Kristi Papamihali's research while affiliated with BC Centre for Disease Control and other places

... Furthermore, studies have suggested that the concurrent use of opioids and stimulants is common among people who access harm reduction sites in BC [10]. Motivations for co-use have been described in a variety of studies, and have ranged from social influences, to seeking to reduce opioid withdrawal, to imrpvoing functionality, energy, or wakefulness [11][12][13]. One study has also revealed a dangerous misperception among people who co-use opioids and stimulants, that stimulants can have a protective against opioid overdose [14]. ...

... Compared to heroin, fentanyl is more potent, rapid acting, and shorter lasting [4]. Although studies across Canada and the US suggest that the majority of people who use drugs (PWUD) were unknowingly exposed to fentanyl through adulteration of street drugs in the past few years, recent evidence shows that more people are now using it knowingly and preferentially [5][6][7][8]. PWUD who intentionally seek out fentanyl report its strength as a primary motivator, and fentanyl preference has been associated with frequency of opioid use and overdose history [6,7]. ...

... The confidence peers had was based on several factors: their experience in responding to overdoses, their compassionate and trauma-informed approach, and the timely response they provided given that they were often physically and/or socially proximal to overdoses. Research consistently shows that peers are willing and able to take action in the event of witnessing opioid overdoses (Bardwell, Anderson, et al., 2018;Faulkner-Gurstein, 2017;Kennedy et al., 2019;McAuley et al., 2018;Wagner et al., 2019;Wallace et al., 2019), and that bystander-administered naloxone is safe and effective for opioid overdose reversal (Moustaqim- Barrette, Papamihali, et al., 2021). Naloxone distribution data indicate that over 90% of kits reported used each year between 2017 and 2020, were by individuals likely to experience an overdose (i.e. ...

... It is possible that they have preferences for treatment, (e.g. different medications or routes of administration such as injecting or smoking) [64] that are not currently available. As such, future research must focus on examining the service preferences of people with OUD who have concurrent StUD and mental illness. ...

... Studies comparing overdose mortality across multiple states have had mixed results, where only one of three shows a significant reduction in fatal overdoses in regions where a drug related Good Samaritan law has been enacted [32][33][34]. Among PWUD and police officers in BC, there is moderate awareness of the GSDOA; however, accurate understanding of the Act is low [30,31,35]. Even among persons who are aware of their local drug related Good Samaritan law, attitudes and perceptions of its effectiveness are not always positive [19]. ...

... Large-scale, coordinated, multidisciplinary collaborations (and more innovative technologies for early detection, monitoring, evaluating, and responding to emerging market trends) have been increasingly recognised as a necessary public health response to the dynamic nature of unregulated drug markets [44][45][46][47]. Rapid detection and early reporting of unexpected deviations in dynamically changing markets can proactively inform policy, policing, health, prevention, education, and harm reduction responses [17,19,48,49]. ...

... Respondents who were previously aware of the GSDOA had a higher likelihood of intention to call 9-1-1 at future overdose events. Past research has provided evidence for an association between awareness of the GSDOA and intent to call 9-1-1 [28,67,[93][94][95]. Since all respondents were educated about the GSDOA, our finding suggests that reinforcing education of the Act can increase intention to call 9-1-1. ...

... 5 More recently, among British Columbians who attended harm reduction services between 2018 and 2019 (excluding for tobacco), crystal methamphetamine was reportedly the most commonly used drug in the previous 3 days (up to 71.7% of attendees) and was frequently paired with opioid use. 9 In 2019, 3.2 users per 1000 across Canada used methamphetamines. 10 In Canada, between 2014 and 2021, there was a coinciding increase in hospitalizations for amphetamine-related psychotic disorders. ...

... These themes align with studies conducted in British Columbia that have reported that common factors associated with using alone include having no one to use with or no other choice; comfort and convenience; safety; material or resource constraints; lack of secure housing; and experiencing stigma or not wanting others to know about drug use. [29][30][31] However, most studies on this topic have focussed on people who access harm reduction or supervised injection services and may not generalize to people who are not connected with these services and who may be more likely to use alone. ...

... We estimated that pharmacies are less effective than OEND programs at increasing naloxone availability among people at risk for opioid overdose, based on British Columbia's Take-Home Naloxone program data. 28 The naloxone availability algorithm assigned the new naloxone kits distributed to become available each month and withdrew 6.5% (1 per 15.5 months) of existing naloxone kits from circulation each month owing to expiration or loss, based on an analysis of the New York City Department of Health and Mental Hygiene data (Andrew Trinidad, MPH, email, February 9, 2021). ...