Fentanyl, carfentanil and other fentanyl analogues in Canada's illicit opioid supply: A cross-sectional study.

Background: Despite the increase in fentanyl-involved overdose deaths in Canada, there have been no national-level studies evaluating the proportion of illicit opioids containing fentanyl or fentanyl analogues in Canada.

Methods: This cross-sectional exploratory study characterized trends in fentanyl, carfentanil and other fentanyl analogues within opioids seized by law enforcement agencies in Canada from 2012 to 2022 and submitted to the Health Canada Drug Analysis Service (DAS). Analyses were stratified by province/region.

High-Dose Buprenorphine Initiation: A Scoping Review.

Objective: The aim of the study is to review and synthesize the literature on high-dose buprenorphine initiation (>12-mg total dose on day of initiation).

Methods: A scoping review of literature about high-dose buprenorphine initiation was conducted. MEDLINE, Embase, PsycINFO, and Cochrane Central were searched.

Rethinking Substance Use as Social History: Charting a Way Forward.

Physicians have traditionally asked about substance use within the Social History section of the consultation note. Drawing on social science theory and using the authors' own experiences as generalists and addiction scholars, we consider the possible unintended harms associated with this approach. The inclusion of the substance use history within the Social History reproduces the discourse of substance use disorders as "life-style choices" rather than medical conditions, and reinforces stigma among healthcare workers through the attribution of personal responsibility for complications associated with problematic substance use.

Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: A population-based cohort study in Ontario, Canada.

Background: Uptake and retention for opioid agonist treatment (OAT) remains low. Novel extended-release formulations may improve OAT accessibility by reducing the frequency of healthcare visits. Our aim was to examine uptake, characteristics, treatment patterns and retention of individuals initiating extended-release subcutaneous buprenorphine (BUP-ER), a monthly injectable OAT.

Assessing the impact of the slow-release oral morphine drug shortages in Ontario, Canada: A population-based time series analysis.

Background: Slow-release oral morphine (SROM) is used to manage pain, and as opioid agonist treatment (OAT). Between 2017 and 2021 in Canada, several drug shortages occurred for Kadian© (SROM-24). The purpose of this study was to evaluate the impact of these shortages on people's ability to remain on this medication.

Methadone-involved overdose deaths in the United States before and during the COVID-19 pandemic.

Background: Few studies have characterized methadone-involved overdose deaths in the US since 2014 despite changing patterns of opioid use, the onset of the COVID-19 pandemic, and changes to take-home dose guidance in opioid treatment programs (OTPs) in March 2020.

Methods: Data on monthly overdose deaths in the US from January 1, 2007 to March 31, 2021 were obtained through CDC WONDER. Interrupted time series models were used to assess for changes in series levels starting in April 2020.

Taking an Evidence-Based Approach to Involuntary Psychiatric Hospitalization.

The field of psychiatry has placed a growing emphasis on research-based diagnostic and treatment practices related to mental illness. Involuntary hospitalization is a controversial and potentially lifesaving intervention in psychiatric care; yet, to what degree is this practice evidence based? This Open Forum examines the ethical and logistical limitations to traditional research, such as randomized controlled trials and observational studies, surrounding involuntary psychiatric hospitalization. Given recent efforts across the United States to expand the use of involuntary hospitalization, the authors call for systematic data collection to monitor, study, and guide the use of this intervention.

Benzodiazepine-Involved Overdose Deaths in the USA: 2000-2019.

Background: Despite the focus on overdose deaths co-involving opioids and benzodiazepines, little is known about the epidemiologic characteristics of benzodiazepine-involved overdose deaths in the USA.

Objective: To characterize co-involved substances, intentionality, and demographics of benzodiazepine-involved overdose deaths in the USA from 2000 to 2019.

Design: Cross-sectional study using national mortality records from the National Vital Statistics System.

Office-based Methadone Prescribing for Opioid Use Disorder: The Canadian Model.

In the context of the US overdose crisis, improving access to medications for opioid use disorder is urgently needed. The Canadian model of methadone treatment, whereby clinicians can prescribe methadone for opioid use disorder in office-based settings and methadone can be dispensed through community pharmacies, offers a compelling model for adoption in the US. Office-based settings in which methadone is prescribed often adopt a rapid-access model, allowing walk-in appointments and same-day initiation of methadone.