Recognizing those who go unseen – the impacts of fatal and non-fatal overdoses

posted on September 1, 2023

August 31st is International Overdose Awareness Day, an annual campaign to end overdoses, remember without stigma those who have died from overdose, and acknowledge the grief of the family and friends left behind. The BC Centre for Excellence in HIV/AIDS (BC-CfE) joins families, friends and communities in mourning the needless losses of life through overdose and continue to advocate for an end to the toxic drug crisis through a safer supply of drugs.

While attention increasingly focuses on combatting the toxic drug supply which is a leading contributor to overdose deaths, communities are working tirelessly to prevent and reverse overdoses on the ground. Often overlooked among the grim numbers of those dying from fatal overdoses, are the thousands of people in BC who experience non-fatal overdoses and the impact on their health.

Through our work in HIV, we’ve seen how the overdose crisis has disproportionately affected those living with HIV, facing increased risks of fatal overdoses, and in fact, reducing the gains in life expectancy made by antiretroviral therapy. To understand the impacts of overdose, the BC-CfE’s Comparative Outcomes And Service Utilization Trends (COAST) Study team, a population-based longitudinal cohort comprised of linked administrative health datasets, has been hard at work examining the occurrence and health impacts of nonfatal and fatal overdoses among people living with HIV compared to a 10% random sample of the general population.

In work shared at CAHR 2023 using COAST data, BC-CfE Post-Doctoral Fellow Dr. Katherine Kooij investigated incidence and time-trends of non-fatal overdoses among people with and without HIV to gain insights into the determinants of non-fatal overdoses among people living with HIV. Looking at data from 2012 to 2020, the study found a significantly higher rate of non-fatal overdoses among people living with HIV, highest among women living with HIV.

While this study stresses the need for policies and programming addressing overdose risk to be tailored towards people living with HIV, particularly women, the work prompted further questions around how social determinants of health influence overdose risk and its impact on HIV progression.

Funded by the National Institutes on Drug Abuse (NIDA) in July 2023, Dr. Kooij and BC-CfE Senior Research Scientist Dr. Robert Hogg were awarded an R21 grant to investigate the health outcomes and healthcare utilization of non-fatal overdoses among people living with HIV. In collaboration with Simon Fraser University and New York’s Columbia University, this grant will support further study using COAST data to examine the following:

The incidence rates of fatal and non-fatal overdoses among people living with and without HIV between 2012-2020 in BC.
What are the changes in health care utilization, chronic comorbidity, and mortality among people living with and without HIV who experienced a non-fatal overdose, and is this different for men and women.
What are the changes in HIV treatment outcomes in people living with HIV who experienced a non-fatal overdose, and is this different for men and women.

These studies broaden our understanding of the impacts of the illicit drug toxicity crisis not only for those living with HIV, but all populations we serve across our initiatives, and contributes to the expansion of the BC-CfE’s Treatment as Prevention (TasP) strategy which supports solutions that prevent morbidity, premature mortality and the transmission of syndemic conditions. TasP was first introduced to prevent HIV transmission, however it has since generated a multiplier effect, preventing transmission of other diseases and syndemic conditions.

Preventing overdose deaths is not only life-saving, but provides an opportunity to access the full spectrum of care to improve an individual’s health and quality of life. The BC-CfE’s Hope to Health Research & Innovation Centre’s (Hope to Health) supervised consumption site and harm reduction services, provide that exact opportunity. Staff at the supervised consumption site support clients with harm reduction education and safer use supports by helping with tie, cleaning, vein location, filtering, preparation, and substance identification. Drug checking is also available on-site to help clients identify potential contamination and minimize the risk of overdose.

Since opening, there have been 119 overdose events in over 20,000 visits with zero fatalities thanks to the dedicated team at Hope to Health who aid the over 800 unique clients who use their services. Visits to the supervised consumption site also serve as opportunities for clients to engage with social workers, mental health workers, nurses, and doctors, all under the same roof. A prescribed safer supply program at Hope to Health helps clients access Pharmacare-covered alternatives to the toxic illicit drug supply, including a range of opioids and stimulants.

Finally, as the preferred mode of consumption is increasingly through inhalation, the BC-CfE successfully applied earlier this year to become Vancouver’s first indoor supervised inhalation site. Renovations are currently underway to expand our services, hoping to be the first of many offering these services in BC.

As we reflect this International Overdose Awareness Day on the lives lost to fatal overdoses, the BC-CfE remains committed to solutions that prevent and reduce overdoses and the impacts they have on the health and quality of life of those who use substances.

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Epidemiology and Population Health

COAST

Treatment as Prevention®

BC Centre for Excellence in HIV/AIDS

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Recognizing those who go unseen – the impacts of fatal and non-fatal overdoses

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