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4. Modeling the population‐level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia

Author

Chaillon, Antoine, Bharat, Chrianna, Stone, Jack, Jones, Nicola, Degenhardt, Louisa, Larney, Sarah, Farrell, Michael, Vickerman, Peter, Hickman, Matthew, Martin, Natasha K, and Bórquez, Annick

Subjects
Clinical and Health Psychology, Public Health, Health Sciences, Psychology, Good Health and Well Being, Analgesics, Opioid, Australia, Drug Overdose, Humans, New South Wales, Opioid-Related Disorders, Prisoners, Incarceration, mathematical modeling, mortality, opioid agonist treatment, opioid use disorders, overdose, Medical and Health Sciences, Psychology and Cognitive Sciences, Substance Abuse, Public health, Clinical and health psychology
Abstract

Background and aimsThe individual-level effectiveness of opioid agonist treatment (OAT) in reducing mortality is well established, but there is less evidence on population-level benefits. We use modeling informed with linked data from the OAT program in New South Wales (NSW), Australia, to estimate the impact of OAT provision in the community and prisons on mortality and the impact of eliminating excess mortality during OAT initiation/discontinuation.DesignDynamic modeling.Setting and participantsA cohort of 49 359 individuals who ever received OAT in NSW from 2001 to 2018.MeasurementsReceipt of OAT was represented through five stages: (i) first month on OAT, (ii) short (1-9 months) and (iii) longer (9+ months) duration on OAT, (iv) first month following OAT discontinuation and (v) rest of time following OAT discontinuation. Incarceration was represented as four strata: (i) never or not incarcerated in the past year, (ii) currently incarcerated, (iii) released from prison within the past month and (iv) released from prison 1-12 months ago. The model incorporated elevated mortality post-release from prison and OAT impact on reducing mortality and incarceration.FindingsAmong the cohort, mortality was 0.9 per 100 person-years, OAT coverage and retention remained high (> 50%, 1.74 years/episode). During 2001-20, we estimate that OAT provision reduced overdose and other cause mortality among the cohort by 52.8% [95% credible interval (CrI) = 49.4-56.9%] and 26.6% (95% CrI =22.1-30.5%), respectively. We estimate 1.2 deaths averted and 9.7 life-years gained per 100 person-years on OAT. Prison OAT with post-release OAT-linkage accounted for 12.4% (95% CrI = 11.5-13.5%) of all deaths averted by the OAT program, primarily through preventing deaths in the first month post-release. Preventing elevated mortality during OAT initiation and discontinuation could have averted up to 1.4% (95% CrI =  0.8-2.0%) and 3.0% (95% CrI = 2.1-5.3%) of deaths, respectively.ConclusionThe community and prison opioid agonist treatment program in New South Wales, Australia appears to have substantially reduced population-level overdose and all-cause mortality in the past 20 years, partially due to high retention.

Published
2022

5. Sex and gender differences in hepatitis C virus risk, prevention, and cascade of care in people who inject drugs: systematic review and meta-analysis

Author

Levinsson, Anna, Zolopa, Camille, Vakili, Farzaneh, Udhesister, Sasha, Kronfli, Nadine, Maheu-Giroux, Mathieu, Bruneau, Julie, Valerio, Heather, Bajis, Sahar, Read, Phillip, Martró, Elisa, Boucher, Lisa, Morris, Leith, Grebely, Jason, Artenie, Adelina, Stone, Jack, Vickerman, Peter, and Larney, Sarah

Published
2024
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6. Rates and causes of death after release from incarceration among 1 471 526 people in eight high-income and middle-income countries: an individual participant data meta-analysis

Author

Borschmann, Rohan, Keen, Claire, Spittal, Matthew J., Preen, David, Pirkis, Jane, Larney, Sarah, Rosen, David L., Møller, Lars, O'Moore, Eamonn, Young, Jesse T., Altice, Frederick L., Andrews, Jason R., Binswanger, Ingrid A., Bukten, Anne, Butler, Tony, Chang, Zheng, Chen, Chuan-Yu, Clausen, Thomas, Christensen, Peer B., Culbert, Gabriel J., Cunningham, Ruth, Degenhardt, Louisa, Dolan, Kate, Fazel, Seena, Fischbacher, Colin, Giles, Margaret, Graham, Lesley, Huang, Yen-Fang, Huber, Florence, Karaminia, Azar, King, Paula, Kouyoumdjian, Fiona G., Lim, Sungwoo, Liu, Yiran E., Lopez, Derrick, Moniruzzaman, Akm, Morenoff, Jeffrey, Pizzicato, Lia N., Proescholdbell, Scott K., Ranapurwala, Shabbar I., Shaw, Jenny, Slaunwhite, Amanda, Somers, Julian M., Spaulding, Anne C., Stavseth, Marianne R., Stern, Marc F., Telfer, Kendra, Viner, Kendra, Wang, Nadia, Zhao, Bin, Zhu, Nanbo, Kinner, Stuart A., and Kinner, Stuart A

Published
2024
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11. Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis

Author

Lewer, Dan, Freer, Joseph, King, Emma, Larney, Sarah, Degenhardt, Louisa, Tweed, Emily J, Hope, Vivian D, Harris, Magdalena, Millar, Tim, Hayward, Andrew, Ciccarone, Dan, and Morley, Katherine I

Subjects
Drug Abuse (NIDA only), Health Services, Emergency Care, Clinical Research, Substance Misuse, Brain Disorders, Methamphetamine, Health and social care services research, 8.1 Organisation and delivery of services, Mental health, Good Health and Well Being, Adult, Amphetamines, Australia, Crack Cocaine, Drug Users, Emergency Service, Hospital, Female, Heroin, Hospitalization, Humans, Illicit Drugs, Male, North America, Patient Acceptance of Health Care, Substance-Related Disorders, Health services, Hospitals, Opiates, Primary Health Care, Stimulants, Medical and Health Sciences, Psychology and Cognitive Sciences, Substance Abuse
Abstract

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.

