INTRODUCTION:Ten years into the most acute phase of the toxic drug crisis in Canada, trends in drug-related deaths remain poorly understood. This is hindered by delayed reporting of drug deaths in some provinces, including Alberta. We used publicly available emergency medical services (EMS) and supervised consumption site (SCS) utilization data to examine their associations with drug poisoning deaths to assess if these measures could serve as reliable proxies for fatalities to support evidence-based public health responses. METHODS:Data on Alberta-wide EMS dispatches for opioid poisoning, Alberta-wide drug deaths, and SCS drug poisoning events at the SCS in Calgary from January 2018 to March 2023 were analyzed. We used linear regression modelling to investigate the association between EMS dispatches and drug deaths (by month) and between SCS drug poisoning events and drug deaths (by month). RESULTS:Significant associations were found between drug-related deaths in Alberta and both the number of EMS dispatches (β = .06, 95% CI: 0.05-0.06) and SCS drug poisoning events (β = .73, 95% CI: 0.57-0.88), suggesting these measures mirror drug-related deaths in the province. Inverse associations were also found between drug-related deaths and SCS visits as well as visits in which drugs were consumed. CONCLUSION:Drug poisoning events recorded in EMS or SCS data may serve as a proxy for understanding trends in drug deaths. These alternative data are often publicly available and may help inform public health response to periods of increased death risk when official death data are delayed or unavailable.

According to McLeroy’s socio-ecological model, inter-organizational collaboration is important in shaping population health. This study aimed to investigate the association between public health unit (PHU) collaboration in secondary schools and student substance use over time. Data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study were used to identify student-level substance use behaviours and school-level PHU engagement. Substance use was measured as self-reported use of alcohol, cannabis, cigarettes, and electronic cigarettes. Multilevel logistic regressions accounted for the hierarchical data structure. This study included 16,575 students attending 68 Canadian schools from 2016/2017 to 2018/2019. Among these schools, 65

IntroductionDix ans après le début de la phase la plus aiguë de la crise d’intoxication aux drogues au Canada, les tendances en matière de décès liés aux drogues demeurent mal comprises. La compréhension est entravée par le retard dans la déclaration des décès liés aux substances dans certaines provinces, dont l’Alberta. Nous avons utilisé des données accessibles au public sur l’utilisation des services médicaux d’urgence (SMU) et des sites de consommation supervisée (SCS) afin d’analyser leur corrélation avec les décès par intoxication aux substances, dans le but d’évaluer si ces mesures pourraient servir d’indicateurs indirects fiables des décès pour appuyer des interventions de santé publique fondées sur des données probantes. MéthodologieDes données sur les interventions des services médicaux d’urgence (SMU) à l’échelle de l’Alberta pour les intoxications aux opioïdes, les décès liés aux drogues à l’échelle provinciale ainsi que les événements d’intoxication aux substances dans un site de consommation supervisée (SCS) à Calgary ont été analysées pour janvier 2018 à mars 2023. Nous avons utilisé une modélisation par régression linéaire afin de mesurer la corrélation entre les interventions des SMU et les décès liés aux drogues (par mois), ainsi qu’entre les événements d’intoxication aux substances dans les SCS et les décès liés aux drogues (par mois). RésultatsDes corrélations significatives ont été observées entre les décès liés aux drogues en Alberta et à la fois le nombre d’interventions des SMU (β = 0,06; IC à 95 % : 0,05 à 0,06) et les événements d’intoxication aux substances dans les SCS (β = 0,73; IC à 95 % : 0,57 à 0,88), ce qui laisse penser que ces mesures offrent un reflet des décès liés aux drogues dans la province. Des corrélations inverses ont également été observées entre d’une part les décès liés aux drogues et d’autre part les visites aux SCS et les visites au cours desquelles des drogues ont été consommées. ConclusionLes événements d’intoxication aux drogues consignés dans les données des SMU ou des SCS peuvent servir d’indicateurs indirects pour comprendre les tendances des décès liés aux drogues. Ces sources de données alternatives sont souvent accessibles au public et peuvent contribuer à orienter les interventions de santé publique lors de périodes de risque accru de décès, lorsque les données officielles sur les décès sont retardées ou ne sont pas disponibles.

