Now showing 1 - 10 of 68
  • Publication
    Commentary on Zeremski et al. (2016): Improvements in HCV-related Knowledge Among Substance Users on Opioid Agonist Therapy After an Educational Intervention
    Zeremski et al highlight how improving patients’ knowledge about Hepatitis C virus (HCV) care can enhance adherence to treatment plans and improved treatment outcomes (Zeremski et al. 2016). In this regard we believe that patients’ knowledge of HCV care can best be optimised through community based approaches to HCV treatment as supported by recent findings from Wade et al and Grebely et al (Wade et al. 2015, Grebely et al. 2016).
      231Scopus© Citations 1
  • Publication
    Nursing Fellowship in Addiction Medicine: A Novel Program in a Canadian Setting
    Substance use disorders disproportionally contribute to the global burden of disease; however, their treatment has been hindered in large part due to a long-standing "bench to practice" gap in which competencies for assessing, treating and preventing substance use disorders are often lacking from healthcare education curricula. Immediate and effective translation of recent advances in addiction research into routine clinical practice requires specialized training programmes for health professionals involved in the care of patients and families affected by substance use disorders.
      387Scopus© Citations 6
  • Publication
    Eligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting
    Objectives: A growing body of evidence supports the effectiveness of injectable diacetylmorphine (i.e., heroin) for individuals with treatment-refractory opioid use disorder. Despite this evidence, and the increasing toll of opioid-associated morbidity and mortality, it remains controversial in some settings. To investigate the possible contribution of heroin-assisted treatment (HAT) to HIV treatment-related outcomes, we sought to estimate the proportion and characteristics of HIV-positive people who inject opioids that might be eligible for HAT in Vancouver, Canada. Methods: We used data from a prospective cohort of people living with HIV who use illicit drugs in Vancouver, Canada. Using generalized estimating equations (GEE), we assessed the longitudinal relationships between eligibility for HAT, using criteria from previous clinical trials and guidelines, with behavioural, social, and clinical characteristics. Results: Between 2005 and 2014, 478 participants were included in these analyses, contributing 1927 person-years of observation. Of those, 94 (19.7%) met eligibility for HAT at least once during the study period. In a multivariable GEE model, after adjusting for clinical characteristics, being eligible for HAT was positively associated with homelessness, female gender, high-intensity illicit drug use, drug dealing and higher CD4 count. Conclusions: In our study of HIV-positive people with a history of injection drug use, approximately 20% of participants were eligible for HAT at ≥ 1 follow-up period. Eligibility was linked to risk factors for sub-optimal HIV/AIDS treatment outcomes, such as homelessness and involvement in the local illicit drug trade, suggesting that scaling-up access to HAT might contribute to achieving optimal HIV treatment in this setting.
    Scopus© Citations 5  322
  • Publication
    Key performance indicators for mental health and substance use disorders: a literature review and discussion paper
    (Taylor and Francis (Routledge), 2014-03) ; ; ;
    With an increasing recognition of the importance of mental and substance use disorders (MESUDS) for population health and health systems and the potential value of systems-based performance indicators in addressing this issue, we aimed to describe the development and content of key performance indicators (KPIs) for MESUDS. Publications were identified through official websites, Google searches and PubMed. Following 'PRISMA' guidelines, 25 studies were kept for qualitative synthesis and six for quantitative analysis. We describe their use in practice by comparing their application across a range of public and mixed healthcare systems. Currently, the KPI development for MESUDS adopts several methodologies, including expert opinion, literature review, stakeholder consultation, and the structured consensus method. The rationales provided for selection of particular KPIs vary greatly between systems. Systems exhibit different levels of KPI adaptability, which is reflective of dynamic changes in evidence-based practices. We noted bias in the level of KPI assessment toward system/health plan evaluation followed by program/service evaluation. Similarly, there is a large skew toward KPIs that reflect evaluation of processes. Collection of data in all systems is nearly exclusively reliant on electronic administrative/medical data. Experiences from these systems are synthesized into methodological recommendations and considerations for further research and clinical practice are provided.
    Scopus© Citations 5  715
  • Publication
    Alcohol screening and brief intervention among drug users in primary care : a discussion paper
    Background problem alcohol use is common among problem drug users (PDU) and associated with adverse health outcomes. Primary care has an important role in the overall stepped approach to alcohol treatment, especially screening and brief intervention (SBI). Aim To discuss three themes that emerged from an exploration of the literature on SBI for problem alcohol use in drug users attending primary care. Methods material for this discussion paper was gathered from three biomedical databases (PubMed, PsycINFO and Cochrane library), conference proceedings and online resources of professional organisations or national health agencies. Themes discussed in this paper are: (a) the potential of primary care for delivery of alcohol SBIs to PDUs, (b) screening methods and (c) application of brief interventions to PDUs. Although SBI improves health outcomes associated with problem alcohol use in the general population, further research is needed among high-risk patient groups, especially PDUs.
