Drug-related Overdose Deaths Research Articles

Access and care for people with opioid use disorder in U.S. skilled nursing facilities: A policy commentary

Referrals for people with opioid use disorder (OUD) to skilled nursing facilities (SNFs) are increasing in the United States (U.S.). Further, legal guidance from the U.S. Department of Justice states that people with OUD cannot be discriminated against by health care institutions because of OUD or treatment with medications for OUD (MOUD). As such, SNFs are an important touchpoint for initiating or continuing MOUD, particularly amid rising drug-related overdose deaths among older adults and because people with OUD experience frailty and other geriatric syndromes at younger chronological ages. Informed by research, clinical expertise, and lived experience, this commentary describes policy and practice opportunities to help address challenges faced by people with OUD in gaining access to care and MOUD in SNFs. We propose opportunities to intervene against barriers that impede SNF placement and access to MOUD for people with OUD, including further revisions to 42 CFR Part 8 regulations to extend waivers for certification as opioid treatment programs (OTPs) to SNFs, allowing them to administer and dispense methadone in the same way as hospitals. If passed, proposed federal changes under the Modernizing Opioid Treatment Act would eliminate the requirement for methadone to be dispensed through OTPs, offering another opportunity to improve access to methadone for SNF residents. Also, we propose national and state-level investment in mobile substance use disorder services and partnerships with OTPs and hospital-based addiction consult services. We also recognize the need for more compassionate attitudes toward people with OUD in healthcare settings and discuss opportunities to address stigma. Although people with OUD are referred to SNFs for skilled care needs and not specifically for OUD care, it is essential for SNFs to be prepared to continue MOUD. It is both legally mandated and imperative that people with OUD have access to high quality and equitable SNF care.

The Perceived Impact of Substance Use Education on Social Work Students' Knowledge, Attitudes, and Skills.

In 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a report revealing that over 46 million individuals in the United States had a substance use disorder (SUD). In the same year, a record number of drug-related overdose deaths were reported. Social workers play an important role in connecting with people who use substances and providing adequate care and treatment; yet, negative attitudes and lack of holistic knowledge about individuals who use substances create challenges in providing effective care. Social work curricula that integrates substance use content has been identified as one way to address this. A 14-week course was introduced in one institution's Master of Social Work curriculum with the goal of providing students with a comprehensive education on SUDs. Foundational knowledge and practical skill development were covered. Seventeen trained instructors taught a total of 1204 students between May 2020 and January 2022. Quantitative and qualitative data were collected to explore changes in student's self-perceived knowledge, attitudes, and skills related to substance use. Among those who completed the survey (N = 553), the majority felt that the course would have a positive impact on their future work and professional development. Specifically, 96.4% reported being satisfied or very satisfied with the course overall. Among those who completed a 30-day follow-up survey (n = 69), data revealed an increase in students' self-perceived knowledge, accompanied by a shift in attitudes and positive changes in self-perceived client-centered care skills. Findings from this article support the development, implementation, and evaluation of evidence-based substance use content within social work curricula. This has implications for improving knowledge, attitudes, and skills among social workers who work with people who use substances.

A case study for local data surveillance in opioid overdose fatalities in Cuyahoga County, OH 2016-2020

IntroductionFentanyl and fentanyl analogs have increased the overdose mortality rates in the United States, significantly impacting states like Ohio. We examined carfentanil overdose deaths, other contributing Cause of Death (COD) drugs, and drug seizure trends from 2016 to 2020 in Northeast Ohio. Materials and methodsWe studied death investigation data from the Cuyahoga County, Ohio Medical Examiner's Office (CCMEO) of all fatal accidental opioid overdoses as well as drug seizure data from Cuyahoga County Regional Forensic Science Laboratory (CCRFSL). We also compared decedents’ race, gender, age, residential locality, drugs contributing to the COD in opioid cases, and for carfentanil, fentanyl, and cocaine seizures in Cuyahoga County from 2016 to 2020 (N = 2948). ResultsDecedents’ had an average of three different drugs contributing to their COD. A bimodal carfentanil spike was observed in fatal accidental overdoses in Cuyahoga County for the years 2017 and 2019. Decedents in urban residency, who were Non-Hispanic, White and younger, significantly predicted the presence of carfentanil contributing to the COD. In 2020, decedents who were Black and older were significantly associated with cocaine contributing to the COD. Carfentanil and carfentanil-related overdoses were significantly correlated. DiscussionThe pervasiveness of illicitly manufactured fentanyl and fentanyl analog (e.g., carfentanil) mixtures with other drugs are changing the demographics of persons who fatally overdose in Cuyahoga County, OH. Significant trending shifts can also be observed for the presence of carfentanil in decedent and seizure county data. ConclusionsLocal data of drug-related overdose deaths and drug seizures from a medical examiner's office and affiliated forensic laboratory lab can be used for timely public health surveillance, and informing prevention, and intervention at the county level.