BACKGROUND:Recent North American trends point towards increased smoking of unregulated drugs and decreased injecting. While supervised consumption sites (SCS) offer a monitored environment for people who use drugs (PWUD), these sites have been less likely to accommodate inhalation in Canada. The objective of this study was to determine the factors associated with willingness to use supervised inhalation sites. METHODS:We performed a cross-sectional survey of 499 PWUD in Edmonton, Canada. We used descriptive statistics to characterize willingness to use a supervised inhalation site and logistic regression to examine factors associated with willingness. RESULTS:Of 467 participants who reported smoking their drugs, the mean age was 43.7 years with 303 (64.9%) identifying as men and 320 (68.5%) identifying as Indigenous. A large proportion (64.9%, n = 303) of participants who smoked their drugs indicated a willingness to use a supervised inhalation site. While having overdosed by accident in the last 6 months (aOR = 2.70, 95% CI: 1.31-5.81) and having borrowed, lent or shared a pipe in the last 6 months (aOR = 2.22, 95% CI: 1.01-4.88) were both positively associated with willingness to use a supervised inhalation site, participants who stated that stimulants were the drugs smoked most frequently in the past 6 months (aOR = 0.43, 95% CI: 0.20-0.88) and those who reported always smoking in public places (aOR = 0.53, 95% CI: 0.28-0.97) were less likely to report willingness to use a supervised inhalation site. CONCLUSIONS:Our results outline significant interest among PWUD in supervised inhalation sites and suggest that individuals who have recently borrowed or shared a pipe or recently experienced an overdose would be more likely to use these sites. Implementation of these sites must include decolonizing approaches that create a welcoming space for Indigenous people.

Advocates of a public health approach to psychoactive substances need actionable evidence. In several countries, multidisciplinary groups have used multi-criteria decision analysis (MCDA) to generate harm scores and rankings for commonly used psychoactive substances; however, these did not fully reflect substances’ prevalence of use. Public health policy decisions around psychoactive substances should be informed by population-level outcomes, which are driven by use prevalence. Led by a policy practitioner, a multidisciplinary group from across Canada conducted a MCDA of harms caused by 16 commonly used psychoactive substances. To make the analysis more relevant to public health policy, we adapted it to account for not only the severity of harms associated with a substance, but also prevalence of use. This adaptation was applied across harm criteria. Adapting MCDA this way allowed for the generation of harm scores that represent total population-level harm caused by each substance rather than individual-level harm. As a result, they provide clear evidence of the relative population-level harm caused by different substances. This evidence can inform prioritization of public health efforts and be used by policy practitioners advocating for a public health approach to substances. Adapting MCDA to reflect population-level outcomes is a practical innovation for public health policy and practice. Prevalence-adjusted MCDA produces evidence that is well aligned with how public health policy decisions are made and evaluated, and may be applicable to other public health issues characterized by multiple data sources and competing policy objectives.

Objectives The roles of pharmacy staff have expanded to include public health functions, such as delivering harm reduction services for people who use drugs (PWUD), particularly unregulated substances and non-medical drug use, in response to an ongoing drug overdose crisis. Nonetheless, their involvement across the full spectrum of harm reduction services remains underexplored. This study mapped existing research describing or evaluating the implementation of harm reduction services for PWUD provided by pharmacy staff.Design Scoping review.Data sources MEDLINE, EMBASE, CINAHL, Web of Science, Scopus and Cochrane Library (inception to July 2025).Study selection Studies reporting on the description or evaluation of harm reduction services for PWUD provided by pharmacy staff.Data extraction Two team members screened studies for eligibility and extracted the data. The data were analysed primarily to describe harm reduction services and the role of pharmacy staff.Results 43 articles were included. The most frequently reported harm reduction services were sexually transmitted and blood-borne infection care (33%), needle and syringe programmes (21%), naloxone distribution (19%) and medication treatment for opioid use disorder (19%). Pharmacy staff were integrated into multidisciplinary teams (79%), with their roles varying from education to medication prescribing. Included studies reported harm reduction services for PWUD delivered by pharmacy staff as effective, feasible and safe. However, implementations were not tailored to equity-deserving populations. Services primarily addressed opioid-related harms, while strategies focusing on the use of non-opioid substances were limited.Conclusion This scoping review highlights the diverse roles pharmacy staff play in delivering harm reduction services for PWUD. Positioned at the intersection of accessibility and healthcare delivery, pharmacy staff are ideally situated to expand access to equitable care. To fully harness this potential, future research and practice should embed harm reduction as a core philosophy, extending beyond individual interventions to support the creation of person-centred, non-judgmental and low-barrier services.

