Drug-related overdose deaths in British Columbia and Ontario, 1992-2004

OBJECTIVE: To compare rates of fatal drug-related overdose death (OD) cases--a major harm outcome of illicit substance use--in the two provinces of British Columbia (BC) and Ontario, and the two largest municipalities in those provincial jurisdictions, namely the cities of Vancouver and Toronto, between 1992 and 2004. METHODS: Provincial coroners' data of drug-related OD cases for the provincial jurisdictions of BC and Ontario, and the municipal jurisdictions of Vancouver and Toronto, are descriptively presented and compared. RESULTS: After drastic increases in the initial part of the observation period, OD rates in BC have been declining; moreover, due to major reductions of OD cases in Vancouver, the ratio of OD cases between Vancouver and the province of BC has fallen considerably. Conversely, OD rates in Ontario have remained stable at low levels, whereas Toronto has seen a slight decline in such rates during the observation period. INTERPRETATION: The recent establishment and expansion of treatment and harm reduction interventions may have influenced the decline of ODs in BC, yet similar interventions in Ontario did not have a similar effect, perhaps due to different patterns of illicit drug use. OD rates in jurisdictions across Canada need to be monitored and analyzed to inform evidence-based policy development

Toking and driving: Characteristics of Canadian university students who drive after cannabis use---an exploratory pilot study

Cannabis use is increasingly prevalent among young adults in Canada. Due to cannabis’ impairment effects, driving under the influence of cannabis has recently developed into a traffic-safety concern, yet little is known about the specific circumstances and factors characterizing this behavior among young people. In this study, we interviewed a sample of university students (n = 45; age 18–28 years) in Toronto who had driven a car after cannabis use in the past year. The study collected information on respondents’ sociodemographic characteristics, cannabis and other drug use, cannabis use and driving (CUD) experiences, law enforcement and accident exposure, perceptions of cannabis and alcohol impairment effects as well as future anticipated substance use and driving behaviors. Results indicated that: CUD originated primarily from social settings; that impairment risks from cannabis were perceived to be low; and that the level of anticipated future CUD was high. Furthermore, high frequency of CUD in the past year was associated with high frequency of cannabis use. Interventions aiming at CUD among young people need to be anchored in the specific sociocultural settings of this behavior; targeted information needs to address cannabis’ impairment potential for driving; possibilities for harm-reduction measures for CUD need to be considered

An examination of injection drug use trends in Victoria and Vancouver, BC after the closure of Victoria's only fixed-site needle and syringe programme

Background: Needle and syringe programmes (NSPs) have been established as effective harm reduction initiatives to reduce injection drug use (IDU)-related risk behaviours, including sharing needles. On May 31, 2008, Victoria, BC's only fixed site NSP was shut down due to community and political pressure. This study examines and compares IDU trends in Victoria with those in Vancouver, BC, a city which has not experienced any similar disruption of IDU-related public health measures. Methods: Quantitative and qualitative data were collected by interviewer-administered questionnaires conducted with injection drug users (n= 579) in Victoria and Vancouver between late 2007 and late 2010. Results: Needle sharing increased in Victoria from under 10% in early 2008 to 20% in late 2010, whilst rates remained relatively low in Vancouver. Participants in Victoria were significantly more likely to share needles than participants in Vancouver. Qualitative data collected in Victoria highlight the difficulty participants have experienced obtaining clean needles since the NSP closed. Recent injection of crack cocaine was independently associated with needle sharing. Conclusions: The closure of Victoria's fixed site NSP has likely resulted in increased engagement in high-risk behaviours, specifically needle sharing. Our findings highlight the contribution of NSPs as an essential public health measure

Nonfatal overdose from alcohol and/or drugs among a sample of recreational drug users

The purpose of this study was to examine nonfatal overdose events experienced among a sample of recreational drug users. We sought to determine predictors of nonfatal overdose from alcohol and/or drugs among a sample of recreational drug users. In addition, we examined the substance(s) used at the last overdose event. Methods: Participants were 637 recreational illicit drug users (had used illicit drugs other than marijuana, in a club or party setting), aged 19 or older, from Victoria or Vancouver, British Columbia, Canada. Data were obtained in structured interviews conducted from 2008 to 2012 as part of the Canadian Recreation Drug Use Survey (CRDUS). Results: In the 12 months prior to interview, 19.3% (n=123) of the participants had experienced an overdose. In multivariate analysis, younger age, unstable housing, and usually consuming eight or more drinks containing alcohol, when drinking, significantly increased overdose risk. In addition, polysubstance use was reported by 67.5% (n=83) participants at their last overdose event. Conclusions: Intervention and prevention measures seeking to reduce overdoses among recreational drug users should not only address illicit drug use but also alcohol and polysubstance use. In addition, measures may target those who usually consume high amounts of alcohol when drinking are younger and who experience housing instability

