(91) Factors Associated With Non-Fatal Overdose Among Patients Enrolled in the OPTIMA Trial

Background: In recent years, the number of fatal and non-fatal overdoses (NFO) has continued to climb in North America, with prescription-type opioids and fentanyl analogues being primary contributors. Currently, little is known about correlates of NFO among treatment-seeking individuals with prescription-type opioid use disorder. The present study examines individual and social-structural factors associated with a lifetime history of non-fatal overdose among individuals with prescription-type opioid use disorder (POUD).

Methods: Data were drawn from OPTIMA, a multicenter, pragmatic, open-label, two-arm randomized control trial comparing supervised methadone and flexible take-home dosing buprenorphine/naloxone models of care among adults with POUD conducted at seven Canadian hospitals and community-based clinics between 2017 and 2020. Bivariable and multivariable logistic regression were used to determine factors associated with a lifetime history of non-fatal overdose among participants enrolled in the trial.

Results: A total of 271 participants were included in the present study, with 158 (58.1%) reporting an overdose event in their lifetime. Of those with a history of NFO, 86 (54.4%) reported having a non-fatal overdose in the last six months. In multivariable analyses, positive urine drug screen (UDS) for methamphetamine (Adjusted Odds Ratio [AOR] = 3.16; 95% confidence interval [CI]: (1.59 to 6.56), positive UDS for fentanyl (AOR = 2.26; CI: (1.01 to 5.10), receiving income assistance (AOR = 2.00; CI: (1.09 to 3.73) and currently not having housing (AOR = 2.38; CI: (1.26 to 4.57) were positively associated with a lifetime history of NFO.

Conclusion: Our research found a high proportion of treatment-seeking adults with POUD in Canada with a history of non-fatal overdose. NFO strongly associated with current use of methamphetamine and fentanyl as well as social-structural marginalization, highlighting the need for individualized care to address the concurrent use of other substances and mitigate future overdose.

References:

SOCIAS, M. Eugenia et al. 2018. “The OPTIMA Study, Buprenorphine/Naloxone and Methadone Models of Care for the Treatment of Prescription Opioid Use Disorder: Study Design and Rationale.” Contemporary clinical trials 69: 21

Caudarella, Alexander et al. 2016. “NON-FATAL OVERDOSE AS A RISK FACTOR FOR SUBSEQUENT FATAL OVERDOSE AMONG PEOPLE WHO INJECT DRUGS.” Drug and alcohol dependence 162: 51

Fischer, Benedikt, Lenka Vojtila, and Jürgen Rehm. 2018. “The ‘Fentanyl Epidemic’ in Canada – Some Cautionary Observations Focusing on Opioid-Related Mortality.” Preventive Medicine 107: 109–13

Kerr, Thomas et al. 2007. “Predictors of Non-Fatal Overdose among a Cohort of Polysubstance-Using Injection Drug Users.” Drug and Alcohol Dependence 87(1): 39–45