BACKGROUND:The unregulated toxic drug supply has had a disproportionate impact on rural communities across Canada, yet most health and social interventions target urban settings. Drawing on the Care Collective's (2020) work on universal care, families often provide care within the larger context of "careless" communities and governments that prioritize economic productivity over relational wellbeing. Although there is a growing body of research on care and caregiving experiences, little is known about the experiences of family caregivers of people who use drugs (PWUD) in rural settings. METHODS:Using a community-engaged qualitative research design, we conducted semi-structured one-on-one interviews with 31 family members caregiving for a person who uses drugs in rural Prairie communities across Canada. Data were analyzed using reflexive thematic analysis to generate themes. RESULTS:Families of PWUD in rural settings provide robust care as a result of the increasing "carelessness" of communities and governments. Neoliberal policy decisions on public service funding and delivery, combined with systemic stigma and racism, create conditions that shift care responsibilities to families. Caregiving for family and, at times, the wider community can result in significant personal impacts. Despite this, caregivers are vocal about the need for structural reforms to foster communities and governments that are more "caring" for PWUD. CONCLUSIONS:The unregulated toxic drug supply has deeply impacted rural communities, placing the burden of care on families. An urgent comprehensive response to the crisis is needed; one that includes rural communities and families. This response should focus on structural changes that reduce sole reliance on family care, enhance resources and infrastructure for community care, adequately addresses families' grief and trauma, and ultimately place care as a central organizing principle in society.

Background: Multi-criteria decision analysis (MCDA) has been used to quantify drug harms in the United Kingdom, the European Union, Australia, and New Zealand. This paper presents the result of an MCDA conducted in Canada, with the aim of informing Canadian drug policy and contributing to public understanding of drugs' relative harms.Methods: A panel composed of 20 experts from six provinces determined 16 drugs to evaluate on 16 dimensions of harm (ten representing harm to people who use the drug; six representing harm to others). At a two-day decision conference, the panel scored each drug on a scale of 0-100 for each harm criterion, then weighted the relative importance of each criterion.Results: This analysis of drug harms in Canada found that alcohol causes the most harm overall, with a cumulative weighted score of 79. It was followed by tobacco (45), nonprescription opioids (33), cocaine (19), methamphetamine (19), and cannabis (15). The finding that alcohol causes the most harm is consistent with the results of previous MCDA drug harm studies.Conclusion: These harm scores express population-level harm rather than individual-level "harmfulness." They reflect not only a drug's pharmacological risk profile but also the current policy context in Canada. The high score for alcohol underscores a failure to adopt policies to address alcohol-related harms, despite the known health harms and the existence of proven policy measures. More broadly, when developing drug policies, governments should consider the harm-both individual and societal-caused by drugs and by the laws and regulations that govern them.

BACKGROUND AND AIMS:Canada's drug toxicity crisis has been largely attributed to a volatile fentanyl-dominated unregulated drug supply with increasing reports of fentanyl detected in combination with benzodiazepines, stimulants and xylazine. Although rates of opioid-related harms vary significantly by region, it remains unknown how the composition of the unregulated drug supply differs across Canada. Therefore, we sought to describe trends in Canadian fentanyl-containing drug seizures nationally and compare trends by province/territory. DESIGN:Repeated cross-sectional analysis between February 2020 and December 2024. SETTING AND CASES:Fentanyl-containing drug samples seized by law enforcement agencies across Canada were analyzed by Health Canada's Drug Analysis Service, with test results made publicly available. MEASUREMENTS:Counts and crude rates of fentanyl-containing drug seizures, with the population of each province/territory used to calculate rates per 100 000. We described the number of notable drug classes (e.g. benzodiazepines, stimulants, non-fentanyl opioids, etc.) and chemical substances identified within each drug seizure and used the Cochrane Armitage Test for Trend to look for significant changes over time. All analyses were conducted overall and stratified by province/territory. FINDINGS:We identified 71 996 fentanyl-containing drug seizures over the study period, with the quarterly number of seizures increasing by 24.4% (from 2640 in 2020 to 3284 in 2024) across Canada. This varied by province/territory, with the highest annual rates of fentanyl-containing seizures in 2024 reported in British Columbia (60.4 per 100 000) and Alberta (52.3 per 100 000). Among fentanyl types, we observed statistically significant increases (P < 0.001) in the detection of para-flurofentanyl (0.0% to 46.3%) and methylfentanyl (0.0% to 28.6%). Additionally, there was a notable rise in the annual proportion of seizures in which benzodiazepines (13.4% to 40.2%) or xylazine (1.5% to 18.9%) were detected. Approximately half of all seizures contained fentanyl in combination with at least one other drug class and over 95% contained fentanyl in combination with at least one other chemical substance. CONCLUSIONS:Across Canada from 2020 to 2024, there has been a 24% increase in fentanyl-containing drug seizures in which multiple substances are detected, most notably benzodiazepines, xylazine and potent fentanyl analogues within a single sample.