Estimating the uncertain effect of the COVID pandemic on drug overdoses.

U.S. drug-related overdose deaths and Emergency Department (ED) visits rose in 2020 and again in 2021. Many academic studies and the news media attributed this rise primarily to increased drug use resulting from the societal disruptions related to the coronavirus (COVID-19) pandemic. A competing explanation is that higher overdose deaths and ED visits may have reflected a continuation of pre-pandemic trends in synthetic-opioid deaths, which began to rise in mid-2019. We assess the evidence on whether increases in overdose deaths and ED visits are likely to be related primarily to the COVID-19 pandemic, increased synthetic-opioid use, or some of both. We use national data from the Centers for Disease Control and Prevention (CDC) on rolling 12-month drug-related deaths (2015-2021); CDC data on monthly ED visits (2019-September 2020) for EDs in 42 states; and ED visit data for 181 EDs in 24 states staffed by a national ED physician staffing group (January 2016-June 2022). We study drug overdose deaths per 100,000 persons during the pandemic period, and ED visits for drug overdoses, in both cases compared to predicted levels based on pre-pandemic trends. Mortality. National overdose mortality increased from 21/100,000 in 2019 to 26/100,000 in 2020 and 30/100,000 in 2021. The rise in mortality began in mid-to-late half of 2019, and the 2020 increase is well-predicted by models that extrapolate pre-pandemic trends for rolling 12-month mortality to the pandemic period. Placebo analyses (which assume the pandemic started earlier or later than March 2020) do not provide evidence for a change in trend in or soon after March 2020. State-level analyses of actual mortality, relative to mortality predicted based on pre-pandemic trends, show no consistent pattern. The state-level results support state heterogeneity in overdose mortality trends, and do not support the pandemic being a major driver of overdose mortality. ED visits. ED overdose visits rose during our sample period, reflecting a worsening opioid epidemic, but rose at similar rates during the pre-pandemic and pandemic periods. The reasons for rising overdose mortality in 2020 and 2021 cannot be definitely determined. We lack a control group and thus cannot assess causation. However, the observed increases can be largely explained by a continuation of pre-pandemic trends toward rising synthetic-opioid deaths, principally fentanyl, that began in mid-to-late 2019. We do not find evidence supporting the pandemic as a major driver of rising mortality. Policymakers need to directly address the synthetic opioid epidemic, and not expect a respite as the pandemic recedes.

Addiction onset and offset characteristics and public stigma toward people with common substance dependencies: A large national survey experiment

Drug-related overdose deaths topped 100,000 between 2020 and 2021. Opioids and stimulants are implicated as the primary drivers of this public health crisis. Stigma remains one of the primary barriers to treatment and recovery from substance use disorders. However, little is known about how stigma varies across different substance types, whether individuals are actively using or in recovery, and medical versus recreational onset. We examined these questions using data from the 2021 Shatterproof Addiction Stigma Index, the only nationally representative data available on this topic. Respondents (N = 7051) completed a vignette-based survey experiment to assess public stigma (social distance, prejudice, competence, and causal attributions) toward people with alcohol, opioid (following a prescription pain or recreational use onset), heroin, or methamphetamine dependencies. Vignette characters were described as active users or in recovery. Adjusting for covariates (e.g., race, age, gender), prejudice and desire for social distance were highest toward heroin and methamphetamine, and lowest toward alcohol dependence. The perceived onset of the dependency affected stigma. Specifically, prescription opioids with a recreational onset were more stigmatized than those with a medical onset. Moreover, individuals depicted as being in recovery were less stigmatized than those depicted as active users. Recovery status had the largest impact on prejudice and social distance toward methamphetamine, relative to other conditions. The nature and magnitude of substance dependency stigma differs across substance types and onset and offset conditions. Reducing stigma will require tailored strategies that consider the multidimensional nature of stigma toward people with addiction.