Published
2020

23. Trends in toxicological findings in unintentional opioid or stimulant toxicity deaths in Québec, Canada, 2012–2021: Has Québec entered a new era of drug‐related deaths?

Author

Do, Uyen, Perron, Paul‐André, Bruneau, Julie, and Larney, Sarah

Subjects
DRUGS of abuse, DRUG toxicity, DRUG overdose, STIMULANTS, DEATH rate
Abstract

Introduction: We aimed to describe rates and toxicological findings of unintentional opioid and stimulant toxicity deaths, 2012–2021. Methods: The dataset included accidental deaths determined by the Coroner to be due to opioids or stimulants. We calculated annual crude mortality rates and described combinations of drugs identified in toxicological examinations of these deaths. We described temporal trends in the detection of specific opioids, stimulants, benzodiazepines (including novel benzodiazepines), gabapentinoids and z‐drugs in deaths due to opioids and stimulants. Results: Mortality rates increased over time, reaching their peak in 2020 and remaining high in 2021. In deaths due to opioids, there was a decline in the proportion of deaths involving pharmaceutical opioids after 2019, and a corresponding increase in the proportion of deaths with fentanyl detected. Benzodiazepines were often present in deaths due to opioids, with novel benzodiazepines increasing rapidly from 2019 onwards. Cocaine was the most frequently detected drug in deaths due to stimulants, but amphetamine/methamphetamine was detected in around half of all stimulant deaths from 2016 onwards. Discussion and Conclusions: Despite availability of a multitude of overdose prevention interventions, mortality rates due to drug toxicity have increased in Québec. Toxicological findings of these deaths suggest concerning shifts in the illicit drug market, with Québec potentially having entered a new era of elevated overdose mortality. Intervention scale‐up is essential, but unlikely to be sufficient, to reduce drug‐related mortality. Policy reform to address the root causes of drug toxicity deaths, including an unpredictable drug supply, strained health systems and socio‐economic precarity, is essential. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Drug Treatment as HIV Prevention Among Women and Girls Who Inject Drugs From a Global Perspective

Author

Springer, Sandra A, Larney, Sarah, Alam-mehrjerdi, Zahra, Altice, Frederick L, Metzger, David, and Shoptaw, Steven

Subjects
Prevention, Behavioral and Social Science, HIV/AIDS, Infectious Diseases, Brain Disorders, Drug Abuse (NIDA only), Substance Misuse, 8.1 Organisation and delivery of services, Evaluation of treatments and therapeutic interventions, Health and social care services research, 6.1 Pharmaceuticals, Infection, Good Health and Well Being, Female, Global Health, HIV Infections, Humans, Substance Abuse, Intravenous, Ukraine, Women's Health Services, Clinical Sciences, Public Health and Health Services, Virology
Abstract

Although there have been significant reductions in the number of new HIV infections globally from 2009 to 2013, incidence remains unacceptably high for persons who use drugs. In many settings, women and girls who inject drugs (WWID) with HIV/AIDS experience poor treatment access, including evidence-based practices like antiretroviral therapy and drug treatment. Medication-assisted therapies (MAT) for substance use disorders are especially inaccessible, which in their absence, increases HIV transmission risk. Irrespective of setting or culture, drug treatment using MAT is not only effective but also cost-effective at reducing opioid use and linked injection and sexual risks. Data presented here for WWID address their access to MAT for opioid addiction and to treatments being developed that address the relationship, family, and vocational needs of this group. The most glaring finding is that globally, WWID frequently are excluded in surveys or studies with an impressive lack of disaggregated data by gender when surveying access to MAT—even in wealthy countries. Despite this, there have been some striking improvements in implementing drug treatment as prevention, notably in Iran and China. Still, real barriers remain for women and girls to accessing drug treatment, other harm reduction services, and antiretroviral therapy. Development and/or implementation of interventions that facilitate women and girls engaging in drug treatment that address their roles within society, work, and family/relationships, and outcome evaluation of these interventions are crucial.

Published
2015

47. Five-Year Trajectories of Prescription Opioid Use

Author

Gisev, Natasa, primary, Buizen, Luke, additional, Hopkins, Ria E., additional, Schaffer, Andrea L., additional, Daniels, Benjamin, additional, Bharat, Chrianna, additional, Dobbins, Timothy, additional, Larney, Sarah, additional, Blyth, Fiona, additional, Currow, David C., additional, Wilson, Andrew, additional, Pearson, Sallie-Anne, additional, and Degenhardt, Louisa, additional

Published
2023
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