The increase in benzodiazepine-laced drugs and related risks in Canada: The urgent need for effective and sustainable solutions
Tóm tắt
The overdose crisis in Canada has continuously evolved and is increasingly challenging to contain, while efforts from governments and policymakers to address it have often fallen short and resulted in unintended consequences. One of the main repercussions has been an unprecedented rise in adulterants in the illegal drug supply, including a wide array of pharmacological and psychoactive compounds and chemicals, which has resulted in a progressively toxic drug supply. Most recently, there has been a stark increase in synthetic benzodiazepine-laced opioids (i.e., ‘benzodope’) in some Canadian jurisdictions. This unique combination carries distinct and amplified risks for people who use drugs including fatal and non-fatal overdoses, increased dependence and withdrawal symptoms, and places them in extremely vulnerable positions. The emergence of benzodiazepines within the illicit drug supply has substantially contributed to drug-related morbidity and mortality in Canada, and has further complicated current public health initiatives and overdose prevention efforts. This reality underscores the need for effective and sustainable policy solutions to address the evolving overdose epidemic including increased knowledge and education on the specific harms of opioid and benzodiazepine co-use (especially in regards to the complexity of opioid/benzodiazepine overdoses), scaling-up harm reduction measures, and eliminating the toxic drug supply altogether.
Từ khóa
#Benzodiazepines #Canada #Drug policy #Opioids #Overdose #Public HealthTài liệu tham khảo
Ali et al., 2021 F. Ali C. Russell F. Nafeh J. Rehm S. LeBlanc T. Elton-Marshall Changes in substance supply and use characteristics among people who use drugs (PWUD) during the COVID-19 global pandemic: A national qualitative assessment in Canada International Journal of Drug Policy 93 2021 103237 Ali, F., Russell, C., Nafeh, F., Rehm, J., LeBlanc, S., & Elton-Marshall, T. (2021). Changes in substance supply and use characteristics among people who use drugs (PWUD) during the COVID-19 global pandemic: A national qualitative assessment in Canada. International Journal of Drug Policy, 93, 103237.
An and Godwin, 2016 H. An J. Godwin Flumazenil in benzodiazepine overdose Canadian Medical Association Journal 188 17-18 2016 10.1503/cmaj.160357 E537-E537 An, H., & Godwin, J. (2016). Flumazenil in benzodiazepine overdose. Canadian Medical Association Journal, 188(17-18), E537-E537. https://doi.org/10.1503/cmaj.160357
Beaulieu et al., 2021 T. Beaulieu E. Wood S. Tobias M. Lysyshyn P. Patel J. Matthews L. Ti Is expected substance type associated with timing of drug checking service utilization?: A cross-sectional study Harm Reduction Journal 18 1 2021 66 10.1186/s12954-021-00514-3 Beaulieu, T., Wood, E., Tobias, S., Lysyshyn, M., Patel, P., Matthews, J., & Ti, L. (2021). Is expected substance type associated with timing of drug checking service utilization?: A cross-sectional study. Harm Reduction Journal, 18(1), 66. https://doi.org/10.1186/s12954-021-00514-3
Belackova and Wilkins, 2018 V. Belackova C. Wilkins Consumer agency in cannabis supply - Exploring auto-regulatory documents of the cannabis social clubs in Spain International Journal of Drug Policy 54 2018 26 34 10.1016/j.drugpo.2017.12.018 Belackova, V., & Wilkins, C. (2018). Consumer agency in cannabis supply - Exploring auto-regulatory documents of the cannabis social clubs in Spain. International Journal of Drug Policy, 54, 26-34. https://doi.org/10.1016/j.drugpo.2017.12.018
Belzak and Halverson, 2018 L. Belzak J. Halverson The opioid crisis in Canada: a national perspective Health Promotion & Chronic Disease Prevention in Canada: Research, Policy & Practice 38 6 2018 Belzak, L., & Halverson, J. (2018). The opioid crisis in Canada: a national perspective. Health Promotion & Chronic Disease Prevention in Canada: Research, Policy & Practice, 38(6).
Biggar et al., 2021 E. Biggar K. Papamihali P. Leclerc E. Hyshka B. Graham M. Taylor J.A. Buxton Towards cross-Canada monitoring of the unregulated street drug supply BMC Public Health 21 1 2021 1678 10.1186/s12889-021-11757-x Biggar, E., Papamihali, K., Leclerc, P., Hyshka, E., Graham, B., Taylor, M., … Buxton, J. A. (2021). Towards cross-Canada monitoring of the unregulated street drug supply. BMC Public Health, 21(1), 1678. https://doi.org/10.1186/s12889-021-11757-x
Blanco and Volkow, 2019 C. Blanco N.D. Volkow Management of opioid use disorder in the USA: present status and future directions The Lancet 393 10182 2019 1760 1772 Blanco, C., & Volkow, N. D. (2019). Management of opioid use disorder in the USA: present status and future directions. The Lancet, 393(10182), 1760-1772.
