OBJECTIVE: Fueled by the prescription opioid overdose crisis and increased influx of illicitly manufactured fentanyl, fentanyl overdoses continue to be a public health crisis that has cost the US economy over $1 trillion in reduced productivity, health care, family assistance, criminal justice, and accounted for over 74,000 deaths in 2023. A recent demographic shift in the opioid crisis has led to a rise in overdose deaths among the Latinx population. Harm reduction interventions, including the use of naloxone and fentanyl test strips, have been shown to be effective measures at reducing the number of opioid overdose deaths. The aim of this scoping review is to summarize naloxone and fentanyl test strip interventions and public health policies targeted to Latinx communities.
METHODS: PubMed, CINHAL, Web of Science, Embase, and PsycINFO research databases using the keywords \"fentanyl,\" \"Latinx,\" \"Harm Reduction,\" \"Naloxone,\" and \"Fentanyl Test Strips\'\' to identify studies published between January 1, 2013 and December 31, 2023. Endnote and Covidence software were used to catalog and manage citations for review of studies. Subsequently, studies that met inclusion criteria were then summarized using resulting themes.
RESULTS: Twenty-seven articles met the inclusion criteria and were further abstracted for the scoping review. Of these articles, 77.7% (n = 21) included a naloxone intervention, while only 11.1% (n = 3) included a fentanyl test strip intervention. Furthermore, 30.1% (n = 8) of these studies were Latinx targeted, and 7.7% (n = 2) of the studies were adapted for Latinx populations. Four themes, including an overall lack of knowledge and awareness, a lack of access to harm reduction or opioid overdose prevention resources, an overall lack of culturally adapted and/or targeted interventions, and restrictive and punitive policies that limit the effectiveness of protective factors were highlighted in this scoping review.
CONCLUSIONS: Limited published research exists on the use of emerging harm reduction behaviors, such as the use of naloxone and fentanyl test strips as community intervention strategies to prevent opioid overdose deaths. Even fewer publications exist on the targeting and cultural adaptation of harm reduction interventions responsive to Latinx communities, especially those using theoretical approaches or frameworks to support these interventions. Future research is needed to assess the unique needs of Latinx populations and to develop culturally responsive programs to prevent opioid-related overdose deaths among this population.

暂无摘要。

The acute toxicity (sometimes called \"overdose\" or \"poisoning\") crisis has affected Canadians across all stages of life, including youth, adults and older adults. Our biological risks and exposures to substances change as we age. Based on a national chart review study of coroner and medical examiner data on acute toxicity deaths in 2016 and 2017, this analysis compares the burden of deaths and circumstances of death, locations of acute toxicity event and death, health history and substances contributing to death of people, by sex and life stage.
UNASSIGNED: La crise des intoxications aiguës (parfois appelées « surdoses » ou « empoisonnements ») touche la population canadienne à toutes les étapes de vie, que ce soit les jeunes, les adultes ou les aînés. Les risques biologiques et l’exposition aux substances changent avec l’âge. Cette analyse, fondée sur une étude nationale portant sur l’examen des dossiers des coroners et des médecins légistes sur les décès attribuables à une intoxication aiguë en 2016 et 2017, compare le fardeau des décès et les circonstances du décès, le lieu de l’intoxication aiguë et du décès, les antécédents en matière de santé et les substances qui contribuent au décès des personnes, selon le sexe et le stade de la vie.
This analysis reveals key differences in the characteristics of acute toxicity deaths by sex and life stage, and suggests potential intervention points for each group. Many people across demographics were alone while using substances before the acute toxicity event, and many were alone when they died. Youth, particularly female youth, more often died in circumstances where someone might have been available to help by calling 911 or administering first aid and naloxone. For the people who were in contact with health care prior to their death, about one-quarter (24%–28%) of adults and older adults sought assistance for reasons related to pain. Youth more often sought assistance for a nonfatal acute toxicity event (13%–14%) or for mental health (particularly female youth, 21%) than people in other life stages. Multiple substances contributed to most deaths, and both pharmaceutical and nonpharmaceutical substances were common causes of death for all life stages and sexes. There are demographic differences in the specific substances contributing to death.
Cette analyse présente les différences clés des caractéristiques des décès attribuables à une intoxication aiguë par sexe et stade de la vie, et propose des interventions possibles pour chaque groupe. Dans toutes les catégories démographiques, plusieurs personnes étaient seules au moment de consommer des substances avant l’intoxication aiguë, et plusieurs d’entre elles étaient seules au moment du décès. Les jeunes, et en particulier les jeunes femmes, sont décédées le plus souvent dans des circonstances où quelqu’un aurait pu être disponible pour aider en appelant le 911 ou en administrant les premiers soins et la naloxone. Parmi les personnes qui étaient en contact avec le système de santé avant leur décès, environ le quart (24 % à 28 %) des adultes et des aînés ont sollicité de l’aide pour des raisons liées à la douleur. Les jeunes ont plus souvent sollicité de l’aide pour une intoxication aiguë non mortelle (13 % à 14 %) ou pour des raisons liées à la santé mentale (en particulier les jeunes femmes, 21 %) que les personnes à d’autres stades de la vie. La polyconsommation de substances était en cause pour la plupart des décès, et les substances pharmaceutiques et non pharmaceutiques étaient toutes deux des causes courantes de décès pour tous les stades de la vie et les sexes. Il existe des différences démographiques en lien avec les substances spécifiques ayant contribué aux décès.

