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Background and Objectives Methods Results Conclusions and Scientific Significance History of nonfatal overdose (NFO) is common among people who use opioids, but little is known about opioid agonist treatment (OAT) outcomes for this high‐risk subpopulation. The objective of this study was to investigate the relative effectiveness of buprenorphine/naloxone and methadone on retention and suppression of opioid use among individuals with opioid use disorder (OUD) and history of NFO.Secondary analysis of a pan‐Canadian pragmatic trial comparing flexible take‐home buprenorphine/naloxone and supervised methadone for people with OUD and history of NFO. Logistic regression was used to examine the impact of OAT on retention in the assigned or in any OAT at 24 weeks and analysis of covariance was used to examine the mean difference in opioid use between treatment arms.Of the 272 randomized participants, 155 (57%) reported at least one NFO at baseline. Retention rates in the assigned treatment were 17.7% in the buprenorphine/naloxone group and 18.4% in the methadone group (adjusted odds ratio [AOR] = 0.54, 95% CI: 0.17–1.54). Rates of retention in any OAT were 28% and 20% in the buprenorphine/naloxone and methadone arms, respectively (AOR = 1.55, 95% CI: 0.65–3.78). There was an 11.9% adjusted mean difference in opioid‐free urine drug tests, favoring the buprenorphine/naloxone arm (95% CI: 3.5–20.3; p = .0057).Among adults with OUD and a history of overdose, overall retention rates were low but improved when retention in any treatment was considered. These findings highlight the importance of flexibility and patient‐centered care to improve retention and other treatment outcomes in this population. [ABSTRACT FROM AUTHOR]

Introduction: The emergence of fentanyl and its analogues have contributed to a drastic rise in overdose‐related mortality in recent years. The objective of this study was to determine the number of drug checking samples containing fentanyl and fentanyl analogues using both point of care and confirmatory drug checking technologies. Methods: Point‐of‐care drug checking data, using a combination of fentanyl immunoassay strips and Fourier‐transform infrared spectroscopy (FTIR), were collected at harm reduction sites in Vancouver and Surrey, British Columbia. Based on current recommendations from the British Columbia Centre on Substance Use Drug Checking Project, a subset of these samples was sent for confirmatory analysis using quantitative nuclear resonance spectroscopy, gas chromatography–mass spectrometry and/or liquid chromatography‐mass spectrometry. Results: A total of 22,916 samples were tested using FTIR and fentanyl immunoassay strips, of which 6125 (29%) were positive for fentanyl and/or fentanyl analogues. FTIR identified a fentanyl analogue in five samples (all carfentanil). Of the 1467 samples sent for confirmatory analysis, fentanyl was identified in 855 (58%) and fentanyl analogues in 85 (6%), including: carfentanil (n = 56), acetyl fentanyl (n = 15), furanyl fentanyl (n = 9) and cyclopropyl fentanyl (n = 5). Discussion and Conclusion: Our research found that FTIR does not consistently distinguish between fentanyl and its analogues at point of care and that highly sensitive confirmatory drug checking technologies are needed to identify fentanyl analogues. These findings underscore the limitations of current drug checking technologies and the importance of using both point of care and confirmatory drug checking initiatives for monitoring changes in the drug supply. [ABSTRACT FROM AUTHOR]

Passive surveillance technology has the potential to increase safety through monitoring spaces where people are at risk of overdose. One key opportunity for the use of passive surveillance technology to prevent overdose fatality is in bathrooms where people may be using drugs. However, uncertainty remains with regards to how to attain informed consent, implications for data storage and privacy and potential negative socio‐legal ramifications for people who use drugs. In addition, there are issues regarding responsibility and liability for the devices. Transparency with regards to data privacy and security may also be needed before bathroom users will feel comfortable with such solutions. In this article, we discuss these issues and offer recommendations to provide a foundation for future research and policy development. [ABSTRACT FROM AUTHOR]