Bonn et al., 2020 M. Bonn A. Palayew S. Bartlett T.D. Brothers N. Touesnard M. Tyndall Addressing the syndemic of HIV, Hepatitis C, overdose, and COVID-19 among people who use drugs: The potential roles for decriminalization and safe supply Journal of Studies on Alcohol and Drugs 81 5 2020 556 560 https://www.ncbi.nlm.nih.gov/pubmed/33028465 Bonn, M., Palayew, A., Bartlett, S., Brothers, T. D., Touesnard, N., & Tyndall, M. (2020). Addressing the syndemic of HIV, Hepatitis C, overdose, and COVID-19 among people who use drugs: The potential roles for decriminalization and safe supply. Journal of Studies on Alcohol and Drugs, 81(5), 556-560. https://www.ncbi.nlm.nih.gov/pubmed/33028465
British Columbia Centre on Substance Use (BCCSU) 2019 British Columbia Centre on Substance Use (BCCSU) Heroin compassion clubs 2019 https://www.bccsu.ca/wp-content/uploads/2019/02/Report-Heroin-Compassion-Clubs.pdf British Columbia Centre on Substance Use (BCCSU). (2019). Heroin compassion clubs. https://www.bccsu.ca/wp-content/uploads/2019/02/Report-Heroin-Compassion-Clubs.pdf
British Columbia Centre on Substance Use (BCCSU) 2020 British Columbia Centre on Substance Use (BCCSU) Drug checking: Detection of etizolam, flualprazolam, and flubromazolam by benzodiazepine-specific lateral flow immunoassay test strips 2020 https://www.bccsu.ca/wp-content/uploads/2020/08/BenzoTestStrip_Report.pdf British Columbia Centre on Substance Use (BCCSU). (2020). Drug checking: Detection of etizolam, flualprazolam, and flubromazolam by benzodiazepine-specific lateral flow immunoassay test strips. https://www.bccsu.ca/wp-content/uploads/2020/08/BenzoTestStrip_Report.pdf
British Columbia Centre on Substance Use (BCCSU) 2021 British Columbia Centre on Substance Use (BCCSU) Clinical Bulletin: Benzodiazepines and opioids 2021 chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.bccsu.ca/wp-content/uploads/2021/06/Bulletin-Benzos-and-Opioids.pdf British Columbia Centre on Substance Use (BCCSU). (2021). Clinical Bulletin: Benzodiazepines and opioids. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.bccsu.ca/wp-content/uploads/2021/06/Bulletin-Benzos-and-Opioids.pdf
Brothers et al., 2022 T.D. Brothers M. Leaman M. Bonn D. Lewer J. Atkinson J. Fraser L. Genge Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness Drug and Alcohol Dependence 235 2022 109440 10.1016/j.drugalcdep.2022.109440 Brothers, T. D., Leaman, M., Bonn, M., Lewer, D., Atkinson, J., Fraser, J., … Genge, L. (2022). Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness. Drug and Alcohol Dependence, 235, 109440. https://doi.org/10.1016/j.drugalcdep.2022.109440
Browne et al., 2021 T. Browne M.S. Gold D.M. Martin The rapidly changing composition of the global street drug supply and its effects on high-risk groups for COVID-19 Current Psychopharmacology 10 2 2021 138 154 Browne, T., Gold, M. S., & Martin, D. M. (2021). The rapidly changing composition of the global street drug supply and its effects on high-risk groups for COVID-19. Current Psychopharmacology, 10(2), 138-154.
Bruneau et al., 2018 J. Bruneau K. Ahamad M.-È. Goyer G. Poulin P. Selby B. Fischer E. Wood Management of opioid use disorders: a national clinical practice guideline Canadian Medical Association Journal 190 9 2018 E247 E257 Bruneau, J., Ahamad, K., Goyer, M.-È., Poulin, G., Selby, P., Fischer, B., … Wood, E. (2018). Management of opioid use disorders: a national clinical practice guideline. Canadian Medical Association Journal, 190(9), E247-E257.
Brunt et al., 2017 T.M. Brunt J. van den Berg E. Pennings B. Venhuis Adverse effects of levamisole in cocaine users: a review and risk assessment Archives of Toxicology 91 6 2017 2303 2313 Brunt, T. M., van den Berg, J., Pennings, E., & Venhuis, B. (2017). Adverse effects of levamisole in cocaine users: a review and risk assessment. Archives of Toxicology, 91(6), 2303-2313.