BACKGROUND: There is a complex relationship between housing status and substance use, where substance use reduces housing opportunities and being unhoused increases reasons to use substances, and the associated risks and stigma.
METHODS: In this descriptive analysis of people without housing who died of accidental substance-related acute toxicity in Canada, we used death investigation data from a national chart review study of substance-related acute toxicity deaths in 2016 and 2017 to compare sociodemographic factors, health histories, circumstances of death and substances contributing to death of people who were unhoused and people not identified as unhoused, using Pearson chi-square test. The demographic distribution of people who died of acute toxicity was compared with the 2016 Nationally Coordinated Point-In-Time Count of Homelessness in Canadian Communities and the 2016 Census.
RESULTS: People without housing were substantially overrepresented among those who died of acute toxicity in 2016 and 2017 (8.9% versus <1% of the overall population). The acute toxicity event leading to death of people without housing occurred more often in an outdoor setting (24%); an opioid and/or stimulant was identified as contributing to their death more frequently (68%-82%; both contributed in 59% of their deaths); and they were more frequently discharged from an institution in the month before their death (7%).
CONCLUSIONS: We identified several potential opportunities to reduce acute toxicity deaths among people who are unhoused, including during contacts with health care and other institutions, through harm reduction supports for opioid and stimulant use, and by creating safer environments for people without housing.
BACKGROUND: Il existe une relation complexe entre le statut résidentiel et la consommation de substances. En effet, la consommation de substances réduit les perspectives de logement et le fait d’être sans logement augmente les raisons de consommer des substances ainsi que les risques et la stigmatisation qui y sont associés.
UNASSIGNED: Dans cette analyse descriptive des personnes sans logement qui ont perdu la vie en raison d’une intoxication aiguë accidentelle liée à une substance au Canada, nous avons utilisé les données relatives aux enquêtes sur les décès tirées d’une étude nationale d’examen des dossiers concernant les décès par intoxication aiguë due à une substance en 2016 et 2017, afin de comparer les facteurs sociodémographiques, les antécédents médicaux, les circonstances du décès et les substances ayant contribué au décès des personnes sans logement et des personnes non identifiées comme sans logement, au moyen du test du khi carré de Pearson. Nous avons comparé le profil démographique des personnes décédées d’une intoxication aiguë aux données du Dénombrement ponctuel coordonné de l’itinérance dans les collectivités canadiennes de 2016 et du Recensement de 2016.
UNASSIGNED: Les personnes sans logement étaient nettement surreprésentées parmi les personnes décédées d’une intoxication aiguë en 2016 et 2017 (8,9 % contre moins de 1 % de la population générale). L’intoxication aiguë ayant entraîné le décès des personnes sans logement a eu lieu plus souvent à l’extérieur (24 %); un opioïde ou un stimulant a plus fréquemment contribué à leur décès (68 % à 82 %; les deux substances ont été responsables de 59 % des décès) et ces personnes avaient plus souvent été libérées d’un établissement correctionnel ou été autorisées à sortir d’un établissement de soins de santé au cours du mois précédant leur décès (7 %).
CONCLUSIONS: Nous présentons plusieurs possibilités de réduire les décès attribuables à une intoxication aiguë chez les personnes sans logement, notamment lors de la prise de contact avec les services de santé et d’autres établissements, par des mesures de soutien à la réduction des méfaits liés à la consommation d’opioïdes et de stimulants ainsi que par la création d’environnements plus sûrs pour les personnes sans logement.
8.9% of people who died of accidental substance-related acute toxicity in 2016 and 2017 were unhoused at the time of their death compared to less than 1% of the general population in Canada. One in four of the acute toxicity events that lead to death occurred outdoors. People who were unhoused at the time of their death had an opioid and/or stimulant identified as contributing to their death more often than those with housing. Toxicology tests detected opioids and stimulants in combination in more than half of the people who were unhoused at the time of their death.
Parmi les personnes décédées d’une intoxication aiguë accidentelle due à une substance en 2016 et 2017, 8,9 % d’entre elles n’avaient pas de logement au moment de leur décès, contre moins de 1 % de la population générale au Canada. Un quart des intoxications aiguës ayant entraîné le décès a eu lieu à l’extérieur. Les personnes sans logement au moment de leur décès avaient plus souvent un opioïde ou un stimulant identifié comme cause de décès par rapport à celles ayant un logement. Les analyses toxicologiques ont détecté la présence d’opioïdes et de stimulants en combinaison chez plus de la moitié des personnes sans logement au moment de leur décès.

