{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:14:48Z","timestamp":1756901688745,"version":"3.44.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":41,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["178163"],"award-info":[{"award-number":["178163"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Despite a high prevalence of alcohol use disorder (AUD) in Canada, access to medication-based treatment remains poor. Therefore, our aim was to explore patterns of alcohol toxicity deaths in Ontario, Canada, circumstances surrounding death, prior healthcare interactions, and pharmacotherapy for AUD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a population-based repeated cross-sectional study of alcohol toxicity deaths occurring between 1 January 2018 and 30 June 2022 in Ontario, Canada. We reported trends in deaths over time and determined demographic characteristics of decedents, circumstances surrounding death, and prior healthcare interactions. Among a subset of the cohort with an AUD diagnosis eligible for public drug benefits, we reported receipt of medications used to treat AUD before death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 1346 alcohol toxicity deaths over the study period, at a median age of 42\u00a0years, with 73.8% occurring among men. The majority of alcohol toxicity deaths involved other substances, including opioids (75.2%), benzodiazepines (10.8%), and\/or stimulants (45.2%). Half had an AUD (50.4%) and 62.7% had an opioid, benzodiazepine or stimulant use disorder. Among decedents who were public drug beneficiaries with an AUD (N\u2009=\u2009361), only 3.6% were actively prescribed first-line AUD pharmacotherapies (naltrexone and\/or acamprosate) at time of death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We found that the majority of alcohol toxicity deaths in Ontario involved other non-alcohol substances. We also detected a high prevalence of prior healthcare encounters for substance use disorders (SUDs) and low prevalence of evidence-based AUD pharmacotherapy. This suggests a need for integrated treatment across concurrent SUDs and improved access to pharmacotherapies for AUD across Ontario.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/alcalc\/agaf055","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T12:06:06Z","timestamp":1756209966000},"source":"Crossref","is-referenced-by-count":0,"title":["Circumstances surrounding alcohol toxicity deaths and prior pharmacotherapy for alcohol use disorder in Ontario, Canada"],"prefix":"10.1093","volume":"60","author":[{"given":"William","family":"Wynne","sequence":"first","affiliation":[{"name":"Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital , 30 Bond St, Toronto, ON M5B 1W8 ,","place":["Canada"]},{"name":"Department of Health Studies, University of Toronto , 25 King\u2019s College Circle, Toronto, ON M5S 1A1 ,","place":["Canada"]},{"name":"Translational Health Sciences, University of Oxford , Wellington Square, Oxford OX1 2JD ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Iacono","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital , 30 Bond St, Toronto, ON M5B 1W8 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Yang","sequence":"additional","affiliation":[{"name":"ICES , 2075 Bayview Ave V Wing, Toronto, ON M4N 3M5 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bisola","family":"Hamzat","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital , 30 Bond St, Toronto, ON M5B 1W8 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela","family":"Leece","sequence":"additional","affiliation":[{"name":"Public Health Ontario , 661 University Avenue, Suite 1701, Toronto, ON M5G 1M1 ,","place":["Canada"]},{"name":"Dalla Lana School of Public Health, University of Toronto , 155 College St, Toronto, ON M5T 3M7 ,","place":["Canada"]},{"name":"Department of Family and Community Medicine, University of Toronto , 500 University Ave, Toronto, ON M5G 1V7 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gillian","family":"Kolla","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Memorial University , 300 Prince Philip Dr, St. John\u2019s, NL A1B 3X5 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rob","family":"Boyd","sequence":"additional","affiliation":[{"name":"Ottawa Inner City Health Inc , 550 Old St. Patrick St, Ottawa, ON K1N 5L5,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikki","family":"Bozinoff","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Toronto , 500 University Ave, Toronto, ON M5G 1V7 ,","place":["Canada"]},{"name":"Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , 1051 Queen St W, Toronto, ON M6J 1H4 