Background
Drug overdoses continue to devastate communities in Canada. British Columbia (BC), Canada’s westernmost province, has one of the highest drug-related mortality rates in the nation, with a fatal overdose rate double the national average (47.0 opioid deaths per 100,000 in BC; 21.1/100,000 in Canada). To better understand the breadth of the overdose crisis, this study evaluates the proportion of fatal overdoses among people with HIV who previously experienced a nonfatal overdose, overall and by sex.
Methods
We used data from the Comparative Outcomes And Service Utilization Trends (COAST) study (April 1, 2012–March 31, 2020). COAST is a linkage of administrative health datasets and includes information on all known people with HIV in BC (N=11,050). We identified nonfatal overdoses via hospitalization records, emergency department visits, and physician visits using ICD-9 and ICD-10 codes related to drug poisoning. We identified fatal overdoses in the Vital Statistics database using ICD-10 codes.
Results
Within the sample of 11,050 people with HIV, 1,304 (11.8%) had a nonfatal overdose between 2012-2020. Among people who experienced a nonfatal overdose, 6.4% (n=84) died of a fatal overdose. The number of nonfatal overdoses per person ranged from 0-42 (Figure 1A). Of people who had at least one nonfatal overdose, most had one (55.5%); 2.4% had ≥10 nonfatal overdoses throughout the study period, highlighting the healthcare burden of nonfatal overdoses. The highest proportion of fatal overdoses was among people who experienced two nonfatal overdoses (Figure 1B). Among males with HIV, 10.2% (n=922) had at least one nonfatal overdose throughout the study period, compared to 18.9% (n=381) of females with HIV (p<0.0001). Among males with HIV who had a nonfatal overdose, 5.9% (n=54) died of a fatal overdose; 7.9% (n=30) of females with HIV who had a nonfatal overdose died of a fatal overdose (not statistically significant).
Conclusions
Our results emphasize that the breadth of the overdose crisis stretch far beyond those who die of an overdose. Potential complications following a nonfatal overdose underscore the impact of this crisis, signaling crucial opportunities for harm reduction and drug use disorder treatment to abate harm from severe nonfatal overdoses and overdose deaths. Findings emphasize a need to link people with HIV who experience a nonfatal overdose with appropriate services.