Gender Influences on Hepatitis C Incidence Among Street Youth in a Canadian Setting

Purpose Few studies have examined gender-based differences in the risk of hepatitis C (HCV) infection among street-involved youth. We compared rates of HCV infection among male and female street-involved youth in a Canadian setting. Methods The At-Risk Youth Study (ARYS) is a prospective cohort of drug-using, street-involved youth. Study recruitment and follow-up occurred in Vancouver, Canada, between September 2005 and November 2011. Eligible participants were illicit drug-using youth aged 14–26 years at enrollment, recruited by street-based outreach. We evaluated rates of HCV antibody seroconversion, measured every six months during study follow-up, and used Cox proportional hazards regression to compare risk factors for HCV incidence between male and female street youth. Results Among 512 HCV-seronegative youth contributing 836 person-years of follow-up, 56 (10.9%) seroconverted to HCV. Among female participants, the incidence density of HCV infection was 10.9 per 100 person-years and in males 5.1 per 100 person-years (p = 0.009). In multivariate analyses, female gender was independently associated with a higher rate of HCV seroconversion (Adjusted Hazard Ratio (AHR) = 2.01; 95% Confidence Interval [CI], 1.18 – 3.44). Risk factors were similar in gender stratified analyses and included injection heroin and injection crystal methamphetamine, although syringe sharing was only associated with HCV incidence among males. Conclusions Among street-involved youth in this setting, females had double the incidence of HCV seroconversion demonstrating the need for gender focused HCV prevention interventions for this population.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofReviewedFacultyResearche

Hospitalization among street-involved youth who use illicit drugs in Vancouver, Canada: a longitudinal analysis

Abstract Background Street-involved youth who use illicit drugs are at high risk for health-related harms; however, the profile of youth at greatest risk of hospitalization has not been well described. We sought to characterize hospitalization among street-involved youth who use illicit drugs and identify the most frequent medical reasons for hospitalization among this population. Methods From January 2005 to May 2016, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada. Multivariable generalized estimating equation (GEE) was used to identify factors associated with hospitalization. Results Among 1216 participants, 373 (30.7%) individuals reported hospitalization in the previous 6 months at some point during the study period. The top three reported medical reasons for hospital admission were the following: mental illness (37.77%), physical trauma (12.77%), and drug-related issues (12.59%). Factors significantly associated with hospitalization were the following: past diagnosis of a mental illness (adjusted odds ratio [AOR] = 1.85; 95% confidence interval [95% CI] 1.47–2.33), frequent cocaine use (AOR = 2.15; 95% CI 1.37–3.37), non-fatal overdose (AOR = 1.76; 95% CI 1.37–2.25), and homelessness (AOR = 1.40; 95% CI 1.16–1.68) (all p < 0.05). Conclusions Findings suggest that mental illness is a key driver of hospitalization among our sample. Comprehensive approaches to mental health and substance use in addition to stable housing offer promising opportunities to decrease hospitalization among this vulnerable population

Impact of incarceration on rates of methadone use in a community recruited cohort of injection drug users

Background: Despite barriers to its use in many settings, opioid agonist therapy with methadone has become the standard of care for treating opioid (e.g. heroin) use disorder. Since people with opioid use disorders have an increased incidence of incarceration, we undertook the present study to evaluate the association between incarceration and methadone maintenance therapy among a cohort of injection drug users in a Canadian setting. Methods: A cohort of people who inject drugs was prospectively followed between May 1996 and May 2013 in Vancouver, Canada. We investigated the relationship between recent incarceration and methadone use using multivariate generalized estimating equation (GEE) logistic regression analysis. Results: Overall, 2758 individuals were recruited during the study period and followed for a median of 64 (interquartile range: 23–106) months. After adjusting for various potential confounders in the multivariate GEE model, being incarcerated remained independently associated with a lower likelihood of having received methadone treatment (Adjusted Odds Ratio: 0.87, 95% confidence interval: 0.81–0.93). Conclusions: Our study demonstrates that incarceration was independently associated with a significantly lower likelihood of being on methadone. Given the role of methadone in reducing the harms of heroin use, including drug acquisitive crime and recidivism, these data suggest a need to scale-up methadone provision for incarcerated injection drug users.Medicine, Faculty ofOther UBCFamily Practice, Department ofMedicine, Department ofReviewedFacultyResearche

Canadian Guidelines on Opioid Use Disorder Among Older Adults

BackgroundIn Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.MethodsA systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.ResultsThirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.ConclusionThese guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.</jats:p