Introduction: Illicit drug use while admitted to hospital is common amongst people who use drugs. Furthermore, non‐medical prescription opioid use (NMPOU) is increasingly being used by this population. This study was undertaken to investigate the relationship between NMPOU and having ever reported using illicit drugs in the hospital. Methods: This study was a cross‐sectional study design based on data derived from participants enrolled in three Canadian prospective cohort studies between December 2011 and November 2016. Using bivariable and multivariable logistic regression analyses, we examined the relationship between NMPOU and having ever reported illicit drug use in the hospital. Results: Among the 1865 participants (951 male, 471 female) enrolled in the studies, 1422 (76.25%) met the inclusion criteria of having ever been hospitalised. Of these, 436 (30.7%) had used illicit drugs while in the hospital. In multivariable analyses, after adjusting for various confounders, we found a positive relationship between the percentage of reporting at least daily NMPOU in the past 6 months during the cohort study period and illicit drug use in the hospital (adjusted odds ratio 3.42; 95% confidence interval 1.46–8.02). Discussion and Conclusions: Among our sample, more persistent NMPOU was positively associated with having reported in‐hospital illicit drug use. Our findings point to the need for better identification and management of opioid use disorder in acute care settings to reduce in‐hospital illicit drug use, and to offer evidence‐based medical treatments to achieve the most optimal outcomes for patients. [ABSTRACT FROM AUTHOR]

Background and aims: To improve evidence‐based addiction care in acute care settings, many hospitals across North America are developing an inpatient addiction medicine consultation service (AMCS). St Paul's Hospital in Vancouver, Canada houses a large interdisciplinary AMCS. This study aimed to: (1) describe the current model of clinical care and its evolution over time; (2) evaluate requests for an AMCS consultation over time; (3) highlight the established clinical training opportunities and educational curriculum and (4) provide some lessons learned. Design, setting and participants: A retrospective observational analysis in an urban, academic hospital in Vancouver, Canada with a large interdisciplinary AMCS, studied from 2013 to 2018, among individuals who presented to hospital and had a substance use disorder. Measurements Data were collected using the hospital's electronic medical records. The primary outcome was number of AMCS consultations over time. Findings In 2014 the hospital's AMCS was restructured into an academic, interdisciplinary consultation service. A 228% increase in the number of consultations was observed between 2013 (1 year prior to restructuring) and 2018 (1373 versus 4507, respectively; P = 0.027). More than half of AMCS consultations originated from the emergency department, with this number increasing over time (55% in 2013 versus 74% in 2018). Referred patients were predominantly male (> 60% in all 5 years) between the ages of 45 and 65 years. Reasons for consultation remained consistent and included: opioids (33%), stimulants (30%), alcohol (23%) and cannabis use (8%). Conclusions: After St Paul's Hospital in Vancouver, Canada was restructured in 2014 to a large, interdisciplinary addiction medicine consultation service (AMCS), the AMCS saw a 228% increase in the number of consultation requests with more than half of requests originating from the emergency department. Approximately two‐thirds of consultation requests were for opioid or stimulant use. [ABSTRACT FROM AUTHOR]

Introduction: Novel psychoactive substances (NPS) are increasingly being consumed worldwide, with synthetic cannabinoids and synthetic opioids being the second and third most commonly used NPS, respectively. Certain synthetic cannabinoids can produce significant harms, particularly when used with opioids. The objective of this study was to characterise the presence of synthetic cannabinoids in the unregulated drug supply in three Canadian settings Methods: In the British Columbia setting, all samples were first analysed at point‐of‐care using combination Fourier‐transform infrared (FTIR) spectroscopy and fentanyl immunoassay strips prior to confirmatory testing using quantitative nuclear magnetic resonance spectroscopy, gas chromatography/mass spectrometry (GC/MS) and/or liquid chromatography/mass spectrometry (LC/MS). In the Toronto, Ontario setting, the samples were analysed directly by GC/MS, LC/MS liquid chromatography‐high resolution/mass spectrometry. Results: Between January 2018 and December 2019, 38 (2.8%) synthetic cannabinoid samples were detected in the unregulated drug supply (25/909 in British Columbia and 13/440 in Ontario). In British Columbia and Ontario, 76% and 85% of samples, respectively, were expected by individuals to be an opioid. Synthetic cannabinoids detected included AMB‐FUBINACA, AB‐FUBINACA, 5‐fluoro‐MDMB‐PINACA, and 5‐fluoro‐MDMB‐PICA, and largely co‐occurred with fentanyl. In the British Columbia context, Fourier‐transform infrared spectroscopy failed to detect synthetic cannabinoid compounds in almost half (48%) of the samples at point‐of‐care. Discussion and Conclusions: As point‐of‐care technologies failed to detect these compounds in many occasions, our findings demonstrate the importance of laboratory confirmatory analysis to identify NPS. Given the high risk of harm associated with the consumption of synthetic cannabinoids, further research should investigate the reasons for adulteration. [ABSTRACT FROM AUTHOR]

