Processes and patterns of cocaine use among patients receiving injectable opioids for the treatment of opioid use disorder : a multi-method study

Background: Injectable opioid agonist treatment with hydromorphone (a licensed opioid analgesic) or diacetylmorphine (pharmaceutical grade heroin) is effective at reducing illicit opioid use and improving health and social functioning among patients with opioid use disorder. Concurrent cocaine use is prevalent among patients receiving injectable opioid agonist treatment, however modest declines have been observed in the proportion of patients using cocaine and in the number of days of cocaine use while engaged in treatment. To date, studies have not explored what processes might explain these reductions, or how patterns of cocaine use might vary over time at the intra- and inter-individual levels. Methods: This study was conducted with patients receiving daily injectable hydromorphone or diacetylmorphine for the treatment of opioid use disorder at a clinic in Vancouver, Canada. The qualitative analysis was guided by a grounded theory approach involving one-on-one patient interviews (n=31). Findings directed covariate selection for the quantitative analysis. The profile of participants using cocaine was characterized (n=166), and multilevel models were used to explain variation in cocaine use over 24-months, using data from a baseline visit and six follow-up visits. Results: Qualitative analysis revealed that access to injectable opioid agonist treatment promoted the self-management of cocaine use. Participants distanced themselves from the street environment, made efforts to “control” their cocaine use, and sought supports to bolster these efforts. Quantitative analyses identified significant intra- and inter-individual variation in cocaine use over 24-months. On average, cocaine use decreased over time, however the rate of change varied from one participant to the next. Women reported more cocaine use than men, and participants with more lifetime years of cocaine use at baseline reported more cocaine use over 24-months. Conclusions: This research highlights heterogeneity in patterns and processes of cocaine use. Intra- and inter-individual variation in cocaine use was identified, and was explained by participant characteristics, including demographics and substance use histories. Given daily contact with care, injectable opioid agonist treatment serves as an optimal setting to integrate treatments for cocaine use disorder. Care providers can communicate with patients about their patterns of cocaine use and associated characteristics to guide treatment plans.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Opioid maintenance treatment retention and perceptions of care among long-term opioid dependent men and women

Background: Opioid dependence is a chronic relapsing disease with a number of related harms. Despite the proven effectiveness of opioid maintenance many men and women are not engaged or retained in this treatment. Accounting for patient perceptions of their interactions with health care providers may offer important evidence as to meeting gender specific heath and treatment needs of this population. Objective: This thesis investigates access to health care and addiction treatment services among long-term opioid dependent men and women. Factors associated with retention to opioid maintenance treatment are explored among participants and stratified by gender. Perceptions of encounters with health care providers as potentially offensive, degrading, or abusive are considered. Finally, the feasibility of sharing study findings with long-term opioid users are explored. Methods: The Gender Matters in the Health of Long-term Opioid Users study is a descriptive cross-sectional study of long-term opioid users in the Downtown Eastside of Vancouver. Descriptive variables were explored and logistic regression models were built to determine associations between independent variables and the opioid maintenance treatment retention and perceived abuse in health care outcomes. Two formats of sharing study findings with participants were piloted and participant perceptions of study findings and the meeting formats were gathered. Results: Rates of opioid maintenance treatment retention were similar among men and women while factors associated with retention differed by gender. Half of participants reported perceived abuse in health care, which was associated with childhood maltreatment and psychological health problems. The majority of participants felt it was important for participants to be involved in knowledge translation, while few had previously had the opportunity to do so. Conclusions: Gender, along with other structural factors have strong implications for the appropriateness and success of the treatment and models of care provided to opioid-dependent men and women. Patient histories and perspectives must be accounted for to determine suitable treatments and to ensure health care encounters are not perceived as offensive, degrading, or abusive. The involvement of participants in knowledge translation can serve as a means of empowering participants and accounting for patient voice in recommendations for service provision and policy.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Peer-led safer supply and opioid agonist treatment medication distribution : a case study from rural British Columbia