BACKGROUND: Multiple Canadian jurisdictions have reported a pattern of chronic pain among people who died from substance-related acute toxicity. This study examined the prevalence and characteristics of those with chronic pain using data from a national study of people who died of accidental acute toxicity.
METHODS: A cross-sectional analysis of accidental substance-related acute toxicity deaths that occurred in Canada between 1 January 2016 and 31 December 2017 was conducted. The prevalence of pain and pain-related conditions were summarized as counts and percentages of the overall sample. Subgroups of people with and without a documented history of chronic pain were compared across sociodemographic characteristics, health history, contextual factors and substances involved.
RESULTS: From the overall sample (n = 7902), 1056 (13%) people had a history of chronic pain while 6366 (81%) had no documented history. Those with chronic pain tended to be older (40 years and older), unemployed, retired and/or receiving disability supports around the time of death. History of mental health conditions, trauma and surgery or injury was significantly more prevalent among people with chronic pain. Of the substances that most frequently contributed to death, opioids typically prescribed for pain (hydromorphone and oxycodone) were detected in toxicology more often among those with chronic pain than those without.
CONCLUSIONS: Findings underscore the cross-cutting role of multiple comorbidities and unmanaged pain, which could compound the risk of acute toxicity death. Continued prioritization of harm reduction and regular patient engagement to assess ongoing needs are among the various opportunities for intervention.
BACKGROUND: Dans plusieurs provinces et territoires du Canada, on remarque que, souvent, les personnes qui décèdent d’une intoxication aiguë liée à une substance souffraient aussi de douleur chronique. Cette étude traite de la prévalence de la douleur chronique et des caractéristiques des personnes qui en sont atteintes en utilisant les données d’une étude nationale sur les décès par intoxication aiguë accidentelle.
UNASSIGNED: Nous avons réalisé une analyse transversale des décès par intoxication aiguë accidentelle liée à une substance qui ont eu lieu au Canada entre le 1er janvier 2016 et le 31 décembre 2017. Nous avons synthétisé, sous forme d’effectifs et de pourcentages, la prévalence de la douleur ainsi que des problèmes de santé liés à la douleur à partir de l’échantillon global. Nous avons effectué des comparaisons entre les personnes avec antécédents documentés de douleur chronique et les personnes sans antécédents documentés de douleur chronique, sur la base de différentes caractéristiques sociodémographiques, des antécédents médicaux, de facteurs contextuels et des substances consommées.
UNASSIGNED: Au sein de l’échantillon global (N = 7 902), 1 056 (13 %) personnes avaient des antécédents documentés de douleur chronique et 6 366 (81 %) n’en avaient pas. En général, les personnes souffrant de douleur chronique étaient plus âgées (40 ans et plus), n’avaient pas d’emploi et étaient à la retraite ou recevaient des prestations d’invalidité au moment de leur décès. Des antécédents de problèmes de santé mentale, de traumatisme et de chirurgie ou de blessure étaient beaucoup plus fréquents chez les personnes atteintes de douleur chronique. Parmi les substances le plus couramment en cause dans les décès, les opioïdes habituellement prescrits pour soulager la douleur (hydromorphone et oxycodone) ont été détectés plus souvent dans les analyses toxicologiques des personnes avec douleur chronique que dans les analyses des personnes sans douleur chronique.
CONCLUSIONS: Les résultats font ressortir le rôle transversal que jouent la présence concomitante de problèmes de santé et la douleur non traitée, cette dernière risquant d’accroître le risque de décès par intoxication aiguë. Continuer à prioriser la réduction des méfaits et mettre à contribution régulière des patients pour l’évaluation des besoins courants font partie des pistes d’intervention.
Between 2016 and 2017, at least one in ten of the people in Canada who died from an accidental acute toxicity had a documented history of chronic pain. People with chronic pain tended to be older and with no formal source of income. Mental health challenges, trauma and a previous surgery or injury were significantly more common among people with chronic pain than those without. Almost all individuals with chronic pain accessed health care services in the year before their death.
En 2016 et 2017, au moins une personne sur dix décédée d’une intoxication aiguë au Canada présentait des antécédents documentés de douleur chronique. En général, les personnes souffrant de douleur chronique étaient plus âgées et n’avaient pas de source officielle de revenus. Les antécédents de problèmes de santé mentale, de traumatisme et de chirurgie ou de blessure étaient nettement plus fréquents chez les personnes avec douleur chronique que chez celles sans douleur chronique. Presque toutes les personnes atteintes de douleur chronique avaient consulté des services de santé dans l’année précédant leur décès.

