Arthur Labatt Family School of Nursing, Western University, London, Canada.
ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada.
Addiction. 2024 Feb;119(2):334-344. doi: 10.1111/add.16357. Epub 2023 Oct 16.
To measure the change in proportion of opioid-related overdose deaths attributed to people experiencing homelessness and to compare the opioid-related fatalities between individuals experiencing homelessness and not experiencing homelessness at time of death.
DESIGN, SETTING AND PARTICIPANTS: Population-based, time-trend analysis using coroner and health administrative databases from Ontario, Canada from 1 July 2017 and 30 June 2021.
Quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness. We also obtained socio-demographic and health characteristics of decedents, health-care encounters preceding death, substances directly contributing to death and circumstances surrounding deaths.
A total of 6644 individuals (median age = 40 years, interquartile range = 31-51; 74.1% male) experienced an accidental opioid-related overdose death, among whom 884 (13.3%) were identified as experiencing homelessness at the time of death. The quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness increased from 7.2% (26/359) in July-September 2017 to 16.8% (97/578) by April-June 2021 (trend test P < 0.01). Compared with housed decedents, those experiencing homelessness were younger (61.3 versus 53.1% aged 25-44), had higher prevalence of mental health or substance use disorders (77.1 versus 67.1%) and more often visited hospitals (32.1 versus 24.5%) and emergency departments (82.6 versus 68.5%) in the year prior to death. Fentanyl and its analogues more often directly contributed to death among people experiencing homelessness (94.0 versus 81.4%), as did stimulants (67.4 versus 51.6%); in contrast, methadone was less often present (7.8 versus 12.4%). Individuals experiencing homelessness were more often in the presence of a bystander during the acute toxicity event that led to death (55.8 versus 49.7%); and where another individual was present, more often had a resuscitation attempted (61.7 versus 55.1%) or naloxone administered (41.2 versus 28.9%).
People experiencing homelessness account for an increasing proportion of fatal opioid-related overdoses in Ontario, Canada, reaching nearly one in six such deaths in 2021.
衡量因无家可归而导致的阿片类药物过量死亡人数的比例变化，并比较无家可归者和非无家可归者在死亡时的阿片类药物相关死亡率。
设计、地点和参与者：使用加拿大安大略省 2017 年 7 月 1 日至 2021 年 6 月 30 日的验尸官和卫生行政数据库进行基于人群的时间趋势分析。
归因于无家可归者的阿片类药物相关过量死亡人数的季度比例。我们还获得了死者的社会人口统计学和健康特征、死亡前的医疗保健接触、直接导致死亡的物质以及死亡周围的情况。
共有 6644 人（中位数年龄为 40 岁，四分位间距为 31-51；74.1%为男性）经历了意外的阿片类药物相关过量死亡，其中 884 人（13.3%）在死亡时被认定为无家可归。归因于无家可归者的阿片类药物相关过量死亡人数的季度比例从 2017 年 7 月至 9 月的 7.2%（26/359）上升到 2021 年 4 月至 6 月的 16.8%（97/578）（趋势检验 P<0.01）。与有房者死者相比，无家可归者更年轻（61.3%年龄在 25-44 岁，而 53.1%），精神健康或药物使用障碍的患病率更高（77.1%比 67.1%），在死亡前一年更经常去医院（32.1%比 24.5%）和急诊室（82.6%比 68.5%）。芬太尼及其类似物更常直接导致无家可归者死亡（94.0%比 81.4%），兴奋剂也是如此（67.4%比 51.6%）；相比之下，美沙酮的存在较少（7.8%比 12.4%）。在导致死亡的急性毒性事件中，无家可归者更经常有旁观者在场（55.8%比 49.7%）；如果有其他人在场，更经常进行复苏尝试（61.7%比 55.1%）或给予纳洛酮（41.2%比 28.9%）。
在加拿大安大略省，无家可归者因阿片类药物相关过量死亡的比例不断增加，2021 年这一比例达到近六分之一。
