{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T22:08:39Z","timestamp":1792274919116,"version":"4.4.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T00:00:00Z","timestamp":1780790400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fatal drug-related harms have risen across high-income countries over the past decade, yet national surveillance systems differ substantially in case definitions, reporting timeliness, and indicator coverage. These differences make it difficult to determine whether observed cross-national differences reflect epidemiological divergence or heterogeneous measurement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>To address this, we compared public surveillance indicators of fatal drug-related harm across the USA, Canada, England and Wales, and European countries reporting to the European Union Drugs Agency (2015\u201323), using three domains: drug-supply toxicity, surveillance latency, and treatment-system integration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fatal drug-harm indicators suggested divergent trajectories: the USA experienced rapid mortality escalation through 2022 followed by a modest decline, while England and Wales reported continued increases in registration-based deaths. In Canada, deaths involving three or more substances increased from 20% in 2018 to 42% in 2023, with opioid\u2013stimulant combinations accounting for ~60% of deaths by 2023. European estimates remained provisional due to incomplete national reporting. Differences between occurrence-based and registration-based surveillance influenced the apparent timing of trends. Continuity of opioid agonist treatment across incarceration transitions emerged as a measurable treatment-integration signal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High-income settings appear to follow distinct fatal drug-harm trajectories shaped by drug-supply toxicity, surveillance architecture, and treatment-system integration. A structured multi-domain framework can help distinguish epidemiological divergence from variation caused by measurement and reporting. It can also guide improvements in timely surveillance, treatment-continuity monitoring, and cross-jurisdictional learning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/pubmed\/fdag042","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:36:06Z","timestamp":1780878966000},"page":"633-643","source":"Crossref","is-referenced-by-count":3,"title":["Divergent trajectories in fatal drug harms across high-income settings: a comparative synthesis of public surveillance indicators, 2015\u201323"],"prefix":"10.1093","volume":"48","author":[{"given":"Ovie Martin","family":"Albert","sequence":"first","affiliation":[{"name":"VODP, Addiction and Mental Health, Centennial Centre for Mental Health and Brain Injury, AB Health Services\/Recovery Alberta , PO Box 1000, Ponoka, Alberta, T4J 1R8 ,","place":["Canada"]},{"name":"Department of Family Medicine, Cumming School of Medicine, University of Calgary , 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Arthur","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Saskatchewan , West Winds Primary Health Centre, 3311 Fairlight Drive, Saskatoon, Saskatchewan, S7M 3Y5 ,","place":["Canada"]},{"name":"St. Joseph\u2019s Hospital , 1175 Nicholson Road, Estevan, Saskatchewan, Saskatchewan, S4A 2V6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,7]]},"reference":[{"key":"2026090109171432100_ref1","volume-title":"Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders","author":"World Health Organization","year":"2024"},{"key":"2026090109171432100_ref2","volume-title":"Over 3 Million Annual Deaths Due to Alcohol and Drug Use, Majority among Men","author":"World Health Organization"},{"key":"2026090109171432100_ref3","doi-asserted-by":"publisher","DOI":"10.18356\/9789211594850","volume-title":"World Drug Report 2025: Booklet 1\u2014Key Findings","author":"United Nations Office on Drugs and Crime","year":"2025"},{"key":"2026090109171432100_ref4","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/S2215-0366(18)30337-7","article-title":"The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990\u20132016: a systematic analysis for the global burden of disease study 2016","volume":"5","author":"Degenhardt","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"2026090109171432100_ref5","volume-title":"In Focus: The Emergence of Opioids in Canada","author":"Health Canada"},{"key":"2026090109171432100_ref6","volume-title":"National Center for Health Statistics. 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