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Canadian Centre on Substance Use and Addiction (CCSA) 2022 Canadian Centre on Substance Use and Addiction (CCSA) Sedatives 2022 chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.ccsa.ca/sites/default/files/2022-06/CCSA-Canadian-Drug-Summary-Sedatives-2022-en_0.pdf Canadian Centre on Substance Use and Addiction (CCSA). (2022). Sedatives. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ccsa.ca/sites/default/files/2022-06/CCSA-Canadian-Drug-Summary-Sedatives-2022-en_0.pdf
Canadian Centre on Substance Use and Addiction (CCSA) & the Canadian Community Epidemiology Network on Drug Use (CCENDU) 2021 Canadian Centre on Substance Use and Addiction (CCSA) & the Canadian Community Epidemiology Network on Drug Use (CCENDU) Risks and harms associated with the nonmedical use of benzodiazepines in the unregulated drug supply in Canada 2021 chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.ccsa.ca/sites/default/files/2021-12/CCSA-CCENDU-Nonmedical-Use-Benzodiazepines-Unregulated-Drug-Supply-Bulletin-2021-en.pdf Canadian Centre on Substance Use and Addiction (CCSA) & the Canadian Community Epidemiology Network on Drug Use (CCENDU). (2021). Risks and harms associated with the nonmedical use of benzodiazepines in the unregulated drug supply in Canada chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ccsa.ca/sites/default/files/2021-12/CCSA-CCENDU-Nonmedical-Use-Benzodiazepines-Unregulated-Drug-Supply-Bulletin-2021-en.pdf.
Catalani et al., 2021 V. Catalani D. Arillotta J.M. Corkery A. Guirguis A. Vento F. Schifano Identifying new/emerging psychoactive substances at the time of COVID-19; a web-based approach Frontiers in psychiatry 11 2021 632405 Catalani, V., Arillotta, D., Corkery, J. M., Guirguis, A., Vento, A., & Schifano, F. (2021). Identifying new/emerging psychoactive substances at the time of COVID-19; a web-based approach. Frontiers in psychiatry, 11, 632405.
Davis and Samuels, 2020 C.S. Davis E.A. Samuels Opioid policy changes during the COVID-19 pandemic - and beyond Journal of Addiction Medicine 14 4 2020 e4 e5 10.1097/ADM.0000000000000679 Davis, C. S., & Samuels, E. A. (2020). Opioid policy changes during the COVID-19 pandemic - and beyond. Journal of Addiction Medicine, 14(4), e4-e5. https://doi.org/10.1097/ADM.0000000000000679
Decorte et al., 2017 T. Decorte M. Pardal R. Queirolo M.F. Boidi C. Sánchez Avilés Ò. Parés Franquero Regulating cannabis social clubs: A comparative analysis of legal and self-regulatory practices in Spain, Belgium and Uruguay International Journal of Drug Policy 43 2017 44 56 10.1016/j.drugpo.2016.12.020 Decorte, T., Pardal, M., Queirolo, R., Boidi, M. F., Sánchez Avilés, C., & Parés Franquero, Ò. (2017). Regulating cannabis social clubs: A comparative analysis of legal and self-regulatory practices in Spain, Belgium and Uruguay. International Journal of Drug Policy, 43, 44-56. https://doi.org/10.1016/j.drugpo.2016.12.020
Drug Users Liberation Front (DULF) and Vancouver Area Network of Drug Users (VANDU) 2022 Drug Users Liberation Front (DULF) and Vancouver Area Network of Drug Users (VANDU) URGENT REQUEST: Section 56(I) exemption to the Controlled Drugs and Substances Act (CDSA) required to ensure the equitable application of public health protections to vulnerable Canadians 2022 Retrieved from https://www.dulf.ca/_files/ugd/fe034c_c3fe03c2dec8461794401fe564d0db8d.pdf?index=true Drug Users Liberation Front (DULF) and Vancouver Area Network of Drug Users (VANDU). (2022). URGENT REQUEST: Section 56(I) exemption to the Controlled Drugs and Substances Act (CDSA) required to ensure the equitable application of public health protections to vulnerable Canadians. Retrieved from https://www.dulf.ca/_files/ugd/fe034c_c3fe03c2dec8461794401fe564d0db8d.pdf?index=true
Edinoff et al., 2022 A.N. Edinoff C.A. Nix A.S. Odisho C.P. Babin A.G. Derouen S.C. Lutfallah A.D. Kaye Novel designer benzodiazepines: Comprehensive review of evolving clinical and adverse effects Neurology International 14 3 2022 648 663 Edinoff, A. N., Nix, C. A., Odisho, A. S., Babin, C. P., Derouen, A. G., Lutfallah, S. C., … Kaye, A. D. (2022). Novel designer benzodiazepines: Comprehensive review of evolving clinical and adverse effects. Neurology International, 14(3), 648-663.
