods: We conducted key informant interviews and focus groups in 3 rural and Aboriginal communities in British Columbia (chosen through purposive sampling). We analyzed transcripts following standard qualitative iterative methodologies to extract themes and for discussing content. Results: There was broad support for a program to train primary care physicians in public health. The characteristics identified as necessary in such a physician included a long-term commitment to the community with partnership building, advocacy, communication and cultural sensitivity skills. The communities we studied identified some priority challenges, most notably that the current remuneration structure does not support physicians engaging in public health or research. Conclusion: There is great potential and support for the training of rural primary care practitioners in public health to improve population health and engage communities in this process. [ABSTRACT FROM AUTHOR]

Reports on carotid artery dissection as a possible severe complication of pertussis in adults. Complications due to paroxysmal coughing; Prevention against the disease by adult booster immunization.

Presents information on a study which assessed antibody response to a single influenza vaccination and the effect of influenza revaccination in healthy elderly persons. Experimental procedures; Results and discussion.

A letter to the editor is presented about methadone dosing in British Columbia.

Issues: Use of crack cocaine and associated medical complications persists globally. Some reports in medical literature describe a sight‐threatening condition commonly referred to as 'crack eye' or 'crack eye syndrome'. The purpose of this review is to describe what is known about crack eye from case reports in peer‐reviewed literature. Approach: A structured search was completed in MEDLINE, TOXLINE, EMBASE, PsychInfo, Scopus and Biomed Central, to collect case reports and case series on corneal complications attributed to crack cocaine smoking. Key Findings: Of 111 articles screened, 11 contained case reports or series. Thirty individual cases of 'crack eye' were reported. The majority (63%) of cases had bilateral involvement; 83% of all cases with microbial culture results had corneal infections. Aggressive treatment caused an improvement in 95% of all cases and 23% of all cases were lost to follow up. Of those who received treatment for corneal complications associated with crack cocaine, 22% remained with significant visual impairment (hand motions only) in the affected eye. Implications: Clinicians should consider crack cocaine involvement in patients presenting with corneal disease without known predisposing factors, and elicit comprehensive drug histories to prevent a reduction in visual acuity. Conclusion: Corneal complications of crack cocaine smoking are caused by a number of synergistic factors, including direct toxicity of crack cocaine vapours to surface cells, impairment of neurogenic support to corneal epithelial integrity, desiccation of the eye surface due to diminished blinking reflex, low level chemical burns and mechanical denudement of surface cells through eye rubbing. [ABSTRACT FROM AUTHOR]

The article offers information on crystal methamphetamine, a very pure, smokeable form of methamphetamine, and extremely addictive stimulant. Its effects release dopamine which results to feelings of euphoria wherein the users may experience anxiety, depression and fatigue. People use crystal methamphetamine since it offers energy to dance for hours and increase libido and its use by gay men is linked with high-risk sexual behavior. The psychiatric intoxication related to methamphetamine use may be treated with diazepam. It is averred that treatment of methamphetamine dependence is challenging since there are no effective medications and behavioural and cognitive approach have not shown long-term benefits.

Examines the role of antigen testing in the diagnosis of histoplasmosis in a group of students and teachers who visited a cave in Belize. Risk factors and symptoms of histoplasmosis; Duration of the symptoms; Sensitivity of antigen detection in patients with subacute or chronic pulmonary histoplasmosis.