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mike","family":"Franklyn","sequence":"additional","affiliation":[{"name":"Northern Ontario School of Medicine , 935 Ramsey Lake Rd, Sudbury, ON P3E 2C6 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Shearer","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital , 30 Bond St, Toronto, ON M5B 1W8 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Smoke","sequence":"additional","affiliation":[{"name":"Ontario Drug Policy Research Network Lived Experience Advisory Group , 38 Shuter St, Toronto, ON M5B 1A6 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangyun","family":"Wu","sequence":"additional","affiliation":[{"name":"ICES , 2075 Bayview Ave V Wing, Toronto, ON M4N 3M5 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Newcombe","sequence":"additional","affiliation":[{"name":"Ontario Drug Policy Research Network Lived Experience Advisory Group , 38 Shuter St, Toronto, ON M5B 1A6 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1468-1965","authenticated-orcid":false,"given":"Tara","family":"Gomes","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute of St. Michael\u2019s Hospital , 30 Bond St, Toronto, ON M5B 1W8 ,","place":["Canada"]},{"name":"ICES , 2075 Bayview Ave V Wing, Toronto, ON M4N 3M5 ,","place":["Canada"]},{"name":"University of Toronto Leslie Dan Faculty of Pharmacy , 144 College St, Toronto, ON M5S 3M2 ,","place":["Canada"]},{"name":"University of Toronto Institute for Health Policy, Management and Evaluation , 155 College St 4th Floor, Toronto, ON M5T 3M6 ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"2025082608060370900_ref1","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1111\/dar.13821","article-title":"Socio-economic inequities in emergency department visits for wholly alcohol-attributable acute and chronic harms in Canada, 2003\u20132017","volume":"43","author":"Benny","year":"2024","journal-title":"Drug Alcohol Rev"},{"key":"2025082608060370900_ref2","doi-asserted-by":"publisher","first-page":"e243387","DOI":"10.1001\/jamanetworkopen.2024.3387","article-title":"Outcomes after initiation of medications for alcohol use disorder at hospital discharge","volume":"7","author":"Bernstein","year":"2024","journal-title":"JAMA Netw Open"},{"key":"2025082608060370900_ref3","doi-asserted-by":"publisher","first-page":"112429","DOI":"10.1016\/j.drugalcdep.2024.112429","article-title":"A systematic review of interventions to enhance initiation of and adherence to treatment for alcohol use disorders","volume":"263","author":"Biswal","year":"2024","journal-title":"Drug Alcohol Depend"},{"key":"2025082608060370900_ref4","doi-asserted-by":"publisher","DOI":"10.54194\/GVUQ2702","volume-title":"Effects of the COVID-19 Pandemic on the Number and Characteristics of Public Drug Program Beneficiaries in Ontario, Canada","author":"Bouck","year":"2024"},{"key":"2025082608060370900_ref5","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1111\/add.15275","article-title":"Shifts in alcohol consumption during the COVID-19 pandemic: Early indications from Australia","volume":"116","author":"Callinan","year":"2021","journal-title":"Addiction"},{"volume-title":"Alcohol","year":"2025","author":"Canadian Centre on Substance Use and Addiction","key":"2025082608060370900_ref6"},{"volume-title":"Rural and Northern Community Issues in Mental Health","year":"2009","author":"Canadian Mental Health Association","key":"2025082608060370900_ref7"},{"key":"2025082608060370900_ref8","doi-asserted-by":"publisher","DOI":"10.31027\/ODPRN.2023.04","author":"Chiefs of Ontario and Ontario Drug Policy Research Network","year":"2023","journal-title":"Opioid Use, Related Harms, and Access to Treatment, among First Nations in Ontario Annual Update, 2013\u20132021"},{"volume-title":"Stigma, Lack of Awareness Linked to Underutilization of Medications that Treat Alcohol Use Disorder: B.C. Study","year":"2023","author":"Clarkson","key":"2025082608060370900_ref9"},{"key":"2025082608060370900_ref10","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1111\/dar.13817","article-title":"Characteristics, toxicology and major organ pathology of deaths due to acute alcohol toxicity in Australia, 2011\u20132022","volume":"43","author":"Darke","year":"2024","journal-title":"Drug Alcohol Rev"},{"volume-title":"Opioid- and Stimulant-Related Harms in Canada","year":"2024","author":"Government of Canada","key":"2025082608060370900_ref11"},{"key":"2025082608060370900_ref12","doi-asserted-by":"publisher","first-page":"e210","DOI":"10.1097\/adm.0000000000000918","article-title":"First-line medications for the outpatient treatment of alcohol use