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      “They’re not doing enough.”: women’s experiences with opioids and naloxone in Toronto

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          Abstract

          Background

          Amid increasing opioid overdose deaths in Canada since 2010 and a changing naloxone access landscape, there is a need for up-to-date research on Canadian women’s experiences with opioids. Studies on Canadian take-home naloxone programs are promising, but research beyond these programs is limited. Our study is the first to focus on women’s experiences and perspectives on the opioid crisis in Ontario, Canada’s most populous province, since the opioid crisis began in 2010.

          Objective

          Our objective was to address research knowledge gaps involving Canadian women with criminal justice involvement who use opioids, and identify flaws in current policies, responses, and practices. While the opioid overdose crisis persists, this lack of research inhibits our ability to determine whether overdose prevention efforts, especially involving naloxone, are meeting their needs.

          Methods

          We conducted semi-structured, qualitative interviews from January to April 2018 with 10 women with experience of opioid use. They were recruited through the study’s community partner in Toronto. Participants provided demographic information, experiences with opioids and naloxone, and their perceptions of the Canadian government’s responses to the opioid crisis. Interviews were transcribed verbatim and inductive thematic analysis was conducted to determine major themes within the data.

          Results

          Thematic analysis identified seven major concerns despite significant differences in participant life and opioid use experiences. Participants who had used illicit opioids since naloxone became available over-the-counter in 2016 were much more knowledgeable about naloxone than participants who had only used opioids prior to 2016. The portability, dosage form, and effects of naloxone are important considerations for women who use opioids. Social alienation, violence, and isolation affect the wellbeing of women who use opioids. The Canadian government’s response to the opioid crisis was perceived as inadequate. Participants demonstrated differing needs and views on ideal harm reduction approaches, despite facing similar structural issues surrounding stigma, addiction management, and housing.

          Conclusions

          Participants experienced with naloxone use found it to be useful in preventing fatal overdose, however many of their needs with regards to physical, mental, and social health, housing, harm reduction, and access to opioid treatment remained unmet.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13011-021-00360-3.

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          Most cited references 79

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          A General Inductive Approach for Analyzing Qualitative Evaluation Data

           D R Thomas (2006)
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            The Burden of Opioid-Related Mortality in the United States

            Key Points Question What has been the burden of opioid-related deaths in the United States over a recent 15-year period? Findings In this serial cross-sectional study, we found that the percentage of all deaths attributable to opioids increased 292% (from 0.4% to 1.5%) between 2001 and 2016, resulting in approximately 1.68 million person-years of life lost in 2016 alone (5.2 per 1000 population). The burden was particularly high among adults aged 24 to 35 years; in 2016, 20% of deaths in this age group involved opioids. Meaning Premature death from opioids imposes an enormous and growing public health burden across the United States.
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              Determinants of increased opioid-related mortality in the United States and Canada, 1990-2013: a systematic review.

              We review evidence of determinants contributing to increased opioid-related mortality in the United States and Canada between 1990 and 2013. We identified 17 determinants of opioid-related mortality and mortality increases that we classified into 3 categories: prescriber behavior, user behavior and characteristics, and environmental and systemic determinants. These determinants operate independently but interact in complex ways that vary according to geography and population, making generalization from single studies inadvisable. Researchers in this area face significant methodological difficulties; most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult. Preventing additional opioid-related mortality will likely require interventions that address multiple determinants and are tailored to specific locations and populations.
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                Author and article information

                Contributors
                Flora.Matheson@unityhealth.to
                Journal
                Subst Abuse Treat Prev Policy
                Subst Abuse Treat Prev Policy
                Substance Abuse Treatment, Prevention, and Policy
                BioMed Central (London )
                1747-597X
                20 March 2021
                20 March 2021
                2021
                : 16
                Affiliations
                [1 ]GRID grid.415502.7, MAP Centre for Urban Health Solutions, St. Michael’s Hospital, ; 30 Bond Street, Toronto, ON M5B1W8 Canada
                [2 ]Elizabeth Fry Society Toronto, 215 Wellesley Street East, Toronto, ON M4X 1G1 Canada
                [3 ]GRID grid.17091.3e, ISNI 0000 0001 2288 9830, School of Population and Public Health, , University of British Columbia, ; 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
                [4 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Dalla Lana School of Public Health, , University of Toronto, ; 55 College St Room 500, Toronto, ON M5T 3M7 Canada
                Article
                360
                10.1186/s13011-021-00360-3
                7980746
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Health & Social care

                criminal justice, qualitative, overdose, women, opioids, naloxone

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