• Reliance on a toxic, illegal drug supply is a main driver of overdose in Canada. • Decriminalization was perceived as unlikely to reduce overdose deaths. • Regulation was seen as the necessary policy approach for reducing overdose deaths. • Under decriminalization, people continue to be exposed to toxic drugs. • The model of regulation is critical to the effectiveness of regulation. North America and the province of British Columbia (BC), Canada, is experiencing an unprecedented number of overdose deaths. In BC, overdose has become the leading cause of death for people between the ages of 10–59 years old. In January 2023, BC decriminalized personal possession of a number of illegal substances with one aim being to address overdose deaths through stigma reduction and promoting access to substance use services. We conducted a qualitative study to understand people who use drugs' (PWUD) perceptions of the new decriminalization policy, immediately prior to its' implementation (October-December 2022). To contextualize decriminalization within broader drug policy, we also asked PWUD what they perceived as the priority issues drug policy ought to address and the necessary solutions. Our final sample included 38 participants who used illegal drugs in the past month. We identified four themes: 1) The illicit drug supply as the main driver of drug toxicity deaths 2) Concerns about the impact of decriminalization on drug toxicity deaths 3) Views towards decriminalization as a policy response in the context of the drug toxicity crisis 4) Regulation as a symbol of hope for reducing drug toxicity deaths. From our data it became clear that many anticipated that decriminalization would have minimal or no impact on the overdose crisis. Regulation was perceived as the necessary policy approach for effectively and candidly addressing the drivers of the ongoing overdose crisis. These findings are important as jurisdictions consider different approaches to moving away from prohibition-based drug policy. [ABSTRACT FROM AUTHOR]

Background: Overdose prevention centers (OPCs) are being implemented in the United States as a strategy to reduce drug-related mortality and morbidity. Previous studies have suggested that people who use drugs (PWUD) with a history of criminal legal system (CLS) involvement (e.g. current probation/parole) are at greater risk of overdose but may also encounter significant barriers to OPC use. The objective of this study was to explore the association between willingness to use an OPC and probation/parole status in a sample of PWUD in Rhode Island. Methods: This study utilized data from the Rhode Island Prescription and Illicit Drug Study, which enrolled adult PWUD from August 2020 to February 2023. We used Pearson's chi-square and Wilcoxon rank-sum tests to assess bivariate associations between willingness to use an OPC and probation/parole status (current/previous/never), as well as other sociodemographic and behavioral characteristics. In multivariable Poisson analyses, we examined the association between willingness to use an OPC and probation/parole status, adjusting for key sociodemographic and behavioral characteristics. Results: Among 482 study participants, 67% were male, 56% identified as white, 20% identified as Hispanic/Latine, and the median age was 43 (IQR 35–53). Nearly a quarter (24%) had never been on probation/parole, 44% were not currently on probation/parole but had a lifetime history of probation and parole, and 32% were currently on probation/parole. Most participants (71%) reported willingness to use an OPC, and in both bivariate and multivariable analyses, willingness to use an OPC did not vary by probation/parole status. Crack cocaine use and lifetime non-fatal overdose were associated with greater willingness to use an OPC (all p < 0.05). Conclusions: These data demonstrate high willingness to use OPC among PWUD in Rhode Island regardless of CLS-involvement. As OPCs begin to be implemented in Rhode Island, it will be imperative to engage people with CLS-involvement and to ensure access to the OPC and protection against re-incarceration due to potential barriers, such as police surveillance of OPCs. [ABSTRACT FROM AUTHOR]

Background: People with opioid use disorder (OUD) are high-risk for short-term mortality and morbidity. Emergency department (ED) interventions can reduce those risks, but benefits wane without ongoing community follow-up. Objective: To evaluate an ED-based intensive community outreach program. Methods: At two urban EDs between October 2019 and March 2020, we enrolled patients with OUD not currently on opioid agonist therapy (OAT) in a prospective cohort study evaluating a one-year intensive community outreach program, which provided ongoing addictions care, housing resources, and community support. We surveyed patients at intake and at scheduled outreach encounters at one, two, six, and twelve months. Follow-up surveys assessed OAT uptake, addictions care engagement, housing status, quality of life scores, illicit opioid use, and outreach helpfulness. We used descriptive statistics for each period and conducted sensitivity and subgroup analyses to account for missing data. Results: Of 84 baseline participants, 29% were female and 32% were housed, with a median age of 33. Sixty participants (71%) completed at least one follow-up survey. Survey completion rates were 37%, 38%, 39%, and 40% respectively at one, two, six, and twelve months. Participants had a median of three outreach encounters. Among respondents, OAT was 0% at enrolment and ranged from 38% to 56% at follow-up; addictions care engagement was 22% at enrolment and ranged from 65% to 81% during follow-up; and housing was 40% at enrolment and ranged from 48% to 59% during follow-up. Improvements from baseline to follow-up occurred for all time periods. OAT and engagement in care benefits were maintained in sensitivity and subgroup analyses. Respondents rated the outreach program as helpful at all time periods, Conclusion: An ED-initiated intensive outreach program for patients with OUD not yet on OAT was associated with a persistent increase in OAT use and engagement in care, as well as housing. [ABSTRACT FROM AUTHOR]