BACKGROUND: Unregulated drug toxicity deaths (or \"overdoses\" or \"poisonings\") remain an ongoing national public health emergency in Canada.
UNASSIGNED: Les décès attribuables à une intoxication (ou « surdose » ou « empoisonnement ») due à des drogues non réglementées demeurent une urgence nationale de santé publique constante au Canada.
This special series includes five articles, each focusing on a specific topic, using data from across all provinces and territories, to provide a national picture of unregulated drug toxicity events in Canada.
Cette série spéciale comprend cinq articles portant chacun sur un sujet particulier et utilisant les données recueillies dans l’ensemble des provinces et des territoires, dans le but de dresser un tableau national des cas d’intoxications dues à des drogues non réglementées au Canada.

BACKGROUND: Illicit opioid overdose continues to rise in North America and is a leading cause of death. Mathematical modeling is a valuable tool to investigate the epidemiology of this public health issue, as it can characterize key features of population outcomes and quantify the broader effect of structural and interventional changes on overdose mortality. The aim of this study is to quantify and predict the impact of key harm reduction strategies at differing levels of scale-up on fatal and nonfatal overdose among a population of people engaging in unregulated opioid use in Toronto.
METHODS: An individual-based model for opioid overdose was built featuring demographic and behavioural variation among members of the population. Key individual attributes known to scale the risk of fatal and nonfatal overdose were identified and incorporated into a dynamic modeling framework, wherein every member of the simulated population encompasses a set of distinct characteristics that govern demographics, intervention usage, and overdose incidence. The model was parametrized to fatal and nonfatal overdose events reported in Toronto in 2019. The interventions considered were opioid agonist therapy (OAT), supervised consumption sites (SCS), take-home naloxone (THN), drug-checking, and reducing fentanyl in the drug supply. Harm reduction scenarios were explored relative to a baseline model to examine the impact of each intervention being scaled from 0% use to 100% use on overdose events.
RESULTS: Model simulations resulted in 3690.6 nonfatal and 295.4 fatal overdoses, coinciding with 2019 data from Toronto. From this baseline, at full scale-up, 290 deaths were averted by THN, 248 from eliminating fentanyl from the drug supply, 124 from SCS use, 173 from OAT, and 100 by drug-checking services. Drug-checking and reducing fentanyl in the drug supply were the only harm reduction strategies that reduced the number of nonfatal overdoses.
CONCLUSIONS: Within a multi-faceted harm reduction approach, scaling up take-home naloxone, and reducing fentanyl in the drug supply led to the largest reduction in opioid overdose fatality in Toronto. Detailed model simulation studies provide an additional tool to assess and inform public health policy on harm reduction.