disorder: A systematic review of perceived barriers","volume":"16","author":"Gregory","year":"2022","journal-title":"J Addict Med"},{"key":"2025082608060370900_ref13","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1016\/j.jadohealth.2020.08.017","article-title":"Rebound of severe alcoholic intoxications in adolescents and young adults after COVID-19 lockdown","volume":"67","author":"Grigoletto","year":"2020","journal-title":"J Adolesc Health"},{"volume-title":"The Epidemic within the Pandemic: The Mental Health Crisis in Northern Ontario","year":"..","author":"Haggarty","key":"2025082608060370900_ref14"},{"key":"2025082608060370900_ref15","doi-asserted-by":"publisher","DOI":"10.31027\/ODPRN.2024.02","volume-title":"Prescribing Patterns, Substance Use Disorder Diagnoses and Access to Treatment Prior to Substance-Related Toxicity Deaths in Ontario","author":"Holton","year":"2024"},{"key":"2025082608060370900_ref16","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s13722-022-00292-8","article-title":"Clinicians\u2019 perspectives and perceived barriers to caring for patients with alcohol use disorder and cirrhosis","volume":"17","author":"Johnson","year":"2022","journal-title":"Addict Sci Clin Pract"},{"key":"2025082608060370900_ref17","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1111\/dar.13446","article-title":"Changes in alcohol use during the COVID-19 pandemic in Europe: A meta-analysis of observational studies","volume":"41","author":"Kilian","year":"2022","journal-title":"Drug Alcohol Rev"},{"key":"2025082608060370900_ref18","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1186\/s12889-022-12678-z","article-title":"Polysubstance use poisoning deaths in Canada: An analysis of trends from 2014 to 2017 using mortality data","volume":"22","author":"Konefal","year":"2022","journal-title":"BMC Public Health"},{"key":"2025082608060370900_ref19","doi-asserted-by":"publisher","first-page":"109705","DOI":"10.1016\/j.drugalcdep.2022.109705","article-title":"Impact of policy changes and drug shortages on acamprosate and naltrexone use in Ontario, Canada","volume":"242","author":"Konstantelos","year":"2023","journal-title":"Drug Alcohol Depend"},{"key":"2025082608060370900_ref20","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.jad.2021.12.132","article-title":"Socioeconomic status, alcohol use disorders, and depression: A population-based study","volume":"301","author":"Lasserre","year":"2022","journal-title":"J Affect Disord"},{"key":"2025082608060370900_ref21","doi-asserted-by":"publisher","first-page":"E1466","DOI":"10.1503\/cmaj.181093","article-title":"Reconciliation and Canada\u2019s overdose crisis: Responding to the needs of indigenous peoples","volume":"190","author":"Lavalley","year":"2018","journal-title":"CMAJ"},{"key":"2025082608060370900_ref22","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1038\/s41572-022-00406-1","article-title":"Hazardous drinking and alcohol use disorders","volume":"8","author":"Mackillop","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2025082608060370900_ref23","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s13722-024-00471-9","article-title":"Pharmacotherapy for alcohol use disorder among adults with medical disorders in Sweden","volume":"19","author":"Mansson","year":"2024","journal-title":"Addict Sci Clin Pract"},{"key":"2025082608060370900_ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejim.2022.08.013","article-title":"Identification and management of acute alcohol intoxication","volume":"108","author":"Mirijello","year":"2023","journal-title":"Eur J Intern Med"},{"volume-title":"About Gabapentin","year":"..","author":"National Health Service","key":"2025082608060370900_ref25"},{"volume-title":"Alcohol-Related Emergencies and Deaths in the United States","year":"2024","author":"National Institute on Alcohol Abuse and Alcoholism","key":"2025082608060370900_ref26"},{"volume-title":"Mental and Substance Use Disorders in Canada","year":"2013","author":"Pearson","key":"2025082608060370900_ref27"},{"key":"2025082608060370900_ref28","doi-asserted-by":"publisher","first-page":"109150","DOI":"10.1016\/j.drugalcdep.2021.109150","article-title":"Alcohol and other substance use during the COVID-19 pandemic: A systematic review","volume":"229","author":"Roberts","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2025082608060370900_ref29","doi-asserted-by":"publisher","first-page":"e0225548","DOI":"10.1371\/journal.pone.0225548","article-title":"Assessing service and treatment needs and barriers of youth who use illicit and non-medical prescription drugs in northern Ontario, Canada","volume":"14","author":"Russell","year":"2019","journal-title":"PloS