{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T19:02:38Z","timestamp":1792004558232,"version":"4.4.0"},"reference-count":62,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T00:00:00Z","timestamp":1697414400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"publisher","award":["2021\u2010HQ\u2010000094"],"award-info":[{"award-number":["2021\u2010HQ\u2010000094"]}],"id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2024,2]]},"abstract":"Abstract<\/jats:title>Aims<\/jats:title>To measure the change in proportion of opioid\u2010related overdose deaths attributed to people experiencing homelessness and to compare the opioid\u2010related fatalities between individuals experiencing homelessness and not experiencing homelessness at time of death.<\/jats:p><\/jats:sec>Design, setting and participants<\/jats:title>Population\u2010based, time\u2010trend analysis using coroner and health administrative databases from Ontario, Canada from 1 July 2017 and 30 June 2021.<\/jats:p><\/jats:sec>Measurements<\/jats:title>Quarterly proportion of opioid\u2010related overdose deaths attributed to people experiencing homelessness. We also obtained socio\u2010demographic and health characteristics of decedents, health\u2010care encounters preceding death, substances directly contributing to death and circumstances surrounding deaths.<\/jats:p><\/jats:sec>Findings<\/jats:title>A total of 6644 individuals (median age\u2009=\u200940\u2009years, interquartile range\u2009=\u200931\u201351; 74.1% male) experienced an accidental opioid\u2010related overdose death, among whom 884 (13.3%) were identified as experiencing homelessness at the time of death. The quarterly proportion of opioid\u2010related overdose deaths attributed to people experiencing homelessness increased from 7.2% (26\/359) in July\u2013September 2017 to 16.8% (97\/578) by April\u2013June 2021 (trend test P<\/jats:italic>\u2009<\u20090.01). Compared with housed decedents, those experiencing homelessness were younger (61.3 versus 53.1% aged 25\u201344), had higher prevalence of mental health or substance use disorders (77.1 versus 67.1%) and more often visited hospitals (32.1 versus 24.5%) and emergency departments (82.6 versus 68.5%) in the year prior to death. Fentanyl and its analogues more often directly contributed to death among people experiencing homelessness (94.0 versus 81.4%), as did stimulants (67.4 versus 51.6%); in contrast, methadone was less often present (7.8 versus 12.4%). Individuals experiencing homelessness were more often in the presence of a bystander during the acute toxicity event that led to death (55.8 versus 49.7%); and where another individual was present, more often had a resuscitation attempted (61.7 versus 55.1%) or naloxone administered (41.2 versus 28.9%).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>People experiencing homelessness account for an increasing proportion of fatal opioid\u2010related overdoses in Ontario, Canada, reaching nearly one in six such deaths in 2021.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16357","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T04:01:27Z","timestamp":1697515287000},"page":"334-344","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Opioid\u2010related overdose deaths among people experiencing homelessness, 2017 to 2021: A population\u2010based analysis using coroner and health administrative data from Ontario, Canada"],"prefix":"10.1111","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0300-9954","authenticated-orcid":false,"given":"Richard G.","family":"Booth","sequence":"first","affiliation":[{"name":"Arthur Labatt Family School of Nursing Western University London Canada"},{"name":"ICES (formerly the Institute for Clinical Evaluative Sciences) Ontario Canada"},{"name":"London Health Sciences Centre Lawson Health Research Institute London Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salimah Z.","family":"Shariff","sequence":"additional","affiliation":[{"name":"Arthur Labatt Family School of Nursing Western University London Canada"},{"name":"ICES (formerly the Institute for Clinical Evaluative Sciences) Ontario Canada"},{"name":"London Health Sciences Centre Lawson Health Research Institute London Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke","family":"Carter","sequence":"additional","affiliation":[{"name":"ICES (formerly the Institute for Clinical Evaluative Sciences) Ontario Canada"},{"name":"London Health Sciences Centre Lawson Health Research Institute London Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W.","family":"Hwang","sequence":"additional","affiliation":[{"name":"ICES (formerly the Institute for Clinical Evaluative Sciences) Ontario Canada"},{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute Unity Health Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron M.","family":"Orkin","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute Unity Health Toronto Toronto Canada"},{"name":"Department of Family and Community Medicine University of Toronto Toronto Canada"},{"name":"Dalla Lana School of Public Health University of Toronto Toronto Canada"},{"name":"Department of Emergency Medicine St Joseph\u2019s Health Centre Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Forchuk","sequence":"additional","affiliation":[{"name":"Arthur Labatt Family School of Nursing Western University London Canada"},{"name":"London Health Sciences Centre Lawson Health Research Institute London Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1468-1965","authenticated-orcid":false,"given":"Tara","family":"Gomes","sequence":"additional","affiliation":[{"name":"ICES (formerly the Institute for Clinical Evaluative Sciences) Ontario Canada"},{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute Unity Health Toronto Toronto Canada"},{"name":"Leslie Dan Faculty of Pharmacy University of Toronto Toronto Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k3207"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","unstructured":"Government of Canada.Opioid\u2010 and stimulant\u2010related harms in Canada. 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