709 results match your criteria: "British Columbia Centre On Substance Use[Affiliation]"

Examining the association between fentanyl use and perceived adequacy of methadone dose: A retrospective cohort study.

Drug Alcohol Depend

January 2025

British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada; Interdepartmental Division of Addiction Medicine, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6.

Background: People exposed to fentanyl may report that the dose of methadone in the commonly accepted therapeutic range feels too low. We examined self-reported methadone dose adequacy.

Methods: We conducted a retrospective cohort study of individuals prescribed methadone at a dose of at least 60mg daily using data from three community-recruited prospective cohort studies of people who use drugs in Vancouver, Canada from December 2016 through March 2020.

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Background: Individuals with opioid use disorder (OUD) have a high prevalence of co-occurring mental health disorders; however, there exists little information on mental health service use for this population. We aimed to determine the prevalence of non-substance use-related mental health emergency department (ED) visits, hospitalizations, and outpatient physician visits for individuals receiving treatment for OUD over one year. We also explored individual-level characteristics associated with mental health care service use and estimated the costs of this care.

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In Canada, the ongoing fatal overdose crisis remains driven by the unpredictable potency and content of the illicit drug supply. From August 2022 until October 2023, the Drug User Liberation Front [DULF] operated a drug compassion club [CC], which sells drugs of known composition and purity without medical oversight. The present study is a qualitative evaluation of this project.

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Background: The substance use crisis continues to progress. Medication for Opioid Use Disorder (MOUD) are prescribed to reduce opioid use and related harms; however, many individuals continue to use substances while on treatment. The objective of this study was to describe the temporal and demographic trends of the agreement between self-reported and urine tested substances.

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Unlabelled: Polysubstance use is prevalent among individuals on opioid agonist treatment (OAT), yet past studies have focused primarily on distinct substances and their association with OAT retention. Data was collected from two prospective cohorts between 2005 and 2020 in Vancouver, Canada. Among 13,596 visits contributed by 1445 participants receiving OAT, we employed repeated measures latent class analysis using seven indicators and identified four longitudinal substance use classes.

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Introduction: In Canada, the COVID-19 pandemic collided with an ongoing overdose crisis driven by a toxic unregulated drug supply. Public health guidance intended to limit transmission of COVID-19 (e.g.

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Background: Building capacity for evidence-based treatment and support for people with substance use disorders (SUD) is an urgent priority in the context of the toxic drug poisoning crisis. We implemented the first substance use-focused Project Extension for Community Healthcare Outcomes (ECHO) in Western Canada for health care providers, to enhance their clinical addiction skills and knowledge, facilitate practice change, and foster a supportive community of practice. The aims of this article are to describe our innovations to the Project ECHO model in British Columbia (BC) and Yukon, and present key program outcomes.

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Importance: Individuals with autism spectrum disorder (ASD) and intellectual disability often experience persistent challenges related to aggressive behaviour and agitation, highlighting the critical need for evidence-based pharmacological interventions among other strategies. Despite previous network meta-analyses (NMAs), the rapidly evolving landscape of treatment options necessitates ongoing and updated assessments.

Objective: To evaluate the efficacy and tolerability of various pharmacotherapies in managing agitation in children and adults with ASD or intellectual disabilities (ID).

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Article Synopsis
  • The study investigates the impact of opioid agonist therapy (OAT) on methamphetamine and amphetamine use among individuals with opioid use disorder (OUD) in Canada, comparing buprenorphine/naloxone and methadone.
  • Conducted over 24 weeks, data from a pan-Canadian trial highlighted that both treatments showed no significant effect on reducing methamphetamine/amphetamine use, as assessed through drug testing and self-reporting.
  • Despite methamphetamine/amphetamine use being prevalent among participants, results indicated that neither treatment method led to notable changes in their usage patterns throughout the study period.
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Article Synopsis
  • - The study aimed to evaluate the effects of the COVID-19 pandemic on the health of people who inject drugs (PWID) using a collaborative data-sharing model established in 2021, which pooled data from multiple studies across North America.
  • - Researchers analyzed data on various health indicators (like substance use treatment and mental health conditions) over four different time periods: pre-pandemic, early-pandemic, mid-pandemic, and late-pandemic, involving 6,213 PWID participants.
  • - The results showed minimal changes in health indicators throughout the pandemic, suggesting stability possibly due to policy adjustments and resilience in support services for PWID, highlighting the potential of the data-sharing model for better health insights.
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Management of opioid use disorder: 2024 update to the national clinical practice guideline.

