Matthew E M Yeung, Chel Hee Lee, Riley Hartmann, Eddy Lang
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We compared rates before and after program implementation in individual Alberta municipalities and province-wide after safe consumption site (March 2018 to October 2018) and community-based naloxone (January 2016) program implementation.</p><p><strong>Results: </strong>A total of 24 107 emergency department visits and 2413 deaths were included in the study. After safe consumption site opening, we saw decreased opioid-related emergency department visits in Calgary (level change -22.7 [-20%] visits per month, 95% confidence interval [CI] -29.7 to -15.8) and Lethbridge (level change -8.8 [-50%] visits per month, 95% CI -11.7 to -5.9), and decreased deaths in Edmonton (level change -5.9 [-55%] deaths per month, 95% CI -8.9 to -2.9). We observed increased emergency department visits after community-based naloxone program implementation in urban Alberta (level change 38.9 [46%] visits, 95% CI 33.3 to 44.4). 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引用次数: 0
摘要
背景:迄今为止，关于安全消费场所和社区纳洛酮计划对区域阿片类药物相关急诊就诊和死亡的影响的研究很少。我们试图确定这些干预措施对阿尔伯塔省区域阿片类药物相关急诊就诊和死亡率的影响。方法:我们采用回顾性观察设计，通过中断时间序列分析，评估城市阿片类药物相关急诊科访问量和阿片类药物相关死亡(由中毒和阿片类药物使用障碍定义)。我们比较了艾伯塔省各个城市和全省安全消费场所(2018年3月至2018年10月)和社区纳洛酮(2016年1月)计划实施前后的比率。结果:共纳入24107例急诊就诊和2413例死亡病例。在安全消费站点开放后，我们看到卡尔加里(水平变化-22.7[-20%]每月就诊，95%置信区间[CI] -29.7至-15.8)和莱斯布里奇(水平变化-8.8[-50%]每月就诊，95%置信区间[CI] -11.7至-5.9)阿片类药物相关急诊科就诊人数减少，埃德蒙顿(水平变化-5.9[-55%]每月死亡人数减少，95% CI -8.9至-2.9)。我们观察到艾伯塔省城市社区纳洛酮项目实施后急诊科就诊人数增加(水平变化38.9 [46%]，95% CI 33.3至44.4)。我们还观察到城市阿片类药物相关死亡增加(水平变化9.1[40%]死亡，95% CI 6.7至11.5)。解释:本研究的结果表明，采用类似干预措施的城市之间存在差异。我们的研究结果还表明语境差异;例如，非法药物供应毒性可能会改变社区纳洛酮方案在没有彻底的公共卫生对策的情况下预防阿片类药物过量的能力。
Opioid-related emergency department visits and deaths after a harm-reduction intervention: a retrospective observational cohort time series analysis.
Background: To date, there has been little research on the effect of safe consumption site and community-based naloxone programs on regional opioid-related emergency department visits and deaths. We sought to determine the impact of these interventions on regional opioid-related emergency department visit and death rates in the province of Alberta.
Methods: We used a retrospective observational design, via interrupted time series analysis, to assess municipal opioid-related emergency department visit volume and opioid-related deaths (defined by poisoning and opioid use disorder). We compared rates before and after program implementation in individual Alberta municipalities and province-wide after safe consumption site (March 2018 to October 2018) and community-based naloxone (January 2016) program implementation.
Results: A total of 24 107 emergency department visits and 2413 deaths were included in the study. After safe consumption site opening, we saw decreased opioid-related emergency department visits in Calgary (level change -22.7 [-20%] visits per month, 95% confidence interval [CI] -29.7 to -15.8) and Lethbridge (level change -8.8 [-50%] visits per month, 95% CI -11.7 to -5.9), and decreased deaths in Edmonton (level change -5.9 [-55%] deaths per month, 95% CI -8.9 to -2.9). We observed increased emergency department visits after community-based naloxone program implementation in urban Alberta (level change 38.9 [46%] visits, 95% CI 33.3 to 44.4). We also observed an increase in urban opioid-related deaths (level change 9.1 [40%] deaths, 95% CI 6.7 to 11.5).
Interpretation: The results of this study suggest differences exist between municipalities employing similar interventions. Our results also suggest contextual variation; for example, illicit drug supply toxicity may modify the ability of a community-based naloxone program to prevent opioid overdose without a thorough public health response.
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