Psychometric validation of the AOSL scale using confirmatory factor analysis: A nationally representative sample

BackgroundThe opioid overdose epidemic has worsened during the COVID-19 pandemic. Recent data revealed a 28.5% increase in drug-related overdose deaths from 2019 to 2020. Adolescents often misuse family members’ and friends’ prescription opioid medications. Furthermore, adolescents may not possess the knowledge or understanding to safely manage opioid medications. There is a need for a validated scale to effectively measure adolescents’ opioid misuse knowledge, attitudes, and interest in learning about prescription opioid safety. ObjectiveThe purpose of this study was to validate the Adolescent Opioid Safety and Learning (AOSL) scale with a nationally representative sample of adolescents and confirm the factor structure of the scale using confirmatory factor analysis (CFA). MethodsAdolescent participants (aged 13-18 years) completed the 16-item AOSL scale in Qualtrics from November to December 2020. A total of 774 responses were analyzed. A CFA was performed to determine the fit of the data to the 4-factor model proposed by a prior exploratory factor analysis of the AOSL scale. Fit was assessed using the chi-square test, comparative fit index (CFI), Tucker-Lewis index (TLI), and root mean-squared error of approximation (RMSEA). ResultsParticipants were 50% male and 62% white non-Hispanic. The CFI was 0.984, TLI was 0.980, and RMSEA was 0.048 ([95% CI 0.041–0.054], P-value that RMSEA ≤ 0.05 = 0.712). The chi-square test results were χ2 = 268.752 on 98 degrees of freedom (P < 0.001). Cronbach’s alpha, a measure of internal consistency, was high within each factor. CFA indicated good fit of the current study’s data to the 4-factor model. ConclusionWe found the AOSL scale measures adolescents’ knowledge of opioid misuse, knowledge of opioid harm, interest in learning about prescription opioids, and likelihood to practice misuse behaviors. This scale can help researchers understand adolescent perceptions and opinions about opioid safety.

Substance abuse and neurotransmission.

The number of people who suffer from a substance abuse disorder has continued to rise over the last decade; particularly, the number of drug-related overdose deaths has sharply increased during the COVID-19 pandemic. Converging lines of clinical observations, supported by imaging and neuropsychological performance testing, have demonstrated that substance abuse-induced dysregulation of neurotransmissions in the brain is critical for development and expression of the addictive properties of abused substances. Recent scientific advances have allowed for better understanding of the neurobiological processes that mediates drugs of abuse and addiction. This chapter presents the past classic concepts and the recent advances in our knowledge about how cocaine, amphetamines, opioids, alcohol, and nicotine alter multiple neurotransmitter systems, which contribute to the behaviors associated with each drug. Additionally, we discuss the interactive effects of HIV-1 or COVID-19 and substance abuse on neurotransmission and neurobiological pathways. Finally, we introduce therapeutic strategies for development of pharmacotherapies for substance abuse disorders.

Opioid overdose deaths and the expansion of opioid agonist treatment: a population-based prospective cohort study.

Effective policies to reduce drug-related overdoses remain a public health priority. We aimed to estimate the causal effects of a national opioid agonist treatment (OAT) program on population level drug fatalities. Population-based prospective cohort study exploiting supply driven variation in treatment uptake across cohort-age groups generated by the introduction and scale-up of a national OAT program. A Poisson difference-in-differences model with an intention-to-treat design was used to assess how treatment uptake altered the age profile of risks and infer treatment effects on drug fatalities. Norway, from 1996 through 2016. The data include a total of 5634 drug-related overdose deaths and cover the introduction of the Norwegian OAT program in 1998 and its initial growth period, reaching 12 286 ever-treated recipients by 2016. Fatal opioid-related overdoses were defined as deaths with a primary cause assigned an International Classification of Diseases 10th Revision (ICD-10) code F11, or X42, X44, X62 or X64 in combination with T40.0-T40.4. Other non-opioid related fatal overdoses were defined by a primary cause registered as F12, F14, F15, F16 or F19, or X42, X44, X62 or 64 in combination with T40.5-T40.9. An additional 887 deaths (95% credibility interval [CI] = 265-1563) would have been expected in the absence of OAT, which implies one death avoided per 111 (95% CI = 61-342) treatment-exposed person-years. At scale, the program reduced annual overdose mortality by 27% in 2016 (95% CI = 10%-41%) relative to a no-OAT counterfactual, corresponding to 99 fewer expected fatal overdoses (95% CI = 28-180) in 2016. Analysing fatal opioid-related and other drug overdoses separately found similar numbers for avoided opioid-related fatalities (921, with 95% CI = 373-1526) and no treatment effects on non-opioid related fatalities (-38, with 95% CI = -193-154). The introduction and rapid scale-up of a national opioid agonist treatment program in Norway was associated with substantial and plausibly causal reductions in drug fatalities.

