RT Journal Article
SR Electronic
T1 Toxicology and prescribed medication histories among people experiencing fatal illicit drug overdose in British Columbia, Canada
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E967
OP E972
DO 10.1503/cmaj.200191
VO 192
IS 34
A1 Crabtree, Alexis
A1 Lostchuck, Emily
A1 Chong, Mei
A1 Shapiro, Aaron
A1 Slaunwhite, Amanda
YR 2020
UL http://www.cmaj.ca/content/192/34/E967.abstract
AB BACKGROUND: Since 2015, illicit drug overdose has been one of British Columbia’s most pressing public health issues. Our objective was to assess prescription history in the context of postmortem toxicology among people who had a fatal illicit drug overdose in BC.METHODS: Toxicology results from drug overdose deaths involving 1 or more illicit drugs, as identified by the BC Coroners Service in 2015–2017, were linked to the prescription drug histories of individuals as recorded in BC’s PharmaNet database for a descriptive analysis. Substances identified in toxicology were considered prescribed if the individual had an active dispensation for a matching medication within 60 days before overdose.RESULTS: There were 2872 deaths from illicit drug toxicity during the study period; 1789 (62.3%) were closed cases with toxicology results available. In 85.5% of cases, 1 or more opioids were found to be relevant to death. Prescribed opioids in the absence of nonprescribed opioids were detected in only 2.0% of cases, and 6.7% had a combination of prescribed and nonprescribed opioids. Among those with 1 or more nonprescribed opioids, 78.5% had fentanyl or fentanyl analogues detected. Medications used in opioid agonist therapy (methadone and buprenorphine) were found to be relevant to death in 7.4% of cases, with methadone (130 cases) much more common than buprenorphine (< 5 cases). Stimulants were detected in 70.6% of cases.INTERPRETATION: Our data show a high prevalence of nonprescribed fentanyl and stimulants, and a low prevalence of prescribed opioids detected on toxicology in people who died from illicit drug overdose. These results suggest that strategies to address the current overdose crisis in Canada must do much more than target deprescribing of opioids.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.201618