European Monitoring Center on Drugs and Drug Abuse (EMCDDA) 2015 European Monitoring Center on Drugs and Drug Abuse (EMCDDA) The misuse of benzodiazepines among high-risk opioid users in Europe 2015 https://www.emcdda.europa.eu/system/files/publications/2733/Misuse%20of%20benzos_POD2015.pdf European Monitoring Center on Drugs and Drug Abuse (EMCDDA). (2015). The misuse of benzodiazepines among high-risk opioid users in Europe. https://www.emcdda.europa.eu/system/files/publications/2733/Misuse%20of%20benzos_POD2015.pdf
Fischer et al., 2020 B. Fischer W. Jones M. Tyndall P. Kurdyak Correlations between opioid mortality increases related to illicit/synthetic opioids and reductions of medical opioid dispensing - exploratory analyses from Canada BMC Public Health 20 1 2020 143 10.1186/s12889-020-8205-z Fischer, B., Jones, W., Tyndall, M., & Kurdyak, P. (2020). Correlations between opioid mortality increases related to illicit/synthetic opioids and reductions of medical opioid dispensing - exploratory analyses from Canada. BMC Public Health, 20(1), 143. https://doi.org/10.1186/s12889-020-8205-z
Fischer and Keates, 2012 B. Fischer A. Keates Opioid Drought', Canadian-style? Potential implications of the 'natural experiment' of delisting Oxycontin in Canada The International Journal of Drug Policy 23 6 2012 495 497 Fischer, B., & Keates, A. (2012). 'Opioid Drought', Canadian-style? Potential implications of the 'natural experiment' of delisting Oxycontin in Canada. The International Journal of Drug Policy, 23(6), 495-497.
Fischer and Rehm, 2017 B. Fischer J. Rehm Revisiting the 'paradigm shift' in opioid use: Developments and implications 10 years later Drug and Alcohol Review 2017 10.1111/dar.12539 Fischer, B., & Rehm, J. (2017). Revisiting the 'paradigm shift' in opioid use: Developments and implications 10 years later. Drug and Alcohol Review. https://doi.org/10.1111/dar.12539
Fischer and Wood, 2020 B. Fischer E. Wood A decade of extreme oscillations in opioid control and availability: implications for public health in a Canadian setting Journal of Public Health Policy 41 2 2020 214 220 Fischer, B., & Wood, E. (2020). A decade of extreme oscillations in opioid control and availability: implications for public health in a Canadian setting. Journal of Public Health Policy, 41(2), 214-220.
Fleming et al., 2020 T. Fleming A. Barker A. Ivsins S. Vakharia R. McNeil Stimulant safe supply: a potential opportunity to respond to the overdose epidemic Harm Reduction Journal 17 1 2020 1 6 Fleming, T., Barker, A., Ivsins, A., Vakharia, S., & McNeil, R. (2020). Stimulant safe supply: a potential opportunity to respond to the overdose epidemic. Harm Reduction Journal, 17(1), 1-6.
Friedman et al., 2022 J. Friedman F. Montero P. Bourgois R. Wahbi D. Dye D. Goodman-Meza C. Shover Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis Drug and Alcohol Dependence 233 2022 109380 10.1016/j.drugalcdep.2022.109380 Friedman, J., Montero, F., Bourgois, P., Wahbi, R., Dye, D., Goodman-Meza, D., & Shover, C. (2022). Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis. Drug and Alcohol Dependence, 233, 109380. 10.1016/j.drugalcdep.2022.109380
Furlan et al., 2014 A.D. Furlan P. MacDougall D. Pellerin K. Shaw D. Spitzig G. Wilson J. Wright Overview of four prescription monitoring/review programs in Canada Pain Research & Management 19 2 2014 102 106 Furlan, A. D., MacDougall, P., Pellerin, D., Shaw, K., Spitzig, D., Wilson, G., & Wright, J. (2014). Overview of four prescription monitoring/review programs in Canada. Pain Research & Management, 19(2), 102-106.