Background: Smoking is the most common mode of unregulated opioid consumption overall and implicated in fatal overdoses in British Columbia (BC). In part, perception of decreased risk (e.g., fewer who smoke carry naloxone kits) and limited smoking-specific harm reduction services contribute to overdose deaths. Overdose prevention services (OPS) offer supervised settings for drug use. Continuous pulse oximetry, common in acute care, allows real-time, remote oxygen monitoring. We evaluated the effectiveness of a novel continuous pulse oximetry protocol aimed at allowing physical distancing (as required by COVID-19, secluded spaces, and to avoid staff exposure to vaporized opioids), its feasibility, and acceptability at OPS for people who smoke opioids. Methods: This was a mixed methods survey study. We developed a continuous pulse oximetry protocol in collaboration with clinical experts and people with lived/living experience of substance use. We implemented our protocol from March to August 2021 at four OPS in BC permitting smoking. We included adults (≥ 18 years) presenting to OPS to smoke opioids. Peer researchers collected demographic, health, and substance use information, and conducted structured observations. OPS clients participating in our study, OPS staff, and peer researchers completed post-monitoring surveys. We analyzed responses using a thematic inductive approach and validated themes with peer researchers. Results: We included 599 smoking events. OPS clients participating in our study had a mean age of 38.5 years; 73% were male. Most (98%) reported using "down", heroin, or fentanyl; 48% concurrently used other substances (32% of whom reported stimulants); 76% reported smoking alone in the last 3 days; and 36% reported an overdose while smoking. Respondents reported that the protocol facilitated physical distancing, was easy to use, high satisfaction, improved confidence, improved sense of safety, and that they would use it again. Conclusions: Continuous pulse oximetry allowed safe physical distancing, was feasible, and acceptable in monitoring people who smoke opioids at OPS. [ABSTRACT FROM AUTHOR]

Peers, i.e. people with lived/living experience of substance use, are at the forefront of harm reduction initiatives in British Columbia, yet they often lack recognition for their contributions. This study aims to understand the role of peers in overdose response settings and their experiences interacting with emergency service providers (ESPs) within the context of the Good Samaritan Drug Overdose Act (GSDOA). Telephone interviews were conducted with 42 people aged 16 years and older, who were likely to witness and respond to overdoses. Participants were asked about their experiences witnessing or responding to overdoses, and interactions with ESPs. Interview transcripts were analyzed thematically. Peers were often the first to respond to overdoses due to their positioning and saw themselves as having unique expertise in responding to overdoses and connecting with other people who use substances. However, peers perceived several barriers that impacted their ability to respond, including stigmatizing attitudes toward ESPs, lack of recognition, and lack of adequate resources. While policies, such as the GSDOA are in place to promote calling 9-1-1, peers feel confident and competent in responding to overdoses and often consider calling 9-1-1 a waste of resources. There is a need to better recognize and support peers as first responders in overdose contexts. [ABSTRACT FROM AUTHOR]