CMAJ

November 2024

Department of Psychology and Neuroscience (Yakovenko, Belliveau, Fraleigh, Stewart); Department of Psychiatry (Yakovenko, Stewart), Dalhousie University, Halifax, NS; Research Centre of Centre Hospitalier de l'Université de Montréal (Mukaneza, Germé), Montréal, Que.; Department of Medicine (Bach, Wood), University of British Columbia; British Columbia Centre on Substance Use (Bach, Wood), Vancouver, BC; Waypoint Centre for Mental Health Care (Poulin); Department of Psychiatry (Poulin), University of Manitoba, Winnipeg, Man.; Addictions Divisions (Selby), Centre for Addition and Mental Health; Dalla Lana School of Public Health (Selby, Rehm), University of Toronto, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Goyer, Bruneau), Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-del'Île-de Montréal, Montréal, Que.; Division of General Internal Medicine (Brothers), Department of Medicine, Dalhousie University, Halifax, NS; Addiction Medicine Consult Service, Mental Health & Addictions Program (Brothers), Nova Scotia Health; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (Rehm), Toronto, Ont.; Department of Psychology (Hodgins), University of Calgary; Department of Psychology (Hodgins), Alberta Gambling Research Institute, Calgary, Alta.; Drug addiction service (Bruneau), Centre Hospitalier de l'Université de Montréal, Montréal, Que.

Article Synopsis
  • - The 2024 update of the 2018 National Guideline for Clinical Management of Opioid Use Disorder emphasizes the need for current scientific evidence to inform treatment practices for opioid use disorder in Canada.
  • - A comprehensive review from 2017 to 2023 was conducted to revise the guidelines, involving a national committee including those with personal experience in opioid use disorder, and ensuring quality through established methods.
  • - Key changes in the recommendations include recognizing methadone and buprenorphine as equally effective first-line treatments, introducing slow-release oral morphine as a second-line option, and highlighting that psychosocial interventions should be optional rather than mandatory.
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"They talk about it like it's an overdose crisis when in fact it's basically genocide": The experiences of Indigenous peoples who use illicit drugs in Vancouver's Downtown Eastside neighbourhood.

Int J Drug Policy

December 2024

British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Internal Medicine, Yale School of Medicine, United States; Department of Social and Behavioral Sciences, Yale School of Public Health, United States; Department of Anthropology, Yale University, United States. Electronic address:

Indigenous Peoples who use illicit drugs (IPWUID) are disproportionately represented among toxic drug poisoning deaths in Canada. These drug-related harms are framed by the historical and ongoing trauma related to settler colonialism and are acutely visible in Vancouver, Canada's Downtown Eastside - a low-income neighbourhood that is an epicenter of the drug poisoning crisis and characterized by entrenched poverty, substance use, violence, and homelessness. This study was undertaken to examine the experiences and perspectives of IPWUID in the Downtown Eastside regarding the drug poisoning crisis and the responsiveness of harm reduction programs within the context of settler colonialism.

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Background: Morbidity and mortality related to substance use have risen to catastrophic levels in North America, and treatment services are often difficult to access. In response, the province of British Columbia (BC), Canada, launched a province-wide addiction medicine support phone line that offers clinicians immediate access to phone consultation with an addictions medicine expert. The service operates 24/7 is accessible to any clinician in the province seeking assistance with an addiction-related question.

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Impacts of the COVID-19 pandemic on the availability and retail price of unregulated drugs in Vancouver, Canada: An interrupted time-series analysis, 2018-2022.

Int J Drug Policy

December 2024

British Columbia Centre on Substance Use, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address:

Background: Impacts of the COVID-19 pandemic on unregulated drug markets in North America have not been well characterized. We sought to estimate potential changes in the availability and retail price of unregulated drugs in Vancouver, Canada pre- vs. post-emergence of the COVID-19 pandemic.

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Clinicians' Perspectives and an Ethical Analysis of Safer Supply Opioid Prescribing.

J Bioeth Inq

October 2024

Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, B.C, V6Z 1Y6, Canada.

In British Columbia, Canada, many physicians providing care to individuals with high-risk opioid use disorder adopted safer supply (SS) opioid prescribing in the spring of 2020 with the goal of facilitating public health measures for COVID-19. This prescribing practice continued after measures were lifted. This study aimed to explore prescribers' perspectives following several years of local experience in prescribing SS opioids, primarily in the form of hydromorphone tablets, and to apply ethical concepts to explore current challenges and ongoing sources of provider distress.