Gomes et al., 2021 T Gomes R Murray G Kolla P Leece S Bansal J Besharah W. J Changing circumstances surrounding opioid-related deaths in Ontario during the COVID-19 pandemic 2021 https://www.publichealthontario.ca/-/media/documents/c/2021/changing-circumstances-surrounding-opioid-related-deaths.pdf?sc_lang=en Gomes T, Murray R, Kolla G, Leece P, Bansal S, Besharah J, … J, W. (2021). Changing circumstances surrounding opioid-related deaths in Ontario during the COVID-19 pandemic. https://www.publichealthontario.ca/-/media/documents/c/2021/changing-circumstances-surrounding-opioid-related-deaths.pdf?sc_lang=en
Gomes et al., 2022 T. Gomes G. Kolla D. McCormack A. Sereda S. Kitchen T. Antoniou Clinical outcomes and health care costs among people entering a safer opioid supply program in Ontario Canadian Medical Association Journal 194 36 2022 E1233 E1242 10.1503/cmaj.220892 Gomes, T., Kolla, G., McCormack, D., Sereda, A., Kitchen, S., & Antoniou, T. (2022). Clinical outcomes and health care costs among people entering a safer opioid supply program in Ontario. Canadian Medical Association Journal, 194(36), E1233-E1242. https://doi.org/10.1503/cmaj.220892
Government of Canada 2021 Government of Canada Federal action on opioids to date 2021 https://www.canada.ca/en/health-canada/services/opioids/federal-actions/overview.html Government of Canada. (2021). Federal action on opioids to date. https://www.canada.ca/en/health-canada/services/opioids/federal-actions/overview.html
Government of Canada 2022a Government of Canada Opioid- and stimulant-related harms in Canada 2022 Retrieved from https://health-infobase.canada.ca/substance-related-harms/opioids/maps?index=1 (Accessed 10 September 2021) Government of Canada. (2022a). Opioid- and stimulant-related harms in Canada. Retrieved from https://health-infobase.canada.ca/substance-related-harms/opioids/maps?index=1. (Accessed 10 September 2021).
Government of Canada 2022b Government of Canada Safer supply 2022 https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis/safer-supply.html Government of Canada. (2022b). Safer supply. https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis/safer-supply.html
Greenwood and Fashola, 2021 L. Greenwood K. Fashola Illicit fentanyl from China: An evolving global operation 2021 https://www.uscc.gov/sites/default/files/2021-08/Illicit_Fentanyl_from_China-An_Evolving_Global_Operation.pdf Greenwood, L., & Fashola, K. (2021). Illicit fentanyl from China: An evolving global operation. https://www.uscc.gov/sites/default/files/2021-08/Illicit_Fentanyl_from_China-An_Evolving_Global_Operation.pdf
Hasegawa et al., 2022 K. Hasegawa K. Minakata M. Suzuki O. Suzuki Non-fentanyl-derived synthetic opioids emerging during recent years Forensic Toxicology 40 2 2022 234 243 10.1007/s11419-022-00624-y Hasegawa, K., Minakata, K., Suzuki, M., & Suzuki, O. (2022). Non-fentanyl-derived synthetic opioids emerging during recent years. Forensic Toxicology, 40(2), 234-243. https://doi.org/10.1007/s11419-022-00624-y
Ivsins et al., 2020 A. Ivsins J. Boyd L. Beletsky R. McNeil Tackling the overdose crisis: The role of safe supply International Journal of Drug Policy 80 2020 102769 10.1016/j.drugpo.2020.102769 Ivsins, A., Boyd, J., Beletsky, L., & McNeil, R. (2020). Tackling the overdose crisis: The role of safe supply. International Journal of Drug Policy, 80, 102769. https://doi.org/10.1016/j.drugpo.2020.102769
Kang et al., 2021 M. Kang M.A. Galuska S. Ghassemzadeh Benzodiazepine toxicity 2021 StatPearls Publishing Treasure Island (FL) http://europepmc.org/abstract/MED/29489152 Kang, M., Galuska, M. A., & Ghassemzadeh, S. (2021). Benzodiazepine toxicity. StatPearls Publishing, Treasure Island (FL). http://europepmc.org/abstract/MED/29489152
Karamouzian et al., 2022 M. Karamouzian J.A. Buxton C. Hategeka E. Nosova K. Hayashi M.J. Milloy T. Kerr Shifts in substance use patterns among a cohort of people who use opioids after delisting of OxyContin in BC, Canada: An interrupted time series study International Journal of Drug Policy 109 2022 103852 10.1016/j.drugpo.2022.103852 Karamouzian, M., Buxton, J. A., Hategeka, C., Nosova, E., Hayashi, K., Milloy, M. J., & Kerr, T. (2022). Shifts in substance use patterns among a cohort of people who use opioids after delisting of OxyContin in BC, Canada: An interrupted time series study. International Journal of Drug Policy, 109, 103852. 10.1016/j.drugpo.2022.103852
Ker et al., 2021 S. Ker J. Hsu A. Balani S.S. Mukherjee A.J. Rush M. Khan J. Sarkar Factors that affect patient attrition in buprenorphine treatment for opioid use disorder: A retrospective real-world study using electronic health records Neuropsychiatric Disease and Treatment 17 2021 3229 3244 10.2147/NDT.S331442 Ker, S., Hsu, J., Balani, A., Mukherjee, S. S., Rush, A. J., Khan, M., … Sarkar, J. (2021). Factors that affect patient attrition in buprenorphine treatment for opioid use disorder: A retrospective real-world study using electronic health records. Neuropsychiatric Disease and Treatment, 17, 3229-3244. https://doi.org/10.2147/NDT.S331442
Klaire et al., 2022 S. Klaire C. Sutherland T. Kerr M.C. Kennedy A low-barrier, flexible safe supply program to prevent deaths from overdose Canadian Medical Association journal 194 19 2022 E674 E676 Klaire, S., Sutherland, C., Kerr, T., & Kennedy, M. C. (2022). A low-barrier, flexible safe supply program to prevent deaths from overdose. Canadian Medical Association journal, 194(19), E674-E676.
