UBC Theses and Dissertations

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UBC Theses and Dissertations

A pilot study on risk and protective factors for opioid overdose among people who use street fentanyl during the COVID-19 pandemic Wong, James Sai Him


North America is in the midst of an opioid overdose epidemic. British Columbia has been particularly impacted by the epidemic, as over 7,000 have died from illicit drug overdoses since the crisis was declared a public health emergency in 2016. These deaths have largely been fueled by the widespread prevalence of illicitly manufactured fentanyl. Moreover, the crisis has now been exacerbated by the COVID-19 pandemic, as several jurisdictions have experienced record numbers of overdose deaths in 2020. We undertook a narrative review to describe the risk and protective factors for opioid overdose examined in the current literature. While a range of factors have been studied, it remains unclear how factors previously identified in those using heroin, and how novel fentanyl-related factors are influencing the risk of overdose in those using fentanyl. We thereby conducted a cross-sectional pilot study to investigate the risk and protective factors for non-fatal opioid overdose among 36 participants using street fentanyl during the COVID-19 pandemic. We found that 86.1% reported the intentional use of fentanyl, and 47.2% reported having overdosed in the past six months. These findings add to the growing evidence base that more individuals are intentionally using fentanyl, rather than unintentionally using it. Gender, history of opioid overdose, and suicidal ideation were identified as risk factors for recent overdose. Route of administration, receiving opioid agonist treatment, and receiving safe supply were not significantly associated with overdose. This suggests that risk and protective factors previously identified in individuals who use heroin should be re-examined as their contributions to overdose risk may be different in individuals who use fentanyl. Novel factors related to fentanyl and the pandemic should be further investigated to examine their roles in overdose risk. Future studies in this urgently needed area of research will improve the identification of individuals at risk of overdose, and inform the development of tailored interventions and policies to improve health outcomes in this vulnerable population.

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