One"},{"key":"2025082608060370900_ref30","doi-asserted-by":"publisher","first-page":"2128","DOI":"10.1111\/add.16273","article-title":"Using a cascade of care framework to identify gaps in access to medications for alcohol use disorder in British Columbia, Canada","volume":"118","author":"Socias","year":"2023","journal-title":"Addiction"},{"key":"2025082608060370900_ref31","first-page":"e277","article-title":"First-line medications for alcohol use disorders among public drug plan beneficiaries in Ontario","volume":"63","author":"Spithoff","year":"2017","journal-title":"Can Fam Physician"},{"volume-title":"Indigenous Peoples in Ontario","year":"2018","author":"Statistics Canada","key":"2025082608060370900_ref32"},{"volume-title":"Provisional Death Counts and Excess Mortality, January 2020 to September 2022","year":"2022","author":"Statistics Canada","key":"2025082608060370900_ref33"},{"key":"2025082608060370900_ref34","doi-asserted-by":"publisher","DOI":"10.31027\/ODPRN.2023.03","author":"The Ontario Drug Policy Research Network and Public Health Ontario","year":"2023","journal-title":"Characteristics of Substance-Related Toxicity Deaths in Ontario"},{"key":"2025082608060370900_ref35","doi-asserted-by":"publisher","first-page":"W-163","DOI":"10.7326\/0003-4819-147-8-200710160-00010-w1","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE): Explanation and elaboration","volume":"147","author":"Vandenbroucke","year":"2007","journal-title":"Ann Intern Med"},{"key":"2025082608060370900_ref36","doi-asserted-by":"publisher","first-page":"108964","DOI":"10.1016\/j.drugalcdep.2021.108964","article-title":"Pharmacotherapy for alcohol use disorders\u2014unequal provision across sociodemographic factors and co-morbid conditions. A cohort study of the total population in Sweden","volume":"227","author":"Wallhed Finn","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2025082608060370900_ref37","doi-asserted-by":"publisher","first-page":"1296239","DOI":"10.3389\/fpubh.2023.1296239","article-title":"Service-level barriers to and facilitators of accessibility to treatment for problematic alcohol use: A scoping review","volume":"11","author":"Wolfe","year":"2023","journal-title":"Front Public Health"},{"key":"2025082608060370900_ref38","doi-asserted-by":"publisher","first-page":"E1364","DOI":"10.1503\/cmaj.230715","article-title":"Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder","volume":"195","author":"Wood","year":"2023","journal-title":"CMAJ"},{"volume-title":"Global Status Report on Alcohol and Health 2018","year":"2018","author":"World Health Organization","key":"2025082608060370900_ref39"},{"volume-title":"Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders","year":"2024","author":"World Health Organization","key":"2025082608060370900_ref40"},{"key":"2025082608060370900_ref41","doi-asserted-by":"publisher","first-page":"EVIDoa2400093","DOI":"10.1056\/EVIDoa2400093","article-title":"Alcohol sales and adverse events during the Covid-19 pandemic","volume":"4","author":"Yaseen","year":"2025","journal-title":"NEJM Evid"},{"key":"2025082608060370900_ref42","doi-asserted-by":"publisher","first-page":"102752","DOI":"10.1016\/j.eclinm.2024.102752","article-title":"Temporal trend of drug overdose-related deaths and excess deaths during the COVID-19 pandemic: A population-based study in the United States from 2012 to 2022","volume":"74","author":"Zhao","year":"2024","journal-title":"EClinicalMedicine."},{"key":"2025082608060370900_ref43","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.7326\/M20-7466","article-title":"Alcohol sales and alcohol-related emergencies during the COVID-19 pandemic","volume":"174","author":"Zipursky","year":"2021","journal-title":"Ann Intern Med"}],"container-title":["Alcohol and Alcoholism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/alcalc\/article-pdf\/60\/5\/agaf055\/64137571\/agaf055.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/alcalc\/article-pdf\/60\/5\/agaf055\/64137571\/agaf055.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T12:06:09Z","timestamp":1756209969000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/alcalc\/article\/doi\/10.1093\/alcalc\/agaf055\/8241294"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,16]]},"references-count":43,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,7,16]]}},"URL":"https:\/\/doi.org\/10.1093\/alcalc\/agaf055","relation":{},"ISSN":["0735-0414","1464-3502"],"issn-type":[{"type":"print","value":"0735-0414"},{"type":"electronic","value":"1464-3502"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,7,16]]},"article-number":"agaf055"}}