Laing et al., 2021 M.K. Laing L. Ti A. Marmel S. Tobias A.M. Shapiro R. Laing M.E. Socías An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: Preliminary results from a community drug checking program using point-of-care and confirmatory methods International Journal of Drug Policy 93 2021 103169 10.1016/j.drugpo.2021.103169 Laing, M. K., Ti, L., Marmel, A., Tobias, S., Shapiro, A. M., Laing, R., … Socías, M. E. (2021). An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: Preliminary results from a community drug checking program using point-of-care and confirmatory methods. International Journal of Drug Policy, 93, 103169. 10.1016/j.drugpo.2021.103169
Lann and Molina, 2009 M.A. Lann D.K. Molina A fatal case of benzodiazepine withdrawal American Journal of Forensic Medicine and Pathology 30 2 2009 177 179 10.1097/PAF.0b013e3181875aa0 Lann, M. A., & Molina, D. K. (2009). A fatal case of benzodiazepine withdrawal. American Journal of Forensic Medicine and Pathology, 30(2), 177-179. https://doi.org/10.1097/PAF.0b013e3181875aa0
Liebrenz et al., 2016 M. Liebrenz M. Schneider A. Buadze M.-T. Gehring A. Dube C. Caflisch High-dose benzodiazepine users' perceptions and experiences of anterograde amnesia Journal of the American Academy of Psychiatry and the Law Online 44 3 2016 328 337 Liebrenz, M., Schneider, M., Buadze, A., Gehring, M.-T., Dube, A., & Caflisch, C. (2016). High-dose benzodiazepine users' perceptions and experiences of anterograde amnesia. Journal of the American Academy of Psychiatry and the Law Online, 44(3), 328-337.
Liu et al., 2021 S. Liu J. O'Donnell R. Matt Gladden L. McGlone F. Chowdhury Trends in nonfatal and fatal overdoses involving benzodiazepines—38 states and the District of Columbia, 2019–2020 American Journal of Transplantation 21 11 2021 3794 3800 Liu, S., O'Donnell, J., Matt Gladden, R., McGlone, L., & Chowdhury, F. (2021). Trends in nonfatal and fatal overdoses involving benzodiazepines—38 states and the District of Columbia, 2019–2020. American Journal of Transplantation, 21(11), 3794-3800.