Objectives Frostbite is a common reason for emergency department (ED) presentations in Canada. Iloprost, a prostacyclin analogue, has been investigated to reduce the risk of amputation with its use expanding. Two Canadian cities implemented iloprost over different times leading to a practice variation that allowed for treatment comparison. Our objective is to evaluate the effectiveness of iloprost compared with non-iloprost treatment. Secondary objectives include assessing the impact of iloprost dosage and homelessness.Methods A retrospective cohort study was conducted on adult severe frostbite cases presenting to EDs in Calgary and Edmonton between November 2021 and April 2024. Data were abstracted from clinical databases and analysed for demographic and injury characteristics, treatment and amputation outcomes.Results Of 1812 total ED encounters for frostbite, 257 patients with grades 2–4 extremity frostbite were included for analysis. Logistic regression found that overall patients receiving iloprost were associated with reduced likelihood of any amputation (OR=0.49, 95% CI 0.25 to 0.96) and fewer digit amputations (p<0.001). In particular, iloprost use was associated with reduced amputation rates in grade 3 injuries compared with non-iloprost care (30% vs 52%, p=0.042). Although over 80% of patients with grade 4 frostbite required amputations regardless of iloprost treatment, its use was associated with improved digit salvage, with 10% fewer digit segments requiring amputation in treated patients in both hands (p=0.049) and feet (p=0.003). When assessing 65 patients who received iloprost for limb frostbite, higher iloprost doses were associated with a lower likelihood of amputation (OR=0.35; 95% CI 0.13 to 0.91; p=0.03). In the patient subgroup who underwent at least one amputation, total iloprost dosage was inversely related to outcome (p=0.033, βST=−0.26). Adverse events were reported in 61% of iloprost-treated patients, with headache being the most common. Homelessness was found to be a significant predictor of delays in arrival to the ED after injury (p<0.001); OR=2.90 (95% CI 1.73 to 4.91).Conclusions Iloprost infusion was associated with a reduction in amputation rates in grade 3 and 4 frostbite with the greatest association seen in grade 3 cases. Greater iloprost dosage was associated with improved digit salvage. Homelessness was associated with delayed ED presentation.

Public drug use in urban central business districts (CBDs) presents an urgent public health challenge in Canada. People who use drugs (PWUD) in CBDs navigate intersecting risks related to criminalization, stigma, hostile architecture, urban redevelopment, and limited access to essential services—factors that compound health disparities and increase morbidity and mortality. Yet CBDs also function as sites of informal social networks, mutual aid, and adaptive survival strategies that, while precarious, constitute critical resources for daily safety and belonging. This focused ethnographic study, conducted in Edmonton’s CBD between July 2022 and September 2023, draws on 25 semi-structured interviews and over 170 h of embedded field immersion to investigate how intersecting environmental forces shape the daily lives of PWUD. Using Collins et al.’s (2019) intersectional risk environment framework and Duff’s (2009) enabling environment concept, we analyzed how physical, social, economic, and policy environments—operating across micro and macro levels—produce differential harms and, simultaneously, generate precarious yet meaningful sites of connection, resourcefulness, and collective care. Findings reveal how displacement, over-policing, and gentrification-driven spatial change coexist with participants’ place-based belonging, moral economies of reciprocity, and culturally grounded survival knowledge. We argue that effective interventions must account for this co-production of risk and enabling conditions and that urban governance must center the voices of those most structurally affected.