UNASSIGNED: Rates of overdose deaths involving synthetic opioids remain high, increasingly involve stimulants combined with opioids, and are increasing rapidly in racially and ethnically minoritized communities, yet little is known about access to harm reduction and treatment services in these groups.
UNASSIGNED: To characterize access and barriers to harm reduction and treatment in a racially and ethnically diverse population of people who use drugs.
UNASSIGNED: A cross-sectional telephone survey of people recruited from 39 treatment, harm reduction, and social service organizations in Milwaukee County, Wisconsin; Flint and Detroit, Michigan; and statewide in New Jersey was conducted from January 30 to July 28, 2023. Adults who used cocaine, methamphetamine, or opioids in the past 30 days called a study hotline and completed an interview in English or Spanish.
UNASSIGNED: Overdose experience, drug types used (opioids only, stimulants only, and polysubstance), and social risk factors (eg, financial instability and criminal legal involvement).
UNASSIGNED: Recent use of any harm reduction services, fentanyl test strips, naloxone possession, treatment, and self-reported barriers to services.
UNASSIGNED: Of the total sample of 1240 adults, 486 (39.2%) were Black non-Hispanic, 183 (14.8%) were Hispanic, and 464 (37.4%) were White non-Hispanic. In the past 30 days, 826 individuals (66.6%) were polysubstance users, 135 (10.9%) used only opioids, and 279 (22.5%) used only stimulants. A total of 349 respondents (28.1%) experienced a prior-year overdose. Compared with those without a prior-year overdose, people with overdose were more likely to possess naloxone (80.7% vs 68.2%; P < .001), possess fentanyl test strips (36.8% vs 23.5%; P < .001), and use harm reduction services (63.4% vs 53.0%; P = .003), while differences in treatment use were nonsignificant (52.0% vs 46.6%; P = .24). Among stimulant-only users, 51.4% possessed naloxone compared with 77.3% of opioid-only users (P < .001) and 77.6% of polysubstance users (P < .001), with similar disparities in fentanyl test strip possession.
UNASSIGNED: In this cross-sectional study of people who used drugs in the past 30 days, findings highlighted low use of harm reduction and treatment services among people who use stimulants. Additional communication regarding their importance may help increase the use of the services amidst a rapidly changing drug supply.

Unintentional and undetermined intent drug overdose fatality records from the State Unintentional Drug Overdose Reporting System (SUDORS) for Hawai\'i from July 1, 2020, to December 31, 2021 revealed that 58.2% of decedents were aged 50-75. The main substance associated with cause of death for those aged 50-75 years was methamphetamine, followed by a combination of mixed drugs. Of those aged 50 and older, 25.5% died from cardiovascular or neurological complications which were likely to be associated with chronic, long-term methamphetamine use. Based on death investigator narrative reports, 76.5% of the older decedents had a history of substance abuse, suggesting possible long-term substance use starting at a young age. The trajectory of substance use over the life course is often influenced by life events and transitions, which can be stressors. Hawai\'i kūpuna (older adults) should be screened for substance use and dependence to ensure that there is treatment if needed, for the entirety of this use trajectory.Also, barriers to kūpuna seeking treatment, such as stigma towards drug use should be addressed.

A 22-kg female in early childhood with a history of reactive airway disease presented to a paediatric emergency department with acute shortness of breath, tachypnoea and wheezing. Despite treatment with albuterol and corticosteroids, her bronchospasm persisted, prompting the administration of terbutaline. The patient received 220 mcg (10 mcg/kg) terbutaline intravenously, followed immediately by an inadvertent supratherapeutic intravenous dose of 10 000 mcg (454.5 mcg/kg). The patient\'s laboratory results obtained minutes after the medication error were notable for: potassium, 3.1 mmol/L, lactate, 2.6 mmol/L and troponin I, 0.30 ng/mL (normal <0.03 ng/mL). Over the next 48 hours, serial serum troponin values decreased. The patient was discharged home approximately 72 hours after the initial presentation and she remained well based on follow-up calls over the next several months. Given the timing and trend of troponin concentrations, we do not believe the terbutaline overdose to be responsible for the myocardial injury.