MacDonald et al., 2022 T. MacDonald A.T. Gallo G. Basso-Hulse K.S. Bennett G.K. Hulse A double-blind randomised crossover trial of low-dose flumazenil for benzodiazepine withdrawal: A proof of concept Drug and Alcohol Dependence 236 2022 109501 10.1016/j.drugalcdep.2022.109501 MacDonald, T., Gallo, A. T., Basso-Hulse, G., Bennett, K. S., & Hulse, G. K. (2022). A double-blind randomised crossover trial of low-dose flumazenil for benzodiazepine withdrawal: A proof of concept. Drug and Alcohol Dependence, 236, 109501. 10.1016/j.drugalcdep.2022.109501
Mars et al., 2019 S.G. Mars D. Rosenblum D. Ciccarone Illicit fentanyls in the opioid street market: desired or imposed? Addiction 114 5 2019 774 780 10.1111/add.14474 Mars, S. G., Rosenblum, D., & Ciccarone, D. (2019). Illicit fentanyls in the opioid street market: desired or imposed? Addiction, 114(5), 774-780. 10.1111/add.14474
McAdam et al., 2022 E. McAdam K. Hayashi H. Dong Z. Cui K.-o. Sedgemore P. Dietze K. DeBeck Factors associated with perceived decline in the quality of drugs during the COVID-19 pandemic: Evidence from community-recruited cohorts of people who use drugs in Vancouver, Canada Drug and Alcohol Dependence 236 2022 109471 10.1016/j.drugalcdep.2022.109471 McAdam, E., Hayashi, K., Dong, H., Cui, Z., Sedgemore, K.-o., Dietze, P., … DeBeck, K. (2022). Factors associated with perceived decline in the quality of drugs during the COVID-19 pandemic: Evidence from community-recruited cohorts of people who use drugs in Vancouver, Canada. Drug and Alcohol Dependence, 236, 109471. 10.1016/j.drugalcdep.2022.109471
Murphy et al., 2016 Y. Murphy E. Wilson E.M. Goldner B. Fischer Benzodiazepine use, misuse, and harm at the population level in Canada: A comprehensive narrative review of data and developments since 1995 Clinical Drug Investigation 36 7 2016 519 530 10.1007/s40261-016-0397-8 Murphy, Y., Wilson, E., Goldner, E. M., & Fischer, B. (2016). Benzodiazepine use, misuse, and harm at the population level in Canada: A comprehensive narrative review of data and developments since 1995. Clinical Drug Investigation, 36(7), 519-530. https://doi.org/10.1007/s40261-016-0397-8
Norton, 2008 R. Norton Unintended consequences. The concise encyclopedia of economics Library of Economics and Liberty 2008 Norton, R. (2008). Unintended consequences. The concise encyclopedia of economics. Library of Economics and Liberty.
Orsolini et al., 2020 L. Orsolini J.M. Corkery S. Chiappini A. Guirguis A. Vento D. De Berardis F. Schifano ‘New/Designer Benzodiazepines’: an analysis of the literature and psychonauts’ trip reports Current Neuropharmacology 18 9 2020 809 837 Orsolini, L., Corkery, J. M., Chiappini, S., Guirguis, A., Vento, A., De Berardis, D., … Schifano, F. (2020). ‘New/Designer Benzodiazepines’: an analysis of the literature and psychonauts’ trip reports. Current Neuropharmacology, 18(9), 809-837.
Palamar et al., 2022 J.J. Palamar D. Ciccarone C. Rutherford K.M. Keyes T.H. Carr L.B. Cottler Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021 Drug and Alcohol Dependence 234 2022 109398 10.1016/j.drugalcdep.2022.109398 Palamar, J. J., Ciccarone, D., Rutherford, C., Keyes, K. M., Carr, T. H., & Cottler, L. B. (2022). Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021. Drug and Alcohol Dependence, 234, 109398. 10.1016/j.drugalcdep.2022.109398
Palis et al., 2022 H. Palis A. Tu M. Scow P. Young S. Wood K. Hu A.K. Slaunwhite Increasing toxicity of the illicit drug supply during COVID-19: the need for an accessible and acceptable safe supply UBC Medical Journal 13 2 2022 Palis, H., Tu, A., Scow, M., Young, P., Wood, S., Hu, K., … Slaunwhite, A. K. (2022). Increasing toxicity of the illicit drug supply during COVID-19: the need for an accessible and acceptable safe supply. UBC Medical Journal, 13(2).
Payer et al., 2020 D.E. Payer M.M. Young B. Maloney-Hall C. Mill P. Leclerc J. Buxton t.N.D.C.W. Group Adulterants, contaminants and co-occurring substances in drugs on the illegal market in Canada: An analysis of data from drug seizures, drug checking and urine toxicology 2020 chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/ https://www.ccsa.ca/sites/default/files/2020-04/CCSA-CCENDU-Adulterants-Contaminants-Co-occurring-Substances-in-Drugs-Canada-Report-2020-en.pdf Payer, D. E., Young, M. M., Maloney-Hall, B., Mill, C., Leclerc, P., Buxton, J., … Group, t. N. D. C. W. (2020). Adulterants, contaminants and co-occurring substances in drugs on the illegal market in Canada: An analysis of data from drug seizures, drug checking and urine toxicology. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.ccsa.ca/sites/default/files/2020-04/CCSA-CCENDU-Adulterants-Contaminants-Co-occurring-Substances-in-Drugs-Canada-Report-2020-en.pdf