Collaborating with people who use or used drugs (PWUD) in research and policy fora and incorporating their perspectives in decision-making processes is a crucial step towards mitigating drug policy-related harm. PWUD are experts in drug use and equipped to share their experiences and knowledge and impact drug policy change. However, equitable inclusion of PWUD in conferences and other fora is typically inadequate. PWUD were central participants in the planning and implementation of the Stimulus 2018: Drugs, Policy, and Practice conference. Conference planners made considerable effort to ensure PWUD attendees had their physical and emotional needs met, including access to overdose prevention services. However, guidance is needed to better safeguard the physical and mental health of conference attendees who use drugs. This Research & Practice Note aims to initiate discussion on this underexplored topic and provide ideas for the safer inclusion of PWUD within research and policy fora.

Psychoactive substance use represents a significant global public health challenge, leading to diverse health, social, and environmental harms. Traditional punitive and commercial approaches have faced criticism for potentially worsening these harms and overlooking potential benefits. Consequently, there is an increasing global call for a comprehensive public health approach to address psychoactive substances, focusing on both supply and demand reduction. However, the core components of a public health approach remain unclear. We aimed to conceptualize a public health approach to psychoactive substances and describe its core values, goals, and activities. We used a two-step process to develop a coherent and comprehensive conceptual framework. First we conducted a scoping review of academic and practice literature on a public health approach to psychoactive substances published between 1950 and 2023 (n = 230 English language records). We then conducted an iterative team-based synthesis of the review findings and expert public health knowledge to address gaps in extant literature using a structured conceptual framework development approach. This conceptual framework includes core values (i.e. social justice, health equity, evidence-informed), activities (i.e. legal and regulatory action, supports and services, prevention and education, advocacy, and research, monitoring, and evaluation), and goals (e.g. improving population health; addressing determinants of substance use, substance harms and substance policy related harms; countering carceral logics) that are central to a public health approach to psychoactive substances. Our coherent and comprehensive framework incorporates international literature and is informed by contemporary values and goals with the aim of promoting a consensus understanding of this critical practice area. This framework can guide efforts to design, implement, and evaluate public health interventions that maximize benefits and mitigate harm associated with psychoactive substances.

The COVID-19 pandemic and Canada’s drug poisoning crisis placed exceptional demands on emergency departments (ED). We aimed to explore the impact of these intersecting crises from the perspectives of ED staff to understand how EDs can improve care and protect the health and well-being of patients who use opioids, ED staff, and healthcare providers. We conducted a focused ethnographic study involving 29 semi-structured interviews with ED staff who cared for patients who use opioids during the pandemic. Interviews explored ED staff perspectives on how the pandemic impacted care for patients who use opioids and how EDs can better serve this population. We conducted latent content analysis and main theme generation was informed by the socioecological model. Four main themes emerged. First, there was a change in patient behaviors, which impacted provider–patient relationships. Second, hospital pandemic policies and resource limitations created new barriers to care. Third, community service alterations, including the shift to virtual care and uncertain availability of services, further complicated patient care. Finally, participants highlighted opportunities to strengthen systems of care, including enhanced hospital addiction resources, improved addiction care training, expanded harm reduction services, and more robust community services. The COVID-19 pandemic highlighted significant changes in ED care delivery for patients who use opioids. Efforts to enhance EDs should include anticipating the needs of people who use substances and the healthcare providers who care for them to mitigate unintended harm and ensure a more resilient healthcare system.

