Leaving the emergency department before treatment completion among people with and without HIV with a suspected overdose in British Columbia, Canada

Bibliographic Data

ID19439383
AuthorsKatherine W Kooij (0000-0001-9530-5728, Simon Fraser University, corresponding author), Rory Trevorrow (University of British Columbia), Rory M Trevorrow (University of British Columbia), Miriam Muirhead (Simon Fraser University), Erin Ding (AIDS Vancouver), Cassidy Tam (AIDS Vancouver), Megan E Marziali (0000-0002-8845-663X, Simon Fraser University), Michael Budu (0000-0003-4453-6256, AIDS Vancouver), Michael O Budu (BC Centre for Excellence in HIV/AIDS), Nance E Cunningham (BC Centre for Excellence in HIV/AIDS), Nance Cunningham (0000-0003-0660-5927, University of British Columbia), Claudette Cardinal (0000-0003-3303-7726, AIDS Vancouver), Scott D Emerson (0000-0001-8055-3542, AIDS Vancouver), Kate A Salters (University of British Columbia), Julio S G Montaner (BC Centre for Excellence in HIV/AIDS), Robert S Hogg (0000-0003-3463-5488, Simon Fraser University)
Year2026
Volume38
Issue4
Pages752-764
Publication date2026-04-03
Open AccessNo
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2025.2611068
PMID41532772
OpenAlexW7124134941
LanguageEN
References cited35

Leaving the emergency department (ED) before treatment completion (LBTC) - either without being seen by a physician or against medical advice - is common in substance use-related presentations and associated with adverse outcomes. We assessed determinants and outcomes of LBTC among people with and without HIV (PWH, PWoH) attending an ED with a suspected overdose between 2012-2020 in British Columbia, Canada, using linked administrative data. We identified suspected overdose events presenting to the ED and classified LBTC using diagnosis codes and/or discharge disposition. Using multivariable regression, we assessed (1) whether HIV was associated with LBTC, (2) determinants of LBTC stratified by HIV-status, and (3) whether LBTC was associated with risk of another overdose-related ED attendance, primary care contact, and OAT dispensation within 30 days. Although LBTC was more common among PWH attending the ED with a suspected overdose (13.9% of 632 presentations) than among PWoH (9.0% of 3,057 presentations), HIV was not independently associated with higher LBTC risk. Determinants of LBTC among PWH were age 19-38, lower triage acuity, ED attendance from 04/2016-03/2020, and opioid agonist therapy in the prior five years. Of note, LBTC was independently associated with increased risk for another overdose-related ED attendance within 30 days (adjusted risk ratio: 1.46; 95%CI: 1.06, 2.01)

Attendance · Emergency department · Human immunodeficiency virus (HIV) · Medical prescription · Opioid overdose · Primary care · Triage · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Opioid Use Disorder Treatment

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