Opioid Prescribing and Utilization During Acute Inpatient Rehabilitation Admissions.

More than 1 billion opioid prescriptions were written between 2014 and 2018 in the United States [1] to treat the acute, subacute, and, in some cases, chronic pain experienced by millions of Americans. These prescriptions were also a significant driver of opioid-related morbidity and mortality as opioid-related overdose deaths accounted for more than half of all drug-related overdose deaths during that same time [2]. Patients with disabilities are among those who suffer from acute and chronic pain and may be especially vulnerable to opioid use, misuse, and overdose-related injury [3, 4]. Patients with disability-related conditions, including spinal cord injury, brain injury, amputations, and strokes, are often treated by physical medicine and rehabilitation (PM&R) physicians who are responsible for managing their complex and sometimes chronic pain. Pain management during an acute inpatient rehabilitation facility (IRF) admission initially continues the acute hospital regimen and is...

Angiotensin axis antagonists increase the incidence of haemodynamic instability in dihydropyridine calcium channel blocker poisoning

Context Amlodipine, a dihydropyridine calcium channel blocker (CCB), is the leading cause of cardiovascular drug-related overdose deaths in the USA. In contrast, angiotensin-II receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) cause minimal toxicity in overdose. ACEIs/ARBs are often combined with dihydropyridines in hypertension treatment. Co-ingested ARBs/ACEIs may significantly contribute to the toxicity of dihydropyridine, but this has not been investigated. Objective To investigate the clinical outcomes from dihydropyridine overdoses with ARBs/ACEIs versus dihydropyridine overdoses alone. Methods This was a retrospective study of patients reported to the New South Wales Poisons Information Centre (NSW PIC) and 3 toxicology units (Jan 2016 to Jun 2019) in Australia. Patients >14 years who took an overdose of dihydropyridines (amlodipine, felodipine, lercanidipine, nifedipine) were included. Concurrent overdoses with non-dihydropyridine CCBs, alpha-blockers and beta-blockers were excluded. Patient demographics, drugs exposure details, serial vital signs, treatments and outcome were collected. Results There were 100 patients. 68 took mixed overdoses of dihydropyridines with ARBs/ACEIs and 32 took single overdoses of dihydropyridines without ARBs/ACEIs. The mixed group had lower median nadir mean arterial pressures (62 vs 75 mmHg, p < 0.001), more frequently had hypotension (OR 4.5, 95%CI: 1.7–11.9) or bradycardia (OR 8.8, 95%CI: 1.1–70). Multivariable analysis indicated the mixed overdoses had an 11.5 mmHg (95%CI: 4.9–18.1) lower minimum systolic blood pressure (SBP) compared with the single group; other factors associated with a lower minimum SBP were higher doses [2.3 mmHg (95%CI: 1.1–3.5) lower per 10 defined daily doses] and younger age [2.2 mmHg (95%CI: 0.3–4.2) higher per decade]. A larger proportion of the mixed ingestion group received intravenous fluids (OR 5.7, 95%CI: 1.8–18.6) and antidotes and/or vasopressors (OR 2.9, 95%CI: 1.004–8.6). Conclusion Combined overdoses of dihydropyridines with ARBs/ACEIs caused more significant hypotension and required more haemodynamic support than overdoses of dihydropyridines alone.

Challenges of Estimates in Drug-Related Overdose Deaths in Iran: Evidence from the Literature.

The article's abstract is no available.

