Rapid Access Addiction Medicine Clinics for People With Problematic Opioid Use.

Importance: New approaches are needed to provide care for individuals with problematic opioid use (POU). Rapid access addiction medicine (RAAM) clinics offer a flexible, low-barrier, rapid access care model for this population.

Objective: To assess the associations of RAAM clinics with emergency department (ED) visits, hospitalizations, and mortality for people with POU.

"Macrodosing" Sublingual Buprenorphine and Extended-release Buprenorphine in a Hospital Setting: 2 Case Reports.

Objectives: To describe 2 case reports in which high-dose administration of sublingual buprenorphine/naloxone quickly stabilized fentanyl users who presented to the hospital. To discuss how early administration of extended-release buprenorphine, before the patient is discharged, may improve retention rates for outpatient buprenorphine treatment.

Methods: Two case reports of fentanyl users presented to the emergency department at the general hospital in Timmins, Canada are described.

Evaluation of the gap in delivery of opioid agonist therapy among individuals with opioid-related health problems: a population-based retrospective cohort study.

Aims: Although opioid-related harms have reached new heights across North America, the size of the gap in opioid agonist therapy (OAT) delivery for opioid-related health problems is unknown in most jurisdictions. This study sought to characterize the gap in OAT treatment using a cascade of care framework, and determine factors associated with engagement and retention in treatment.

Design: A population-based retrospective cohort study.

Facilitating rapid access to addiction treatment: a randomized controlled trial.

Background: Obtaining timely access to addiction medicine treatment for patients with substance use disorders is challenging and patients often have to navigate complex referral pathways. This randomized controlled trial examines the effect of providing an expedited pathway to addiction medicine treatment on initial treatment engagement and health care utilization.

Methods: Individuals with possible alcohol or opioid use disorder were recruited from three residential withdrawal management services (WMS).

Effectiveness of opiate substitution treatment in reducing HIV risk behaviors among African, Caribbean, and Black people: a systematic review.

Objective: The objective of this systematic review is to identify, appraise, and synthesize the best available evidence on the effectiveness of opioid substitution treatment in reducing HIV risk behavior among African, Caribbean, and Black people.

Introduction: Substance use plays an important role in HIV transmission among Black people by increasing risky sexual behavior and the risk of HIV acquisition. Opioid substitution treatment, such as methadone maintenance treatment and buprenorphine therapy, has been found to be an effective measure to minimize HIV transmission attributable to opioid addiction.

Long-term treatment outcomes in a First Nations high school population with opioid use disorder.

Objective: To assess for long-term positive effects of buprenorphine treatment (BT) on opioid use disorder (OUD) at a Nishnawbe Aski Nation high school clinic.

Design: Postgraduation telephone survey of high school students between March 2017 and January 2018.

Setting: Dennis Franklin Cromarty High School in Thunder Bay, Ont.

Individuals' experiences of the integration of substance use/addiction and HIV/AIDS services in community settings: a qualitative systematic review protocol.

Objective: The objectives of this systematic review are: i) to identify, appraise, and synthesize the best available evidence on individuals' experiences of the integration of substance use/addiction and HIV/AIDS services in community settings, and ii) to identify barriers to and facilitators of the integration of the services.

Introduction: The integration of drug use treatment and HIV services has shown to improve HIV prevention, decrease HIV infection and progression, while improving access to social and support services among substance users. Combined pharmacological and behavioral drug use treatments have been proven to diminish behaviors that increase HIV risk, decrease incidence of the disease, and improve adherence to antiretroviral therapy among individuals who use drugs and are HIV-positive.

Effectiveness of opiate substitution treatment in reducing HIV risk behaviors among African, Caribbean and black people: a systematic review protocol.

Objective: This systematic review aims to identify, appraise and synthesize the best available evidence on the effectiveness of methadone maintenance treatment or buprenorphine therapy in reducing sex- and drug-related HIV risk among African, Caribbean and black people.

Introduction: Substance use plays an important role in HIV transmission and acquisition among African, Caribbean and black people by increasing risky sexual behavior and the risk of HIV acquisition. Pharmacological interventions targeting drug use, injection-related risk behaviors and HIV risk behaviors have been found to be effective measures in minimizing HIV transmission attributable to opioid addiction.

Improving opioid guideline adherence: evaluation of a multifaceted, theory-informed pilot intervention for family physicians.

Objectives: Opioid-related deaths continue to increase in North America, an epidemic that was initiated by high rates of opioid prescribing. We designed a multifaceted, theory-informed Opioid Self-Assessment (OSA) package, to increase adherence to the Canadian Opioid Guideline among family physicians. This study aimed to assess changes in Canadian family physicians' knowledge and practices after completing the OSA package.

Opioid agonist therapy during residential treatment of opioid use disorder: Cohort study on access and outcomes.

Objective: To determine access to opioid agonist therapy (OAT) for those entering residential treatment for opioid use disorder; to report on treatment outcomes for those taking OAT and those not taking OAT; and to determine the association between OAT use and residential treatment completion.

Design: Retrospective cohort study.

Setting: Ontario.

Substance use disorders among African, Caribbean and Black (ACB) people in Canada: a scoping review protocol.

Introduction: Previous research demonstrated that substance use continues to be one of the most complex and prevalent problems among African, Caribbean and Black (ACB) people. A number of studies were conducted to characterise substance use patterns in this population. To our knowledge, this is the first known review in Canada characterising substance use disorders on ACB people.

Buprenorphine in the emergency department: Randomized clinical controlled trial of clonidine versus buprenorphine for the treatment of opioid withdrawal.

Objective: To compare buprenorphine to clonidine for the treatment of opioid withdrawal in the emergency department (ED) and to study the effect assigned treatment medication had on longer-term addiction treatment outcomes.

Design: Randomized controlled trial.

Setting: Toronto, Ont.

Quality of primary care among individuals receiving treatment for opioid use disorder.

Objective: To determine if people receiving opioid agonist treatment (OAT), a long-term treatment approach, are also receiving high-quality primary care.

Design: Retrospective cohort study.

Setting: Ontario.

Opioid use in pregnancy and parenting: An Indigenous-based, collaborative framework for Northwestern Ontario.

Opioid use affects up to 30% of pregnancies in Northwestern Ontario. Health care providers in Northwestern Ontario have varying comfort levels providing care to substance-involved pregnant women. Furthermore, health care practitioners, social service agencies and community groups in Northwestern Ontario often work in isolation with little multidisciplinary communication and collaboration.

Patterns of physician prescribing for opioid maintenance treatment in Ontario, Canada in 2014.

Background: Despite concerns surrounding high patient volumes in methadone clinics, little is known about the practice patterns of opioid maintenance therapy (OMT) providers in Ontario. We examined the distribution of these services and how physician characteristics differ based on prescribing volume.

Methods: We conducted a cross-sectional study among prescribers of methadone or buprenorphine to Ontario public drug beneficiaries in 2014 by stratifying physicians into low- (lower 50%), moderate- (51-89%) and high-volume (top 10%) prescribers.

Primary care management of opioid use disorders: Abstinence, methadone, or buprenorphine-naloxone?

Objective: To advise physicians on which treatment options to recommend for specific patient populations: abstinence-based treatment, buprenorphine-naloxone maintenance, or methadone maintenance.

Sources Of Information: PubMed was searched and literature was reviewed on the effectiveness, safety, and side effect profiles of abstinence-based treatment, buprenorphine-naloxone treatment, and methadone treatment. Both observational and interventional studies were included.