Background: British Columbia (BC) has been facing a public health emergency of overdose since 2016, with rural regions of the province facing the highest rates of death. Peers (in this case, people with lived experience of substance use) are known to be effective patient navigators in health systems and can play a role in connecting patients to care and reducing overdose risk. Case presentation: We outline a peer-led program focused on opioid agonist treatment and prescribed safe supply medication delivery that began in March 2020 at a clinic in rural BC. The peer takes an Indigenous harm reduction approach and is focused on meeting the needs of the whole person. The peer has regular contact with approximately 50 clients and navigates medication delivery and appointments for approximately 10–15 people each day. Clients have been retained on the medication, and experienced improvement in other outcomes, including securing housing, employment and managing acute and chronic health conditions. The peer has established contact with clients since March 2020 to support engagement with health care and continuity of medication access. This program highlights the importance and value of peer-led work and need for further investments in peer-led programs to respond to the unregulated drug poisoning crisis. Conclusions: This peer-led intervention is a promising approach to engaging people who remain disconnected from health services in care in a rural community. This model could be adapted to other settings to support patient contact with the health system and medication access and continuity, with the ultimate goal of reducing overdose risk.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofPsychiatry, Department ofReviewedFacultyResearche

Feasibility of Applying the Life History Calendar in a Population of Chronic Opioid Users to Identify Patterns of Drug Use and Addiction Treatment

Uncovering patterns of drug use and treatment access is essential to improving treatment for opioid dependence. The life history calendar (LHC) could be a valuable instrument for capturing time-sensitive data on lifetime patterns of drug use and addiction treatment. This study describes the methodology applied when collecting data using the LHC in a sample of individuals with long-term opioid dependence and aims to identify specific factors that impact the feasibility of administering the LHC interview. In this study, the LHC allowed important events such as births, intimate relationships, housing, or incarcerations to become reference points for recalling details surrounding drug use and treatment access. The paper concludes that the administration of the LHC was a resource-intensive process and required special attention to interviewer training and experience with the study population. These factors should be considered and integrated into study plans by researchers using the LHC in addiction research

Use of sustained release dextroamphetamine for the treatment of stimulant use disorder in the setting of injectable opioid agonist treatment in Canada: a case report

Abstract Background For people with opioid use disorder who are not responding to oral opioid agonist treatment, evidence supports the effectiveness of injectable opioid agonist treatment with injectable hydromorphone (an opioid analgesic) and diacetylmorphine (pharmaceutical grade heroin). While this treatment is effective at reducing illicit opioid use, concurrent cocaine use is prevalent. Dextroamphetamine (a central nervous system stimulant) has been found to be a safe and effective treatment for cocaine dependence among people receiving injectable opioid agonist treatment in Europe. We present the first report of dextroamphetamine prescribing offered for the treatment of stimulant use disorder among a patient receiving iOAT outside of a clinical trial. This case report can be used to inform clinical practice in the treatment of cocaine use disorder, an area where interventions are currently lacking. Case presentation Dextroamphetamine was prescribed to a 51-year-old male who was diagnosed with concurrent opioid and stimulant use disorder in an injectable opioid agonist treatment clinic in Vancouver, Canada. He reported smoking crack cocaine daily for more than two decades and was experiencing health consequences associated with this use. He presented to his routine physician visit with the goal of reducing his cocaine use and was prescribed dextroamphetamine for the treatment of stimulant use disorder. After 4-weeks the patient was tolerating the medication with no observed adverse events and was achieving his therapeutic goal of reducing his cocaine use. Conclusions Dextroamphetamine can be prescribed to support patients with stimulant use disorder to reduce or stop their use of cocaine. The case demonstrated that when dextroamphetamine was prescribed, a significant reduction in cocaine use was experienced among a patient that had been regularly using cocaine on a daily basis for many years. Daily contact with care for the opioid medication promoted adherence to the stimulant medication and allowed for monitoring of dose and tolerance. Settings where patients are in regular contact with care such as oral and injectable opioid agonist treatment clinics serve as a suitable location to integrate dextroamphetamine prescribing for patients that use illicit stimulants to reduce use and associated harms. </jats:sec

Use of sustained release dextroamphetamine for the treatment of stimulant use disorder in the setting of injectable opioid agonist treatment in Canada: a case report