Evaluating complex transformation

The purpose of this paper is to present a detailed case study of the evaluation strategies of a complex, multi-faceted response to a public health emergency: drug-related overdose deaths. It sets out the challenges of evaluating such a complex response and how they were overcome. It provides a pragmatic example of the rationale and issues faced to address the what, the why and particularly the how of the evaluation. The case study overviews British Columbia's Provincial Response to the Overdose Public Health Emergency, and the aims and scope of its evaluation. It then outlines the conceptual approach taken to the evaluation, setting out key methodological challenges in evaluating large-scale, multi-level, multisectoral change. The evaluation is developmental and summative, utilization focused and system informed. Defining the scope of the evaluation required a strong level of engagement with government leads, grantees and other evaluation stakeholders. Mixed method evaluation will be used to capture the complex pattern of relationships that have informed the overdose response. Working alongside people with drug use experience to both plan and inform the evaluation is critical to its success. This case study builds on a growing literature on evaluating large-scale and complex service transformation, providing a practical example of this.

Accidental drug overdose deaths in Connecticut, 2012–2018: The rise of polysubstance detection?

ObjectivesTo examine trends in polysubstance detection associated with drug-related overdose deaths in Connecticut. MethodsWe used 2012–2018 data provided by Connecticut’s Office of the Chief Medical Examiner (OCME) on accidental overdose deaths. We estimated annual trends, standardizing the number of deaths per 100,000 Connecticut residents each year. We then conducted stratified analyses by polysubstance use status. We also examined the numbers of deaths involving fentanyl in a separate analysis. We obtained data in April 2019, and statistical analyses were performed from April to September 2019. ResultsThe rate of overdose deaths in Connecticut increased from 9.9 per 100,000 residents in 2012 to 28.5 per 100,000 residents in 2018—a 221 % increase—with the majority occurring among persons aged 35–64 (65.3 %), men (73.9 %), and non-Hispanic whites (78.5 %). Among deaths involving fentanyl, the overall deaths escalated from 5.2 deaths per 100,000 residents in 2015 to 21.3 deaths per 100,000 residents in 2018, and more than 50% of these fentanyl-related deaths involved polysubstance use. ConclusionsConnecticut experienced a more-than doubling of opioid-involved overdose deaths, largely driven by fentanyl and polysubstance use. The role of polysubstance use should be considered in efforts toward reducing opioid-related overdose incidents.

Factors Associated with Nonfatal Overdose During a Public Health Emergency

Background: In 2016, in the Canadian province of British Columbia, the Provincial Health Officer declared drug-related overdose deaths a public health emergency. Objectives: In this study, we examine factors associated with recent non-fatal overdose during a time of unprecedented rates of overdose and increasing involvement of fentanyl and fentanyl derivatives in overdose deaths. Methods: Between June and September 2016, a cross-sectional survey was conducted among people who inject drugs (PWID) in Victoria, British Columbia, Canada. Bivariable and multivariable logistic regression analyses were used to examine factors associated with recent non-fatal overdose. Results: A total of 187 PWID were included in the present study, of whom 56 (29.9%) reported having overdosed in the previous 6 months. In multivariable analyses, fentanyl injection (Adjusted Odds Ratio [AOR] = 2.60; 95% confidence interval [CI]: (1.08 – 6.27) and public injection (AOR = 2.20; 95% CI: 1.09 – 4.43) were positively associated with recent non-fatal overdose. Conclusions: Fentanyl injection and public injection were associated with an increased likelihood of non-fatal overdose. These findings underscore the need for drug checking, safer sources of opioids and safer injecting interventions as part of overdose prevention strategies.

A Primer on Heroin and Fentanyl.

Heroin and fentanyl use have reached epidemic proportions in the United States and are now blamed for the majority of drug-related overdose deaths. Both drugs are produced primarily in South America and Asia and enter the United States illegally. One result of smoking or injecting heroin or fentanyl is the development of a substance use disorder (SUD), which causes changes in brain chemistry and function. These changes result in negative behaviors and an inability to stop use. Yet, treatments are available and recovery is possible. Nurses have the potential to impact the heroin and fentanyl epidemic through developing therapeutic relationships with patients who are at risk or already have a SUD. Strategies for effective communication include maintaining a supportive, nonjudgmental attitude and incorporating motivational interviewing. All patients should be screened for opioid use and referred for treatment if indicated. It is important for nurses to be knowledgeable about heroin and fentanyl and available treatments. [Journal of Psychosocial Nursing and Mental Health Services, 55(6), 16-20.].

