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Opioid-related emergency department visits and deaths after a harm-reduction intervention: a retrospective observational cohort time series analysis

Matthew E.M. Yeung, Chel Hee Lee, Riley Hartmann and Eddy Lang
June 20, 2023 11 (3) E537-E545; DOI: https://doi.org/10.9778/cmajo.20220104
Matthew E.M. Yeung
Departments of Emergency Medicine (Yeung, Lang) and Critical Care Medicine (Lee), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Hartmann), University of Saskatchewan, Saskatoon, Sask.
BHSc
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Chel Hee Lee
Departments of Emergency Medicine (Yeung, Lang) and Critical Care Medicine (Lee), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Hartmann), University of Saskatchewan, Saskatoon, Sask.
PhD
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Riley Hartmann
Departments of Emergency Medicine (Yeung, Lang) and Critical Care Medicine (Lee), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Hartmann), University of Saskatchewan, Saskatoon, Sask.
MD MSc
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Eddy Lang
Departments of Emergency Medicine (Yeung, Lang) and Critical Care Medicine (Lee), University of Calgary, Calgary, Alta.; Department of Emergency Medicine (Hartmann), University of Saskatchewan, Saskatoon, Sask.
MD
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    Figure 1:

    Opioid-related emergency department visits after opening of supervised consumption sites. Piecewise 95% confidence interval (CI) in orange, ARIMAX 95% CI in pink. (A) Calgary: intervention on Oct. 1, 2017. (B) Edmonton: intervention on Mar. 1, 2018. (C) Red Deer: intervention on Oct. 1, 2018. (D) Lethbridge: intervention on Mar. 1, 2018. Note: ARIMAX = autoregressive integrated moving average with explanatory variable.

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    Figure 2:

    Opioid-related deaths after opening of supervised consumption sites. Piecewise 95% confidence interval (CI) in orange, ARIMAX 95% CI in pink. (A) Calgary: intervention on Oct. 1, 2017. (B) Edmonton: intervention on Mar. 1, 2018. Note: ARIMAX = autoregressive integrated moving average with explanatory variable.

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    Figure 3:

    Opioid-related emergency department (ED) visits and deaths after community-based naloxone program initiation. Piecewise 95% confidence interval (CI) in orange. ARIMAX 95% CI in pink. (A) Urban opioid-related ED visits: intervention on Jan. 1, 2016. (B) Rural opioid-related deaths: intervention on Jan. 1, 2016. (C) Urban opioid-related deaths: intervention on Jan. 1, 2016. (D) Rural opioid-related ED visits: intervention on Jan. 1, 2016. Note: ARIMAX = autoregressive integrated moving average with explanatory variable.

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    Table 1:

    Population data

    LocationOpening datePreopening, no.Postopening, no.PreopeningPostopening
    Mean age ± SDMale sex, %Mean age ± SDMale sex, %
    SCS or OPS site analysis
    ED visits
     CalgaryOctober 20175134450236.5 ± 14.757.337.0 ± 13.459.4
     EdmontonMarch 20186964482537.7 ± 18.755.338.3 ± 13.158.9
     Red Deer*October 2018110732336.4 ± 14.058.136.1 ± 13.159.8
     LethbridgeMarch 201887038237.3 ± 15.547.439.2 ± 16.550.0
    Deaths
     CalgaryOctober 201767936241.7 ± 14.068.341.2 ± 14.675.4
     EdmontonMarch 201880115443.2 ± 15.465.841.6 ± 14.168.2
     Red Deer*October 201819133.3 ± 9.068.4†
     LethbridgeMarch 201817937.8 ± 12.552.936.9 ± 10.688.9
    LocationProgram start datePre–program start, no.Post–program start, no.Pre–program startPost–program start
    Mean age ± SDMale sex, %Mean age ± SDMale sex, %
    CBN program analysis
    ED visits
     Urban AlbertaJanuary 2016530416 08637.0 ± 14.357.337.3 ± 15.758.0
     Rural AlbertaJanuary 20164260976438.0 ± 15.250.938.7 ± 15.152.5
    Deaths
     Urban AlbertaJanuary 2016662133441.8 ± 14.369.942.1 ± 14.868.9
     Rural AlbertaJanuary 201610531238.4 ± 12.362.437.9 ± 11.567.8
    • Note: CBN = community-based naloxone, ED = emergency department, OPS = overdose prevention site, SCS = supervised consumption site, SD = standard deviation.

    • ↵* OPS site.

    • ↵† Unreportable owing to low case count.

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    Table 2:

    Interrupted time series analyses

    LocationPreintervention period*Postintervention period*Absolute level change at time of intervention, visits or deaths per month (95% CI)Slope change, change in visits or deaths per month ± SESlope change significance, p value
    SCS site analysis
    ED visits
     CalgaryOctober 2013–October 2017October 2017–February 2020−22.7 (−29.7 to −15.8)−0.2 ± 0.40.5
     EdmontonOctober 2013–March 2018March 2018–February 20200.7 (−11.4 to 12.8)−1.0 ± 0.60.07
     Red Deer†October 2013–October 2018October 2018–February 2020−1.4 (−4.5 to 1.7)0.01 ± 0.2> 0.9
     LethbridgeOctober 2013–March 2018March 2018–February 2020−8.8 (−11.7 to −5.9)−0.9 ± 0.2< 0.001
    Deaths
     CalgaryOctober 2013–October 2017October 2017–March 2019−1.7 (−4.5 to 0.9)−0.3 ± 0.20.09
     EdmontonOctober 2013–March 2019March 2018–March 2019−5.9 (−8.9 to −2.9)−1.4 ± 0.2< 0.001
     Red Deer†October 2013–March 2019October 2018–March 2019−0.1 (−0.5 to 0.3)−0.1 ± 0.10.09
     LethbridgeOctober 2013–March 2018March 2018–March 20190.03 (−0.4 to 0.7)−0.01 ± 0.030.6
    CBN program analysis
    ED visits
     Urban AlbertaOctober 2013–January 2016January 2016–February 202038.9 (33.3 to 44.4)−1.9 ± 0.4< 0.001
     Rural AlbertaOctober 2013–January 2016January 2016–February 20203.7 (−0.3 to 7.1)−1.1 ± 0.2< 0.001
    Deaths
     Urban AlbertaOctober 2013–January 2016January 2016–March 20199.1 (6.7 to 11.5)−0.5 ± 0.20.004
     Rural AlbertaOctober 2013–January 2016January 2016–March 20192.6 (2.6 to 4.7)−0.1 ± 0.10.2
    • Note: CBN = community-based naloxone, ED = emergency department, SCS = safe consumption site, SE = standard error.

    • ↵* All periods are defined as the first date of the indicated month.

    • ↵† OPS site.

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CMAJ Open: 11 (3)
Vol. 11, Issue 3
1 May 2023
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Opioid-related emergency department visits and deaths after a harm-reduction intervention: a retrospective observational cohort time series analysis
Matthew E.M. Yeung, Chel Hee Lee, Riley Hartmann, Eddy Lang
May 2023, 11 (3) E537-E545; DOI: 10.9778/cmajo.20220104

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Opioid-related emergency department visits and deaths after a harm-reduction intervention: a retrospective observational cohort time series analysis
Matthew E.M. Yeung, Chel Hee Lee, Riley Hartmann, Eddy Lang
May 2023, 11 (3) E537-E545; DOI: 10.9778/cmajo.20220104
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