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2S/LGBTQ+ youth substance use and pathways to homelessness: A photovoice study.

Int J Drug Policy

November 2024

British Columbia Centre on Substance Use, Vancouver, Canada; École de Santé Publique, Université de Montréal, Montréal, Canada; Centre de Recherche en Santé Publique (CReSP), Montréal, Canada.

Background: Studies have posited that substance use is associated with, or contributes to, homelessness for 2S/LGBTQ+ youth. However, interconnections between these issues are poorly articulated.

Methods: This community-based photovoice study describes the narratives used by 2S/LGBTQ+ youth about how substance use featured in their pathways to homelessness.

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Article Synopsis
  • Previous studies showed limited evidence on how buprenorphine versus methadone affects different groups of people using opioids, particularly with the rise of fentanyl use.
  • The study aimed to compare the risks of treatment discontinuation and mortality between individuals using buprenorphine/naloxone versus those using methadone for opioid use disorder in British Columbia from 2010 to 2020.
  • Findings revealed that users of buprenorphine/naloxone had a significantly higher likelihood of discontinuing treatment after 24 months compared to those on methadone, with 88.8% versus 81.5% discontinuing, indicating that methadone may be more effective in retaining users.
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Article Synopsis
  • Canada is facing a serious opioid crisis marked by rising mortality rates, leading to challenges in conducting traditional randomized controlled trials (RCTs) for opioid use disorder (OUD) treatments.
  • Emulated clinical trials, which use existing healthcare data to mimic RCTs, offer a solution to issues like long timelines, high costs, and difficulties in participant recruitment, enabling faster generation of real-world evidence.
  • The commentary discusses the shift from a traditional RCT to an emulated trial due to COVID-19 restrictions, aiming to guide other researchers in applying this methodology to enhance clinical research and address critical treatment questions.
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Looking beyond drugs: A scoping review of recovery in the context of illicit substance use among adolescents and young adults.

Int J Drug Policy

November 2024

Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada.

Article Synopsis
  • The study explores the under-researched concept of "recovery" for young people who use drugs (YPWUD), highlighting the importance of understanding their perspectives and experiences in navigating recovery processes.
  • Through a scoping review of 28 peer-reviewed studies from 1999 to 2023, the research identifies diverse definitions of recovery which go beyond mere abstinence and emphasize a continuum of support.
  • The findings emphasize the need for tailored recovery-oriented care that meets the unique needs of YPWUD, involving both harm reduction and abstinence approaches, and recognizing the critical role of caregivers in the recovery journey.
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Repurposing prescribed hydromorphone: Alternative uses of safer supply and tablet-injectable opioid agonist treatment to meet unaddressed health needs.

Int J Drug Policy

November 2024

British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo ON, N2L 3G1, Canada. Electronic address:

Article Synopsis
  • In Canada, opioid agonist treatment programs provide hydromorphone to people at high risk of overdose, with varying methods for dispensing it, aimed at reducing reliance on contaminated drugs.
  • A qualitative study involving in-depth interviews explored how individuals repurpose hydromorphone tablets to meet various personal needs beyond just treating addiction.
  • Findings reveal that while many participants reduced their use of illicit drugs, they also used hydromorphone for managing anxiety, sleep issues, withdrawal symptoms, and chronic pain, highlighting its role in addressing unmet health needs in a public health context.
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Article Synopsis
  • The study examines the impact of high-potency synthetic opioids (HPSOs) on addiction treatment, with a focus on how they affect the prescribing practices of addiction specialists in the USA.
  • Findings reveal that a significant majority of addiction specialists (89%) believe HPSOs have influenced treatment protocols, with 84% seeing a need for additional opioid agonist therapies beyond methadone.
  • The study highlights a strong support (80%) among specialists for using slow-release oral morphine (SROM) as a potential new treatment option for opioid use disorder (OUD) in response to the growing crisis.
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Background: Among patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment.

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A Scoping Review of Evidence-Based Interventions and Health-Related Services for Youth Who Use Nonmedical Opioids in Canada and the United States.

J Adolesc Health

September 2024

Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Foundry, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.

Purpose: This scoping review synthesizes the characteristics and outcomes of recent evidence-based treatments and services for youth with nonmedical opioid use/opioid use disorder in the context of the ongoing opioid crisis in Canada and the United States.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews guidelines, empirical health databases were searched for literature describing treatments or health-related services for nonmedical opioid use/opioid use disorder among youth (ages 12-25). Two independent reviewers conducted study screening, selection, and data extraction.

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