An examination of injection drug use trends in Victoria and Vancouver, BC after the closure of Victoria's only fixed-site needle exchange

Background: Needle and syringe programmes (NSPs) have been established as effective harm reduction initiatives to reduce injection drug use (IDU)-related risk behaviours, including sharing needles. On May 31, 2008, Victoria, BC's only fixed site NSP was shut down due to community and political pressure. This study examines and compares IDU trends in Victoria with those in Vancouver, BC, a city which has not experienced any similar disruption of IDU-related public health measures. Methods: Quantitative and qualitative data were collected by interviewer-administered questionnaires conducted with injection drug users (n= 579) in Victoria and Vancouver between late 2007 and late 2010. Results: Needle sharing increased in Victoria from under 10% in early 2008 to 20% in late 2010, whilst rates remained relatively low in Vancouver. Participants in Victoria were significantly more likely to share needles than participants in Vancouver. Qualitative data collected in Victoria highlight the difficulty participants have experienced obtaining clean needles since the NSP closed. Recent injection of crack cocaine was independently associated with needle sharing. Conclusions: The closure of Victoria's fixed site NSP has likely resulted in increased engagement in high-risk behaviours, specifically needle sharing. Our findings highlight the contribution of NSPs as an essential public health measure

Sexual identity and drug use harm among high-risk, active substance users

Research shows that sexual minorities are at greater risk for illicit substance use andrelated harm than their heterosexual counterparts. This study examines a group ofactive drug users to assess whether sexual identity predicts increased risk of substanceuse and harm from ecstasy, ketamine, alcohol, marijuana, cocaine and crack.Structured interviews were conducted with participants aged 15 years and older inVancouver and Victoria, BC, Canada, during 2008–2012. Harm was measured withthe World Health Organization’s AUDIT and ASSIST tools. Regression analysiscontrolling for age, gender, education, housing and employment revealed lesbian, gayor bisexual individuals were significantly more likely to have used ecstasy, ketamineand alcohol in the past 30 days compared to heterosexual participants. Inadequatehousing increased the likelihood of crack use among both lesbian, gay and bisexualsand heterosexuals, but with considerably higher odds for the lesbian, gay and bisexualgroup. Lesbian, gay and bisexual participants reported less alcohol harm but greaterecstasy and ketamine harm, the latter two categorised by the ASSIST as amphetamineand hallucinogen harms. Results suggest encouraging harm reduction among sexualminority, high-risk drug users, emphasising ecstasy and ketamine. The impact of stablehousing on drug use should also be considered

A 'standard joint'? the role of quantity in predicting cannabis-related problems

The 'standard drink' concept is widely used as a standardized measure of alcohol consumption. There is no equivalent measure of cannabis consumption, perhaps due to challenges such as varied joint size, tetrahydrocannabinol content, and means of delivery. This study introduces a new measure of cannabis quantity and examines whether it predicts cannabis-related social problems with and without controlling for frequency of use. Cannabis-related problems, measured by the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), were predicted from cannabis use frequency (days in past month) and quantity (one joint = 0.5g, five bong or pipe hits, 10 puffs), controlling for age and gender. The sample consisted of 665 participants aged 1567 (mean=28.2, SD=11.8) from the British Columbia Alcohol and Other Drug Monitoring Project, High Risk Group Surveys, 2008 to 2009. Cannabis use frequency and quantity were positively associated with cannabis-related problems. Individuals who consumed cannabis daily and consumed more than one joint per day were at the greatest risk of problems. Controlling for frequency, the effect of quantity remained significant for failure to do what is expected due to cannabis use. This study suggests that quantity, above and beyond frequency, is an important predictor of cannabis problems. We discuss the potential usefulness and validity of this new measure in harm reduction