Now showing 1 - 6 of 6
  • Publication
    Development and Evaluation of the Online Addiction Medicine Certificate: Free Novel Program in a Canadian Setting
    Background: Despite the enormous burden of disease attributable to drug and alcohol addiction, there remain major challenges in implementing evidence-based addiction care and treatment modalities. This is partly because of a persistent lack of accessible, specialized training in addiction medicine. In response, a new online certificate in addiction medicine has been established in Vancouver, Canada, free of charge to participants globally. Objective: The objective of this study was to evaluate and examine changes in knowledge acquisition among health care professionals before and after the completion of an online certificate in addiction medicine. Methods: Learners enrolled in a 17-module certificate program and completed pre- and postknowledge tests using online multiple-choice questionnaires. Knowledge acquisition was then evaluated using a repeated measures t test of mean test scores before and after the online course. Following the certificate completion, a subset of learners completed the online course evaluation form. Results: Of the total 6985 participants who registered for the online course between May 15, 2017 and February 22, 2018, 3466 (49.62%) completed the online pretest questionnaire. A total of 1010 participants completed the full course, achieving the required 70% scores. TThe participants self-reported working in a broad range of health-related fields, including nursing (n=371), medicine (n=92), counseling or social work (n=69), community health (n=44), and pharmacy (n=34). The median graduation year was 2010 (n=363, interquartile range 2002-2015). Knowledge of the addiction medicine increased significantly postcertificate (mean difference 28.21; 95% CI 27.32 to 29.10; P<.001). Physicians scored significantly higher on the pretest than any other health discipline, whereas the greatest improvement in scores was seen in the counseling professions and community outreach. Conclusions: This free, online, open-access certificate in addiction medicine appeared to improve knowledge of learners from a variety of disciplines and backgrounds. Scaling up low threshold learning opportunities may further advance addiction medicine training, thereby helping to narrow the evidence-to-practice gap.
      303Scopus© Citations 5
  • Publication
    Prescription opioids, opioid use disorder, and overdose crisis in Canada: Current dilemmas and remaining questions
    (Wolters Klumer, 2018-06-01) ; ;
    In Canada, a rise in opioid use disorder (OUD) and overdose has been linked to opioid prescriptions in a number of contexts. At the same time, relatively few patients prescribed opioids reportedly develop OUD. This combination of findings suggests a pressing need for research on specific avenues through which medically prescribed opioids influence OUD and overdose in Canada. In this commentary, we therefore discuss a few of the potential processes that might allow for medically prescribed opioids to indirectly influence rising overdose rates, and the processes that might account for inconsistencies between large correlational research and studies of OUD incidence in opioid prescribed patients.
      382Scopus© Citations 2
  • Publication
    Slow release oral morphine versus methadone for the treatment of opioid use disorder
    Objective: To assess the efficacy of Slow release oral morphine (SROM) as a treatment for opioid use disorder. Design: Systematic review and meta-analysis of randomized controlled trials (RCT). Data sources: Three electronic databases were searched through May 1st, 2018: the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. We also searched the following electronic registers for ongoing trials: ClinicalTrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Current Controlled Trials, and the EU Clinical Trials Register. Eligibility criteria for selecting studies: We included RCTs of any duration, assessing the effect of SROM on measures of treatment retention, heroin use and craving in adults who met the diagnostic criteria for opioid use disorder. Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the random-effects model and expressed as Risk Ratios (RR) or mean differences (MDs) with 95% CIs. Heterogeneity was assessed (chi-squared statistic) and quantified (I2 statistic) and a sensitivity analysis was undertaken to assess the impact of particular high-risk trials. Results: Among 1315 records screened and four studies reviewed, four unique randomized trials met inclusion criteria (n = 471), and compared SROM with methadone. In the meta-analysis, we observed no significant differences between SROM and methadone in improving treatment retention (risk ratio [RR] = 0.98; 95% Confidence Interval [CI]: 0.94 - 1.02, p = 0.34), and heroin use (RR = 0.96; 95% CI: 0.61- 1.52, p = 0.86). Craving data was not amenable to meta-analysis. Available data implied no differences in adverse events, heroin, cocaine, or benzodiazepine use. Conclusions: Meta-analysis of existing randomized trials suggests SROM may be generally equal to methadone in retaining patients in treatment and reducing heroin use as methadone while potentially resulting in less craving. The methodological quality of the included RCTs was low-to-moderate.