Background: Edmonton and Calgary are Albertan cities with populations of over 1 million each and experience cold winter temperatures, making frostbite a common emergency departments (ED) presentation. In 2024 the estimated unhoused population was approximately 7000 across both cities. Our primary objective was to assess the frequency and severity of frostbite injuries in individuals experiencing houselessness (IEH) compared to those with housing. Methods: This retrospective study of administrative data assessed patients treated in Edmonton and Calgary with severe frostbite over three winters. Data abstracted include patient characteristics, frostbite grade, and time between injury and ED presentation. Ambient temperatures at injury time were assessed from the Alberta Climate Information Service. IEH was determined via clinician notes. Descriptive analysis and statistical methods were used to compare housing status and the grade of injury and arrival time to the ED. The relationship between homelessness and time of injury to arrival at the hospital was examined using ordinal logistic regression. The dependent variable, Time of Injury to Arrival, was categorized as: <12 hours, 12 to 24 hours, 24 to 48 hours, 48 to 72 hours, and >72 hours. Results: 257 cases of severe frostbite were abstracted. Mean age 42.5 (SD13.7), Sex male 208/257(80.9%). IEH comprised 140/257 (54.5%) of cases and unknown in 40/257(15.6%). Houselessness was a precipitating frostbite factor in 102/257(39.7%). IEH was not found to be a statistically significant predictor of frostbite grade (p = .109); OR = 1.55 (95% CI = 0.910 - 2.67). IEH experienced delays in arrival to the ED (p < .001, OR = 2.90, 95% CI = 1.73 - 4.91). IEH were nearly three times as likely to fall into a higher delay category of arrival time compared to non-IEH. Additionally, among the IEH population in this study, 43.48% of Grade 4, 25.86% of Grade 3, and 34.48% of Grade 2 cases occurred at temperatures warmer than -20 degrees Celsius. Implication and lessons learned: Individuals experiencing houselessness had a threefold increase in the likelihood of delayed frostbite ED presentation. Additionally, a significant proportion of frostbite injuries occurred at temperatures warmer than -20C. This study suggests a need for current cold weather system responses to reexamine opportunities for prevention, proactive care, and the availability of shelter for IEH at temperatures warmer than -20C, which is warmer than many cities cold weather responses.

BACKGROUND:On January 31, 2023, Health Canada approved a three-year pilot decriminalization initiative allowing adults in British Columbia (BC), Canada, to legally possess a cumulative 2.5 g of opioids, cocaine, methamphetamine, or MDMA. The policy aims to reduce the harms associated with drug use, including stigma, which contributes to barriers for people who use drugs in accessing harm reduction and treatment services. Addressing stigma is considered a crucial step in mitigating BC's overdose crisis, by encouraging people who use drugs to feel more comfortable to access and utilize services without fear of judgment. This study examined the impacts of the decriminalization policy on stigma among people who use drugs within the first year of implementation. METHODS:From October 2023 to February 2024, 100 semi-structured telephone interviews and brief socio-demographic surveys with people who use drugs from across BC were conducted to explore their experiences of stigmatization post-decriminalization. A qualitative thematic analysis was used to synthesize the data. RESULTS:Findings revealed that societal, structural and self-stigma remain pervasive among people who use drugs post-decriminalization. While most participants reported little change in their experiences of stigma since the policy's implementation, some reported an increase, while others observed a decrease across all forms of stigma. Increased stigma was attributed to perceived heightened visibility of public drug use, which amplified societal stigma. Conversely, decreased stigma was linked to shifting public perceptions of drug use as a public health issue and more humanized interactions with the police. Despite mixed experiences, participants remained optimistic that the policy could contribute to long-term stigma reduction and offered recommendations to support this goal. CONCLUSION:While decriminalization has the potential to reduce stigma and increase comfort in accessing critical harm reduction and substance use treatment services among people who use drugs, achieving these outcomes requires additional efforts. Public awareness campaigns, targeted anti-stigma education, and broader systemic changes were suggested by participants as essential to address stigmatization in BC. Strengthening these areas could enhance access to and utilization of services, ultimately supporting the broader goals of decriminalization.

INTRODUCTION:Emergency departments (EDs) are important health care access points for people who use drugs (PWUD), but little is known about whether the onset of the COVID-19 pandemic was associated with changes in opioid-related emergency presentations. We investigated whether (1) the onset of the COVID-19 pandemic was associated with any change in average rates of opioid-related ED visits in Alberta; and (2) this varied across regions with different COVID-19 case rates. METHODS:We conducted maximum-likelihood interrupted time series analyses to compare opioid-related ED visits during the "prepandemic period" (3 March 2019-1 March 2020) and the "pandemic period" (2 March 2020-14 March 2021). RESULTS:There were 8883 and 11 657 opioid-related ED visits during the prepandemic and pandemic periods, respectively. The onset of the COVID-19 pandemic was associated with an increase in opioid-related ED visits (Edmonton: IRR = 1.37, 95% CI: 1.30- 1.44, p < 0.05; Calgary: IRR = 1.14, 95% CI: 1.07-1.20, p < 0.05; Other health zones: IRR = 1.14, 95% CI: 1.07-1.21, p < 0.05). Changing COVID-19 case counts did not correspond with changing rates of opioid-related ED visits across regions. CONCLUSION:The increase in opioid-related ED visits associated with the onset of the COVID-19 pandemic was unrelated to COVID-19 case prevalence in Alberta.