Rammohan et al., 2022 I. Rammohan Z. Bouck S. Fusigboye J. Bowles K. McDonald N. Maghsoudi D. Werb Drug checking use and interest among people who inject drugs in Toronto, Canada International Journal of Drug Policy 107 2022 103781 10.1016/j.drugpo.2022.103781 Rammohan, I., Bouck, Z., Fusigboye, S., Bowles, J., McDonald, K., Maghsoudi, N., … Werb, D. (2022). Drug checking use and interest among people who inject drugs in Toronto, Canada. International Journal of Drug Policy, 107, 103781. 10.1016/j.drugpo.2022.103781
Scarfone et al., 2022 K.M. Scarfone N. Maghsoudi K. McDonald C. Stefan D.R. Beriault E. Wong Toronto's Drug Checking Service Working, G. Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019–April 2020 Harm Reduction Journal 19 1 2022 3 10.1186/s12954-021-00585-2 Scarfone, K. M., Maghsoudi, N., McDonald, K., Stefan, C., Beriault, D. R., Wong, E., … Toronto's Drug Checking Service Working, G. (2022). Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019–April 2020. Harm Reduction Journal, 19(1), 3. https://doi.org/10.1186/s12954-021-00585-2
Sharma et al., 2020 V. Sharma S.H. Simpson S. Samanani E. Jess D.T. Eurich Concurrent use of opioids and benzodiazepines/Z-drugs in Alberta, Canada and the risk of hospitalisation and death: a case cross-over study BMJ Open 10 11 2020 e038692 Sharma, V., Simpson, S. H., Samanani, S., Jess, E., & Eurich, D. T. (2020). Concurrent use of opioids and benzodiazepines/Z-drugs in Alberta, Canada and the risk of hospitalisation and death: a case cross-over study. BMJ Open, 10(11), e038692.
Singh et al., 2020 V.M. Singh T. Browne J. Montgomery The emerging role of toxic adulterants in street drugs in the US illicit opioid crisis Public Health Reports 135 1 2020 6 10 Singh, V. M., Browne, T., & Montgomery, J. (2020). The emerging role of toxic adulterants in street drugs in the US illicit opioid crisis. Public Health Reports, 135(1), 6-10.
Socías et al., 2020 M.E. Socías H. Dong E. Wood R. Brar L. Richardson K. Hayashi M.J. Milloy Trajectories of retention in opioid agonist therapy in a Canadian setting International Journal of Drug Policy 77 2020 102696 10.1016/j.drugpo.2020.102696 Socías, M. E., Dong, H., Wood, E., Brar, R., Richardson, L., Hayashi, K., … Milloy, M. J. (2020). Trajectories of retention in opioid agonist therapy in a Canadian setting. International Journal of Drug Policy, 77, 102696. 10.1016/j.drugpo.2020.102696
Sproule, 2015 B. Sproule Prescription monitoring programs in Canada: Best practice and program review 2015 http://www.ccsa.ca/Resource%20Library/CCSA-Prescription-Monitoring-Programs-in-Canada-Report-2015-en.pdf Sproule, B. (2015). Prescription monitoring programs in Canada: Best practice and program review. http://www.ccsa.ca/Resource%20Library/CCSA-Prescription-Monitoring-Programs-in-Canada-Report-2015-en.pdf
Thompson et al., 2022 H, M.K. Thompson N Maghsoudi D. Werb What's contaminating Toronto's drug supply? Insights from samples checked by Toronto's drug checking service: January 1 - December 31, 2021 2022 https://drugchecking.cdpe.org/wp-content/uploads/dlm_uploads/2022/08/Torontos-Drug-Checking-Service-Report_2021.pdf Thompson H, M. K., Maghsoudi N, Werb D. (2022). What's contaminating Toronto's drug supply? Insights from samples checked by Toronto's drug checking service: January 1 - December 31, 2021. https://drugchecking.cdpe.org/wp-content/uploads/dlm_uploads/2022/08/Torontos-Drug-Checking-Service-Report_2021.pdf
Tyndall, 2020 M. Tyndall Safer opioid distribution in response to the COVID-19 pandemic International Journal of Drug Policy 83 2020 102880 10.1016/j.drugpo.2020.102880 Tyndall, M. (2020). Safer opioid distribution in response to the COVID-19 pandemic. International Journal of Drug Policy, 83, 102880. https://doi.org/10.1016/j.drugpo.2020.102880
Vernaz et al., 2018 N. Vernaz A. Calmy S. Hurst Y. Jackson F. Negro A. Perrier H. Wolff A buyers' club to improve access to hepatitis C treatment for vulnerable populations Swiss Medical Weekly 148 2018 w14649 10.4414/smw.2018.14649 Vernaz, N., Calmy, A., Hurst, S., Jackson, Y., Negro, F., Perrier, A., & Wolff, H. (2018). A buyers' club to improve access to hepatitis C treatment for vulnerable populations. Swiss Medical Weekly, 148, w14649. https://doi.org/10.4414/smw.2018.14649