{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:28:49Z","timestamp":1786580929213,"version":"build-2736575974"},"reference-count":67,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01DA038886"],"award-info":[{"award-number":["U01DA038886"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01\u2010DA021525"],"award-info":[{"award-number":["U01\u2010DA021525"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT\u2010175162"],"award-info":[{"award-number":["PJT\u2010175162"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT\u2010197892"],"award-info":[{"award-number":["PJT\u2010197892"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["FBC\u2010199491"],"award-info":[{"award-number":["FBC\u2010199491"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PP7\u2010192591"],"award-info":[{"award-number":["PP7\u2010192591"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["EV1\u2010174804"],"award-info":[{"award-number":["EV1\u2010174804"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>In British Columbia, Canada, an initiative was implemented in 2020 to reduce overdose mortality by prescribing pharmaceutical opioids (primarily hydromorphone) as a substitute for the toxic unregulated drug supply. This study estimated changes in the level and trend of unregulated opioid use and non\u2010prescribed hydromorphone use before and after the implementation of prescribed pharmaceutical alternatives (PPA) among a cohort of young people who use drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Longitudinal observational study. Data were drawn from a community\u2010recruited prospective cohort study. We used interrupted time series (ITS) analyses to assess level and trend of self\u2010reported quarterly unregulated opioid and non\u2010prescribed hydromorphone use before, upon and after the implementation of PPA. We used generalized estimating equations (GEE) models to adjust for factors known to influence substance use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Vancouver, British Columbia, Canada, between December 2015 and May 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>644 street\u2010involved young people who use drugs (median age at baseline: 23.4\u2009years; 32.6% women).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>The main outcomes were self\u2010reported any unregulated opioid use and any non\u2010prescribed hydromorphone use in the past six months, obtained through interviewer\u2010administered questionnaires. The primary explanatory variables for the GEE analyses were: time in quarters, interview date after PPA implementation and an interaction term between time and PPA implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>436 (67.7%) participants reported unregulated opioid use, and 124 (19.3%) reported non\u2010prescribed hydromorphone use during the study. In the ITS analysis, unregulated opioid use showed a statistically significant immediate drop following PPA implementation [per\u2010quarter coefficient (PQC): \u22125.30; 95% confidence interval (CI) = \u221210.51 to \u22120.09], with no statistically significant trend observed in the post\u2010PPA period (PQC: 0.06; 95% CI = \u22120.35 to 0.47). For non\u2010prescribed hydromorphone use, a downward trend was observed in the pre\u2010PPA period (PQC: \u22120.46; 95% CI = \u22120.80 to \u22120.12). Following PPA implementation, no level change was observed (PQC: 2.61; 95% CI = \u22122.60 to 7.82), and the pre\u2010existing downward trend was halted (PQC: 0.31; 95% CI = \u22120.10 to 0.72). The GEE analysis confirmed these opposing trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>British Columbia, Canada's 2020 implementation of prescribed pharmaceutical alternatives to reduce opioid overdose mortality was associated with a statistically significant decline in unregulated opioid use and a halt to the pre\u2010existing downward trend in non\u2010prescribed hydromorphone use among a cohort of young people.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70573","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T23:59:02Z","timestamp":1786579142000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prescribed pharmaceutical alternatives initiative coinciding with reductions in unregulated street opioid use among young people who use drugs: An interrupted time series analysis"],"prefix":"10.1111","author":[{"given":"Erica","family":"McAdam","sequence":"first","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver British Columbia Canada"},{"name":"Interdisciplinary Studies Graduate Program University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Karamouzian","sequence":"additional","affiliation":[{"name":"Centre On Drug Policy Evaluation, MAP Centre for Urban Health Solutions St. Michael's Hospital  Toronto Ontario Canada"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael John","family":"Milloy","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver British Columbia Canada"},{"name":"Division of Social Medicine, Department of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Verdicchio","sequence":"additional","affiliation":[{"name":"ARYS Community Research Associates BC Centre on Substance Use  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric C.","family":"Sayre","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3843-2928","authenticated-orcid":false,"given":"Kanna","family":"Hayashi","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver British Columbia Canada"},{"name":"Faculty of Health Sciences Simon Fraser University  Burnaby British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kerr","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver British Columbia Canada"},{"name":"Division of Social Medicine, Department of Medicine University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2045-1653","authenticated-orcid":false,"given":"Kora","family":"DeBeck","sequence":"additional","affiliation":[{"name":"British Columbia Centre on Substance Use  Vancouver British Columbia Canada"},{"name":"School of Public Policy Simon Fraser University  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"AhmadF CisewskiJ RossenL SuttonP.Provisional drug overdose death counts. 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