Background: For people with opioid use disorder who are not responding to oral opioid agonist treatment, evidence supports the effectiveness of injectable opioid agonist treatment with injectable hydromorphone (an opioid analgesic) and diacetylmorphine (pharmaceutical grade heroin). While this treatment is effective at reducing illicit opioid use, concurrent cocaine use is prevalent. Dextroamphetamine (a central nervous system stimulant) has been found to be a safe and effective treatment for cocaine dependence among people receiving injectable opioid agonist treatment in Europe. We present the first report of dextroamphetamine prescribing offered for the treatment of stimulant use disorder among a patient receiving iOAT outside of a clinical trial. This case report can be used to inform clinical practice in the treatment of cocaine use disorder, an area where interventions are currently lacking. Case presentation: Dextroamphetamine was prescribed to a 51-year-old male who was diagnosed with concurrent opioid and stimulant use disorder in an injectable opioid agonist treatment clinic in Vancouver, Canada. He reported smoking crack cocaine daily for more than two decades and was experiencing health consequences associated with this use. He presented to his routine physician visit with the goal of reducing his cocaine use and was prescribed dextroamphetamine for the treatment of stimulant use disorder. After 4-weeks the patient was tolerating the medication with no observed adverse events and was achieving his therapeutic goal of reducing his cocaine use. Conclusions: Dextroamphetamine can be prescribed to support patients with stimulant use disorder to reduce or stop their use of cocaine. The case demonstrated that when dextroamphetamine was prescribed, a significant reduction in cocaine use was experienced among a patient that had been regularly using cocaine on a daily basis for many years. Daily contact with care for the opioid medication promoted adherence to the stimulant medication and allowed for monitoring of dose and tolerance. Settings where patients are in regular contact with care such as oral and injectable opioid agonist treatment clinics serve as a suitable location to integrate dextroamphetamine prescribing for patients that use illicit stimulants to reduce use and associated harms.Medicine, Faculty ofOther UBCNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult

The relationship between sense of community belonging and self-rated mental health among Canadians with mental or substance use disorders

<p><i>Background</i>: One-third of Canadians meet the criteria for a mental or substance use disorder at some point in their lifetime. While prevention and treatment efforts have been focused on the individual, studies suggest the importance of incorporating social and community factors.</p> <p><i>Aims</i>: This study investigates the relationship between community belonging and self-rated mental health among Canadians with mental or substance use disorders.</p> <p><i>Methods</i>: The Canadian Community Health Survey-Mental Health (2012) is a nationally representative survey of Canadians aged 15 years and older (<i>n</i> = 25,113). The present analytic sample is comprised of respondents reporting a mental or substance use disorder in the previous 12 months (<i>n</i> = 2628). The relationship between community belonging and self-rated mental health is depicted with a multivariable multinomial logistic regression model.</p> <p><i>Results</i>: Self-rated mental health was reported as follows: poor or fair (38.1%); good (33.7%); and very good or excellent (28.2%). In the multivariable multinomial model, a positive relationship was observed. Those reporting very strong compared to very weak community belonging had an increased odds of better mental health.</p> <p><i>Conclusions</i>: Findings indicate the importance of social and community-based interventions to effectively engage and retain individuals in services for the prevention and treatment of mental and substance use disorders.</p

Change in Police Attendance at Overdose Events following Implementation of a Police Non-Notification Policy in British Columbia

Introduction. Bystanders at overdose events often hesitate to call 911 due to fear of police involvement. To address this, in 2016, British Columbia Emergency Health Services (BCEHS) introduced a policy to not routinely inform police of overdose events. This study explores change in police attended overdose events after the policy was implemented. Methods. Data on police attended overdose events were derived from naloxone administration forms in BC’s Take-Home Naloxone (THN) kits returned before and after the policy change. Segmented regression was conducted to quantify change in police attended overdose events. Results. The average proportion of police attended overdose events pre-policy was 55.6% compared to 37.9% post-policy. The segmented regression model demonstrated a 0.98% (95% CI: (−1.70 to −0.26)) decline (p=0.01) in police attended overdose events each month following the policy. Conclusion. Our findings suggest that the BCEHS policy contributed to a decrease in police attended overdose events