      377Scopus© Citations 11
  • Publication
    In-hospital training in addiction medicine: A mixed-methods study of health care provider benefits and differences
    Background: Hospital-based clinical addiction medicine training can improve knowledge of clinical care for substance-using populations. However, application of structured, self-assessment tools to evaluate differences in knowledge gained by learners who participate in such training has not yet been addressed. Methods: Participants (n = 142) of an elective with the hospital-based Addiction Medicine Consult Team (AMCT) in Vancouver, Canada, responded to an online self-evaluation survey before and immediately after the structured elective. Areas covered included substance use screening, history taking, signs and symptoms examination, withdrawal treatment, relapse prevention, nicotine use disorders, opioid use disorders, safe prescribing, and the biology of substance use disorders. A purposefully selected sample of 18 trainees were invited to participate in qualitative interviews that elicited feedback on the rotation. Results: Of 168 invited trainees, 142 (84.5%) completed both pre- and post-rotation self-assessments between May 2015 and May 2017. Follow-up participants included medical students, residents, addiction medicine fellows, and family physicians in practice. Self-assessed knowledge of addiction medicine increased significantly post-rotation (mean difference in scores = 11.87 out of the maximum possible 63 points, standard deviation = 17.00; P < .0001). Medical students were found to have the most significant improvement in addiction knowledge (estimated mean difference = 4.43, 95% confidence interval = 0.76, 8.09; P = .018). Illustrative quotes describe the dynamics involved in the learning process among trainees. Conclusions: Completion of a hospital-based clinical elective was associated with improved knowledge of addiction medicine. Medical students appear to benefit more from the addiction elective with a hospital-based AMCT than other types of learners.
      260Scopus© Citations 8
  • Publication
    Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users
    Background: Problem alcohol use is common among illicit drug users and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opiate overdose in opioid users. Objectives: To assess the effects of psychosocial interventions for problem alcohol use in illicit drug users (principally problem drug users of opiates and stimulants). Search methods: We searched the Cochrane Drugs and Alcohol Group trials register (June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 11, June 2014), MEDLINE (1966 to June 2014); EMBASE (1974 to June 2014); CINAHL (1982 to June 2014); PsycINFO (1872 to June 2014) and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; 2) online registers of clinical trials: Current Controlled Trials, Clinical, Center Watch and the World Health Organization International Clinical Trials Registry Platform. Selection criteria: Randomised controlled trials comparing psychosocial interventions with another therapy (other psychosocial treatment, including non-pharmacological therapies, or placebo) in adult (over the age of 18 years) illicit drug users with concurrent problem alcohol use. Data collection and analysis: We used the standard methodological procedures expected by The Cochrane Collaboration
      528Scopus© Citations 33
  • Publication
    How Can We Investigate the Role of Topiramate in the Treatment of Cocaine Use Disorder More Thoroughly?
    We read with interest Drs Darke and Farrell’s commentary on our meta-analysis of Topiramate published in the eight issue of 2016. To elaborate on some of the ideas raised by the commentary, we focus our response on the question of why some studies implied a benefit and others did not. Overall, although the current evidence is not strong enough to support the routine clinical use of Topiramate for the treatment of cocaine use disorder, it may be useful for researching in certain circumstances in terms of helping people with cocaine use disorders stay abstinent from cocaine use.
      287Scopus© Citations 2
  • Publication
    Optimizing writing schemes for addiction researchers
    (Elsevier, 2016-12-02)
    Writing constitutes a significant challenge for junior addiction researchers. Writing support programmes appear to improve writing skills and enhance productivity. However, addiction researchers have not benefited from writing support groups to the same extent as other professions, mainly due to the lack of support for and considerable variation among these programmes. Given a lack of research about the contribution of writing support programmes to publication productivity among early-stage addiction researchers, this article offers critical insights into the process and outcomes of such programmes, based on the substantial experience accumulated from taking part in several writing support programmes, including the scheme of the International Society of Addiction Journal Editors (ISAJE). A better understanding of what makes writing groups effective may help build evidence for writing programs and universities to equip addiction investigators with the skills they need to improve the health of people with substance use disorders via better writing.
      237Scopus© Citations 1
  • Publication
    Large Variation in Provincial Guidelines for Urine Drug Screening During Opioid Agonist Treatment in Canada
    Urine drug screening (UDS) is commonly used to detect or validate self-reported substance use, particularly when beginning and maintaining opioid agonist therapy. However, there is currently no summary of the published clinical practice guidelines for UDS in Canada, and no measure of the consistency with which different provinces suggest administering UDS. Therefore, we conducted a policy scan of UDS guidelines, examining the published clinical practice guidelines for each Canadian province and extracting all relevant data in March 2017. Our Canadian guideline and policy scan found that UDS frequency recommendations vary greatly among Provinces for persons receiving opioid agonist therapy for opioid use disorder.
      343Scopus© Citations 6