British Columbia Centre on Substance Use, Vancouver, BC, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada.
British Columbia Centre on Substance Use, Vancouver, BC, Canada.
Int J Drug Policy. 2024 Oct;132:104564. doi: 10.1016/j.drugpo.2024.104564. Epub 2024 Sep 5.
Many people who use drugs in the United States and Canada continue to access the contaminated unregulated drug supply, resulting in the ever-escalating overdose epidemic. In Canada, even in areas where healthcare providers are authorized to prescribe alternatives to the unregulated supply (e.g., prescribed safer supply), availability and accessibility are low. We sought to characterize the needs of people who use unregulated opioids in Vancouver, Canada by asking them whether access to any pharmaceutical opioids would reduce their use of unregulated opioids, and if so, which pharmaceutical opioids they preferred.
We analyzed data from participants who self-reported using unregulated opioids in three Vancouver-based prospective cohort studies between 2021 and 2022. We employed multivariable logistic regression to identify factors associated with reporting a preferred pharmaceutical opioid to reduce unregulated opioid use.
Of 681 eligible participants, 504 (74.0 %) identified a preferred pharmaceutical opioid to reduce unregulated opioid use. The most commonly reported preferred opioids included: diacetylmorphine (42.9 %), fentanyl patches (11.1 %), and fentanyl powder (10.5 %). Overall, 5.6 % of participants who identified diacetylmorphine, 12.5 % of participants who identified fentanyl patches, and no participants who identified fentanyl powder as their preferred opioids reported receiving prescriptions of them. In multivariable analysis, exposure to benzodiazepines through unregulated drug use (adjusted odds ratio [AOR] = 2.57; 95 % confidence interval [CI] = 1.69-3.90), and receipt of prescribed safer supply of opioids without opioid agonist therapy (OAT; AOR = 2.66; 95 % CI = 1.12-6.36) within the past six months were significantly associated with reporting a preferred pharmaceutical opioid.
Three-quarters of participants reported that receiving prescribed pharmaceutical opioids of their preference could reduce their use of unregulated opioids; however, the proportions of those actually being prescribed their preferred opioids were very low. Further, these participants were also more likely to report exposure to benzodiazepine-adulterated drugs. Our findings provide important implications for future safer supply programs.
在美国和加拿大，许多吸毒者仍在使用受污染的不受监管的毒品供应，导致不断升级的过量用药 epidemic。在加拿大，即使在卫生保健提供者被授权开处方替代不受监管的供应品（例如，开处方更安全的供应品）的地区，供应品的可及性和可获得性也很低。我们试图通过询问他们是否获得任何处方类阿片类药物会减少他们使用不受监管的阿片类药物，并在这种情况下，他们更喜欢哪些处方类阿片类药物，来描述加拿大温哥华使用不受监管的阿片类药物者的需求。
我们分析了 2021 年至 2022 年期间在三个基于温哥华的前瞻性队列研究中自我报告使用不受监管的阿片类药物的参与者的数据。我们采用多变量逻辑回归来确定与报告首选处方类阿片类药物以减少不受监管的阿片类药物使用相关的因素。
在 681 名合格参与者中，有 504 名（74.0%）确定了首选处方类阿片类药物以减少不受监管的阿片类药物使用。报告的最常用首选阿片类药物包括：二乙酰吗啡（42.9%）、芬太尼贴片（11.1%）和芬太尼粉末（10.5%）。总体而言，5.6%的二乙酰吗啡使用者、12.5%的芬太尼贴片使用者和没有芬太尼粉末使用者报告收到了他们的处方。在多变量分析中，通过不受监管的药物使用接触苯二氮䓬类药物（调整后的优势比[OR] = 2.57；95%置信区间[CI] = 1.69-3.90）和在过去六个月内收到没有阿片类药物激动剂治疗（OAT）的处方更安全的阿片类药物供应（OR = 2.66；95%CI = 1.12-6.36）与报告首选处方类阿片类药物显著相关。
四分之三的参与者报告说，接受他们首选的处方类阿片类药物可能会减少他们使用不受监管的阿片类药物；然而，实际上被开处方他们首选的阿片类药物的比例非常低。此外，这些参与者也更有可能报告接触到苯二氮䓬类药物掺假的药物。我们的研究结果对未来的更安全供应计划具有重要意义。
