Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada

Hasina Samji; Amanda Yu; Stanley Wong; James Wilton; Mawuena Binka; Maria Alvarez; Sofia Bartlett; Margo Pearce; Prince Adu; Dahn Jeong; Emilia Clementi; Zahid Butt; Jane Buxton; Mark Gilbert; Mel Krajden; Naveed Z Janjua

doi:10.1016/j.drugpo.2020.102989

Drug-related deaths in a population-level cohort of people living with and without hepatitis C virus in British Columbia, Canada

Int J Drug Policy. 2020 Oct 19:86:102989. doi: 10.1016/j.drugpo.2020.102989. Online ahead of print.

Authors

Hasina Samji¹, Amanda Yu², Stanley Wong², James Wilton², Mawuena Binka², Maria Alvarez², Sofia Bartlett³, Margo Pearce⁴, Prince Adu⁴, Dahn Jeong⁴, Emilia Clementi⁴, Zahid Butt⁵, Jane Buxton⁴, Mark Gilbert⁴, Mel Krajden³, Naveed Z Janjua⁴

Affiliations

¹ Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, British Columbia, Canada, V5A 1S6; British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4. Electronic address: Hasina.Samji@bccdc.ca.
² British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4.
³ British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; Department of Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, British Columbia, Canada, BC V6T 2B5.
⁴ British Columbia Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada, V5Z 4R4; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, Canada, V6T 1Z3.
⁵ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1.

Abstract

Background: The majority of new HCV infections in Canada occur in people who inject drugs. Thus, while curative direct antiviral agents (DAAs) herald a promising new era in hepatitis C virus (HCV) treatment, improving the lives and wellbeing of people living with HCV (PLHCV) must be considered in the context of reducing overdose-related harms and with a syndemic lens. We measure drug-related deaths (DRDs) among HCV-negative people and PLHCV in British Columbia (BC), Canada, and the impact of potent contaminants like fentanyl on deaths.

Methods: We identified DRDs among PLHCV and HCV-negative individuals from 2010 to 2018 in the BC Hepatitis Testers Cohort, a population-based dataset of ~1.7 million British Columbians comprising comprehensive administrative and clinical data. We estimated annual standardized liver- and drug-related mortality rates per 100,000 person-years (PY) and described the contribution of specific drugs, including fentanyl and its analogues, implicated in DRDs over time.

Results: DRDs constituted 20.1% of deaths among PLHCV and 4.7% of deaths among HCV-negative individuals; a 4.3-fold (95% confidence interval: 4.0-4.5) difference. Drug-related mortality overtook liver-related mortality for PLHCV in 2015 and HCV-negative individuals in 2016 and rose from 241.7 to 436.5 per 100,000 PY from 2010 to 2018 amongPLHCV and from 20.0 to 57.1 per 100,000 PY for HCV-negative individuals over the same period. The proportion of deaths attributable to drugs among PLHCV and HCV-negative individuals increased from 15.1% to 26.1% and 3.1% to 8.0%, in 2010 and 2018, respectively. The proportion of DRDs attributed solely to synthetic opioids such as fentanyl averaged across both groups increased from 2.1% in 2010 to 69.6% in 2017.

Conclusion: Steep drug-related mortality increases among PLHCV and HCV-negative individuals over the last decade highlight the urgent need to address overdose-related drivers and harms in these populations using an integrated care approach.

Keywords: Drug-related deaths; Fentanyl; HCV; Overdose.