      317Scopus© Citations 38
  • Publication
    Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain
    (American Medical Association (AMA), 2019-05-03) ; ; ;
    Importance: Although prescription opioid use disorder is associated with substantial harms, strategies to identify patients with pain among whom prescription opioids can be safely prescribed have not been systematically reviewed. Objective: To review the evidence examining factors associated with opioid addiction and screening tools for identifying adult patients at high vs low risk of developing symptoms of prescription opioid addiction when initiating prescription opioids for pain. Data Sources: MEDLINE and Embase (January 1946 to November 2018) were searched for articles investigating risks of prescription opioid addiction. Study Selection: Original studies that were included compared symptoms, signs, risk factors, and screening tools among patients who developed prescription opioid addiction and those who did not. Data Extraction and Synthesis: Two investigators independently assessed quality to exclude biased or unreliable study designs and extracted data from higher quality studies. The Preferred Reporting Items for Systematic Reviews and Meta-analyses of Diagnostic Accuracy Studies (PRISMA-DTA) reporting guideline was followed. Main Outcomes and Measures: Likelihood ratios (LRs) for risk factors and screening tools were calculated. Results: Of 1287 identified studies, 6 high-quality studies were included in the qualitative synthesis and 4 were included in the quantitative synthesis. The 4 high-quality studies included in the quantitative synthesis were all retrospective studies including a total of 2 888 346 patients with 4470 cases that met the authors’ definitions of prescription opioid addiction. A history of opioid use disorder (LR range, 17-22) or other substance use disorder (LR range, 4.2-17), certain mental health diagnoses (eg, personality disorder: LR, 27; 95% CI, 18-41), and concomitant prescription of certain psychiatric medications (eg, atypical antipsychotics: LR, 17; 95% CI, 15-18) appeared useful for identifying patients at high risk of opioid addiction. Among individual findings, only the absence of a mood disorder (negative LR, 0.50; 95% CI, 0.45-0.52) was associated with a lower risk of opioid addiction. Despite their widespread use, most screening tools involving combinations of questions were based on low-quality studies or, when diagnostic performance was assessed among high-quality studies, demonstrated poor performance in helping to identify patients at high vs low risk. Conclusions and Relevance: While a history of substance use disorder, certain mental health diagnoses, and concomitant prescription of certain psychiatric medications appeared useful for identifying patients at higher risk, few quality studies were available and no symptoms, signs, or screening tools were particularly useful for identifying those at lower risk.
      497Scopus© Citations 120
  • Publication
    Diagnosing opioid addiction in people with chronic pain
    Over the past two decades, a steep rise in the number of opioids dispensed for pain treatment has been accompanied by a dramatic rise in overdose deaths in the United States. In 2016, up to 32 000 deaths reportedly involved prescription opioids, and the economic burden of prescription opioid overdose has been estimated to exceed $78bn (£59bn; €67bn) annually. Despite all the evidence of harm, however, it remains unclear exactly how to determine if a patient with chronic pain has opioid addiction, or what criteria should serve as a gold standard in making a diagnosis of opioid use disorder (OUD) in this context. This is an important gap in the literature that hinders both evidence-based care and research on the links between prescription opioids and OUD. In this editorial, we discuss the limitations of diagnosing OUD in people with chronic pain, and make several recommendations for further research.
      778Scopus© Citations 16
  • 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.
      310Scopus© Citations 12