Introduction and Aims: People who use illicit drugs (PWUD) are vulnerable to an array of negative health outcomes, and increased hospital services utilisation. PWUD are also a transient population which poses challenges to the provision of optimal health care. The objective of this study was to identify out-migration patterns from Vancouver's Downtown Eastside (DTES), a neighbourhood where services for PWUD are concentrated, and to estimate the impact of these patterns on hospitalisation events among PWUD.Design and Methods: Data were collected through three prospective cohorts of PWUD in Vancouver, which were linked with health administrative data. Latent class growth analysis was used to define migration trajectory groups. Poisson regression was used to estimate the effect of migration patterns on hospitalisation events.Results: A total of 1180 participants were included in the study. Four latent classes were identified: early migration out (243, 20.6%); frequent revisit (112, 9.5%); late migration out (219, 18.6%); and consistently living in the DTES (606, 51.4%). Compared with those who consistently lived in the DTES, participants in the early migration out group had lower hospitalisation events (adjusted rate ratio = 0.65; 95% confidence interval: 0.48-0.90).Discussion and Conclusion: We found that PWUD who migrated out of the DTES early had lower hospitalisation events compared to those who consistently lived in the DTES, which may be a function of lesser addiction severity among this trajectory group. These findings underscore a need to provide transitional health and social service supports for other trajectory groups in an effort to minimise hospitalisation for preventable causes. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Drug checking is a harm reduction intervention increasingly used in the context of the opioid overdose epidemic. The aim of the study was to determine the limit of detection for fentanyl of two point-of-care drug checking technologies.Design and Methods: Samples tested at point-of-care using Bruker Fourier transform infrared (FTIR) spectroscopy and BTNX fentanyl immunoassay strips were sent for confirmatory laboratory analysis using quantitative nuclear magnetic resonance (qNMR) spectroscopy. Concentrations by weight were determined and compared to results obtained with point-of-care methods.Results: In total, 283 samples were sent for qNMR analysis; among these, 173 (61.1%) tested positive for fentanyl. As determined by qNMR, fentanyl concentration by weight ranged from 1% to 91%. Among these 173 samples, fentanyl was not detected in 30 (17.3%) samples by FTIR and in 4 (2.3%) samples by test strip. Samples containing fentanyl that went undetected by FTIR had concentrations ≤10%. The four samples containing fentanyl that went undetected by test strip had concentrations ≤5% (i.e. 1%, 3%, 4%, 5%).Discussion and Conclusions: Fentanyl immunoassay strips were able to consistently detect the presence of fentanyl in samples at lower concentrations than FTIR spectroscopy. Given that FTIR spectroscopy is able to quantify content, mixture and concentrations on an array of compounds beyond just fentanyl but requires concentrations generally greater than 10%, these findings provide evidence for use of FTIR spectroscopy and immunoassay strips in combination to compensate for the limitations of each technology alone. [ABSTRACT FROM AUTHOR]

Introduction and Aims: People who inject drugs (PWID) are a key group within the hepatitis C virus (HCV) pandemic. Chronic pain is a common condition among PWID as these individuals are often exposed to soft tissue infections due to injections and violence. This study aims to characterise the relationship between HCV exposure and pain among PWID.Design and Methods: Data were derived from three prospective cohorts of PWID in Vancouver, Canada, between December 2011 and November 2016. The primary outcome was pain severity, which was defined based on the Euroqol EQ-5D-3L pain subscale. A bivariable and multivariable ordinal generalised estimating equations model was used to quantify the association between HCV exposure and pain among participants.Results: One thousand and twelve of 2038 participants (50%) reported moderate/extreme pain at baseline. In total, 1473 (72%) participants were HCV-antibody positive. In unadjusted analyses, HCV exposure was positively associated with increased pain [odds ratio (OR) = 1.47; 95% confidence interval (CI): 1.20-1.81]. However, once adjusted for known confounders in multivariable analyses, HCV exposure did not remain significantly associated with increased pain (adjusted OR = 1.00; 95%CI: 0.78-1.28).Discussion and Conclusions: In this sample of PWID, HCV exposure was not significantly associated with pain once other factors were considered. These various factors may explain the elevated risk of pain among PWID and should be addressed in future initiatives when managing pain among PWID with HCV exposure. Future studies should also examine whether pain changes with changes in HCV status (i.e. active vs. cleared infection). [ABSTRACT FROM AUTHOR]