BACKGROUND:A polycrisis of rising drug toxicity, pervasive houselessness, pandemic-related disruptions, coloniality and climate disasters is creating and exacerbating health inequities for People Who Use/Have Used Drugs (PWUD). This confluence of intersecting health, socio-political and environmental issues highlights the need for community-driven and adaptive innovation to address inequities in complex systems of care. To inform service innovations in an inner city social service hub in Edmonton, Alberta, we co-created a process that centres PWUD in health service planning and prioritization. METHODS:Using a community-based participatory research methodology informed by complexity theory, we conducted research with PWUD using SenseMaker micro-narratives and optional arts-based asset-mapping. Academic and peer researchers co-developed the study with input from the PWUD community and collected data at social service hubs and on outreach in the community. An iterative four-phase approach to research design, data collection and analysis guided the study: (i) Pre-data collection, (ii) Formal data collection, (iii) Readjusting, and (iv) Accountability. RESULTS:This methodology paper describes how our four-phase framework guided the study and promoted a dynamic and accountable approach to centering PWUD in health system innovation. Over five months, 215 PWUD participants shared narratives and rich insights into their experiences with healthcare access, harm reduction, and community support. Our results emphasise the importance of taking time to orient to each other and the community, even as a diverse team with many preexisting relationships. An iterative data analysis process allowed for adjustments in real-time to guide research focus, ensuring equity-oriented engagement with structurally vulnerable groups. Accountability began with research design, was maintained throughout data collection by creating safety for participants, and then defined the final phase of the research where we created an accessible final report and are now working with the host nonprofit partner and community members on action-oriented responses to the narratives shared. CONCLUSIONS:Meaningful engagement with PWUD in co-creating health system innovation requires relational and adaptive methodologies. The process-focused results of this study demonstrate how community-based participatory research informed by complexity theory can enable accountable healthcare innovation amidst a changing social and political landscape. We conclude with a set of recommendations for co-creation and other peer-centred approaches that prioritize PWUD voices in developing effective health services.

IntroductionLes services d’urgence sont des points d’accès important aux soins de santé pour les personnes qui consomment des drogues, mais on ne sait pas véritablement si le début de la pandémie de COVID-19 a été associé à des changements dans les visites à l’urgence liées aux opioïdes. Nous avons cherché à savoir si 1) le début de la pandémie de COVID-19 a été associé à un changement quelconque des taux moyens de visites à l’urgence liées aux opioïdes en Alberta et 2) si ces taux moyens variaient selon les zones présentant des taux de cas de COVID-19 différents. MéthodologieNous avons mené des analyses de séries temporelles interrompues par maximum de vraisemblance afin de comparer les visites à l’urgence liées aux opioïdes pendant la « période prépandémique » (du 3 mars 2019 au 1er mars 2020) et pendant la « période pandémique » (du 2 mars 2020 au 14 mars 2021). RésultatsIl y a eu 8 883 visites à l’urgence liées aux opioïdes durant la période prépandémique et 11 657 durant la période pandémique. Le début de la pandémie de COVID-19 a été associé à une augmentation du nombre de visites à l’urgence liées aux opioïdes (Edmonton : rapport des taux d’incidence [RTI] = 1,37, intervalle de confiance [IC] à 95 % : 1,30 à 1,44, p $lt; 0,05; Calgary : RTI = 1,14, IC à 95 % : 1,07 à 1,20, p $lt; 0,05; autres zones sanitaires : RTI = 1,14, IC à 95 % : 1,07 à 1,21, p $lt; 0,05). L’évolution du nombre de cas COVID-19 n’offre pas de correspondance en fonction des zones avec les variations dans les taux de visites à l’urgence liées aux opioïdes. ConclusionIl n’y a aucune association entre l’augmentation du nombre de visites à l’urgence liées aux opioïdes ayant eu lieu au début de la pandémie de COVID-19 et la prévalence des cas de COVID-19 en Alberta.