February 25, 2021
Current overdose prevention efforts aren’t enough to support those most at risk of fatal overdose, people who inject drugs alone, according to a new Simon Fraser University-led study published recently.
Dr. Kanna Hayashi, St. Paul’s Hospital Chair in Substance Use Research, and her team interviewed 590 people who inject drugs in Vancouver about their awareness of fentanyl exposure during 2016 and 2017.
The study, published in Drug and Alcohol Review, found that approximately half of participants had tested positive for recent exposure for fentanyl. Of those, about half (26 per cent of the entire sample) were not aware they had been exposed to fentanyl at the time.
One of the alarming findings was that people who were aware of their fentanyl exposure were more likely to inject drugs alone. People in this group were also more likely to have experienced recent incarceration and report difficulty accessing health or social services.
“The majority of overdose deaths we have seen in British Columbia during this public health emergency have been people who use drugs alone,” says Hayashi, an assistant professor in SFU’s Faculty of Health Sciences. “So it was very concerning to see that it was people who were aware of their fentanyl exposure, not the people who were unaware, that were more likely to inject drugs alone, and those people were marked with severe marginalization.”
Hayashi says more research needs to be done to find out why this group would continue to use drugs alone despite knowing the risk, but previous research on HIV risk behaviour suggests that that individual-level awareness and education alone are not enough to get some people to access services when there are broader social and structural barriers at play. For example, another study reported that some women do not use overdose prevention sites and intentionally used drugs alone at home because they didn’t consider the sites to be safe environments.
The research team continues to follow the participants and Hayashi acknowledged that incidents of fentanyl exposure have only increased since this survey was done. There were 1,716 overdose deaths in British Columbia in 2020, the most ever. More than half of the deaths occurred in private residences where people used drugs alone. Fentanyl was detected in more than 80 per cent of deaths. Decriminalizing drug use and addressing the toxic drug supply by providing safer alternatives should be part of the multi-faceted solution, she said.