Pittsburgh project takes novel approach in fighting opioid epidemic.

Knowing that a certain opioid is responsible for deaths in a community can be useful in preventing more such fatalities, according to a pharmacy faculty member whose project aims to do that and more. Associate professor Janice L. Pringle directs the Program Evaluation and Research Unit at the University of Pittsburgh School of Pharmacy. She and the unit led the creation of OverdoseFreePA.org, an online resource for Pennsylvania communities to increase their efforts in treating and preventing substance use disorders. A major project at OverdoseFreePA.org is to clean the data that county coroners and medical examiners provide on drug-related overdose deaths. The cleanup is based in part on heroin metabolism: the human body converts heroin to morphine or 6-monoacetylmorphine and converts morphine to codeine. At autopsy of persons exposed to heroin, according to OverdoseFreePA.org, that drug oftentimes is not detectable in a toxicology screen, but a metabolite (morphine) is detectable; thus, their death certificates almost exclusively list morphine and perhaps antidepressants and marijuana, Pringle said.

Assessing the impact of prescribing directives on opioid prescribing practices among Veterans Health Administration providers.

The study aimed to test whether directives on opioid prescribing released by the Veterans Health Administration (VHA) or the Food and Drug Administration (FDA) had an impact on prescribing among VHA providers. We used the VHA's linked pharmacy and patient medical records database to identify new prescriptions written for propoxyphene, fentanyl, and controlled release (CR) oxycodone between 1/1/2000 and 12/31/2009. We plotted the monthly proportion of these prescriptions that complied with components of four specific safety alerts or directives for these substances issued by the VHA or FDA between 1/1/2001 and 12/31/2008. We modeled compliance using interrupted time series analysis and a generalized additive model with the addition of an indicator variable to flag prescriptions that followed the directive's release date. A total of 32.2 million new prescriptions for fentanyl, oxycodone CR, and propoxyphene were written for VHA patients meeting inclusion criteria. Compliance with guidelines in the directives increased steadily throughout the entire study period, with no clinically meaningful inflection point near the date of each directive's release. Generalized additive modeling and interrupted time series analysis found that the indicator flag slightly improved the fit of the data, but visual inspection of the plots revealed no change at a level of practical significance. While prescribing compliance increased throughout the period, release of FDA and VHA alerts and guidelines did not appear to contribute to this change. Given the fivefold increase in the rate of drug-related overdose deaths since 1990, identifying effective methods to communicate safety messages and change prescriber behavior remains a priority for future work. Copyright © 2016 John Wiley & Sons, Ltd.

Prescription drug overdose: between patients and their doctors

Prescription drug overdose: between patients and their doctors

London audit of drug‐related overdose deaths: characteristics and typology, and implications for prevention and monitoring

To describe the circumstances and draft a typology of drug-related overdose deaths. London, 2003. An audit of 148 drug overdose deaths (involving heroin, methadone, dihydrocodeine, cocaine, amphetamine or MDMA) investigated by coroners during 2003. Information extracted on toxicology, pathology and circumstances were used to identify drug(s) implicated in the death. Poly- or multiple drug use was detected in the majority of deaths with at least 69 different combinations, including 66% for heroin and 42% for cocaine. Six categories of death were identified involving an opiate (100, 68%); cocaine (14, 9%); other controlled drug (five, 3%); mixed drug overdose (18, 12%); other prescribed drug (five, 3%); and other causes (seven, 5%). A witness was present and the death was not instantaneous in 92 (61%) cases, although evidence in the coronial file suggested that in the majority of cases the overdose went unnoticed until too late to intervene. In all, 15 (one in 10) of the deceased were released from prison within 3 months of death; and 37 (one in four) were reported as in receipt of a methadone prescription. Perhaps for the first time in the United Kingdom cocaine was detected in more drug overdose deaths than methadone. However, reducing heroin use is central to the prevention of drug-related deaths. We recommend that overdose prevention encompasses strategies to encourage a 'mutual duty of care' among problem drug users, and in the United Kingdom further investigation of the relationship of methadone treatment failures on overall trends in drug-related deaths is merited.

Drug-related Overdose Deaths in British Columbia and Ontario, 1992–2004

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.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.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.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.