Background: With growing rates of unregulated drug toxicity death and concerns regarding COVID-19 transmission among people who use drugs, in March 2020, prescribed safer supply guidance was released in British Columbia. This study describes demographic and substance use characteristics associated with obtaining prescribed safer supply and examines the association between last 6-month harm reduction service access and obtaining prescribed safer supply. Methods: Data come from the 2021 Harm Reduction Client Survey administered at 17 harm reduction sites across British Columbia. The sample included all who self-reported use of opioids, stimulants, or benzodiazepines in the prior 3 days (N = 491), given active use of these drugs was a requirement for eligibility for prescribed safer supply. The dependent variable was obtaining a prescribed safer supply prescription (Yes vs. No). The primary independent variables were access to drug checking services and access to overdose prevention services in the last 6 months (Yes vs. No). Descriptive statistics (Chi-square tests) were used to compare the characteristics of people who did and did not obtain a prescribed safer supply prescription. Multivariable logistic regression models were run to examine the association of drug checking services and overdose prevention services access with obtaining prescribed safer supply. Results: A small proportion (n = 81(16.5%)) of the sample obtained prescribed safer supply. After adjusting for gender, age, and urbanicity, people who reported drug checking services access in the last 6 months had 1.67 (95% CI 1.00–2.79) times the odds of obtaining prescribed safer supply compared to people who had not contacted these services, and people who reported last 6 months of overdose prevention services access had more than twice the odds (OR 2.08 (95% CI 1.20–3.60)) of prescribed safer supply access, compared to people who did not access these services. Conclusions: Overall, the proportion of respondents who received prescribed safer supply was low, suggesting that this intervention is not reaching all those in need. Harm reduction services may serve as a point of contact for referral to prescribed safer supply. Additional outreach strategies and service models are needed to improve the accessibility of harm reduction services and of prescribed safer supply in British Columbia. [ABSTRACT FROM AUTHOR]

The proliferation of fentanyl and its analogs in illegal, unregulated drug markets remains a major driver of the overdose crisis in North America. Drug checking services have been implemented as a harm reduction strategy to address the crisis. However, little is known about their potential utility as a mechanism for monitoring population-level risk of overdose stemming from changing fentanyl concentration in unregulated drugs over time. Therefore, this study assessed the relationship between median fentanyl concentration in expected opioid drug checking samples and the death rate due to illicit drug toxicity over time in Vancouver, Canada. Monthly population-based rates of death due to illicit drug toxicity were drawn from provincial coroner records. Monthly median percent fentanyl concentration was calculated using a validated quantification model from point-of-care Fourier-transform infrared spectra among expected opioid samples that tested positive for fentanyl at community drug checking services. A time-series analysis using generalized additive modeling was conducted to examine the association between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, controlling for calendar month. Analyses were conducted in 2021–2022. Between January 2019 and October 2020, 577 deaths due to illicit drug toxicity occurred in Vancouver, and the observed monthly rate ranged from 1.75 to 7.65 deaths per 100,000 population. A significant, positive association was observed between monthly median fentanyl concentration and monthly death rate due to illicit drug toxicity, adjusting for calendar month (chi-square=52.21, p <0.001). Findings suggest a role for point-of-care drug checking as a tool for monitoring evolving overdose risk at the population level. [ABSTRACT FROM AUTHOR]

People experiencing homelessness and serious mental illness exhibit high rates of criminal justice system involvement. Researchers have debated the causes of such involvement among people experiencing serious mental illness, including what services to prioritize. Some, for example, have emphasized mental illness while others have emphasized poverty. We examined factors associated with criminal convictions among people experiencing homelessness and serious mental illness recruited to the Vancouver At Home study. Participants were recruited between October 2009 and June 2011. Comprehensive administrative data were examined over the five-year period preceding study baseline to identify risk and protective factors associated with criminal convictions among participants (n = 425). Eight variables were independently associated with criminal convictions, some of which included drug dependence (RR = 1.53; P = 0.009), psychiatric hospitalization (RR = 1.44; P = 0.030), an irregular frequency of social assistance payments (compared to regular payments; 1.75; P < 0.001), and prior conviction (RR = 3.56; P < 0.001). Collectively, findings of the present study implicate poverty, social marginalization, crises involving mental illness, and the need for long-term recovery-oriented services that address these conditions to reduce criminal convictions among people experiencing homelessness and serious mental illness. [ABSTRACT FROM AUTHOR]