Background & Aims: Despite the high burden of hepatitis C virus (HCV) infection among people who inject drugs (PWID), uptake of interferon‐based therapies has been extremely low. Increasing availability of direct‐acting antiviral (DAA)‐based therapies offers the possibility of rapid treatment expansion with the goal of controlling the HCV epidemic. We evaluated DAA‐based treatment uptake among HCV‐positive PWID in Vancouver after introduction of DAAs in the government drug formulary. Methods: Using data from three cohorts of PWID in Vancouver, Canada, we investigated factors associated with DAA‐therapies uptake among participants with HCV between April 2015 and November 2017. Results: Of the 915 HCV‐positive PWID, 611 (66.8%) were recent PWID and 369 (40.3%) had HIV coinfection. During the study period, 146 (16.0%) initiated DAA‐therapies, a rate of 6.0 per 100 person‐year, with higher initiation rates among non‐recent PWID and an increasing trend over time. In multivariable analysis, HIV coinfection (Adjusted Odds Ratio [AOR] = 2.29, 95% Confidence Interval [CI]: 1.55‐3.40), white race (AOR = 1.56, 95% CI: 1.05‐2.35), and engagement in HCV care (AOR = 1.94, 95% CI: 1.31‐2.90) were positively associated with DAA‐therapies uptake, while high‐risk drinking (AOR = 0.47, 95% CI: 0.23‐0.88) and daily crack use were negatively associated (AOR = 0.41, 95% CI: 0.17‐0.85). Among recent PWID, engagement in opioid agonist therapy emerged as an independent correlate of DAA uptake. Conclusions: Despite increases in HCV treatment uptake among PWID after the introduction of DAAs in our setting, disparities in access remain. Social‐structural and behavioural barriers to HCV care should be addressed for the success of any HCV elimination strategy. [ABSTRACT FROM AUTHOR]

The article discusses ways to address the growing problem of prescription opioid misuse and illicit use in hospital settings. These include monitoring inappropriate opioid prescribing in hospitals, training in addiction medicine and pain management, and treating patients with opioid use disorder. Also mentioned are statistics on opioid-related death around the world, and the benefit of utilizing a prescription drug monitoring program.

Introduction and Aims: Strategies are needed to transition persons who inject drugs out of injecting. We undertook this study to identify protective factors associated with cessation of injection drug use.Design and Methods: Data were derived from three prospective cohorts of people who use illicit drugs in Vancouver, Canada, between September 2005 and November 2011. Generalised estimating equations were used to examine protective factors and 6-month cessation of injection drug use.Results: Our sample of 1663 people who inject drugs included 563 (33.9%) women, and median age was 40 years. Overall, 904 (54.4%) individuals had at least one 6-month injection cessation event. In multivariable analysis, protective factors associated with cessation of injection drug use included the following: having a regular place to stay [adjusted odds ratio (AOR) = 1.30; 95% confidence interval (CI) 1.13-1.48]; formal employment (AOR = 1.12; 95% CI 1.01-1.23); social support from personal contacts (AOR = 1.22; 95% CI 1.10-1.35); social support from professionals (AOR = 1.26; 95% CI 1.14-1.39); ability to access health and social services (AOR = 1.21; 95% CI 1.09-1.34); and positive self-rated health (AOR = 1.21, 95% CI 1.11-1.32).Discussion and Conclusions: Over half of people who inject drugs in this study reported achieving 6-month cessation of injection drug use, with cessation being associated with a range of modifiable protective factors. Policy makers and practitioners should promote increased access to stable housing, employment, social support and other services to promote cessation of injection drug use. [Luchenski S, Ti L, Hayashi K, Dong H, Wood E, Kerr T. Protective factors associated with short-term cessation of injection drug use among a Canadian cohort of people who inject drugs Drug Alcohol Rev 2016;35:620-627]. [ABSTRACT FROM AUTHOR]

Introduction and Aims: While persons with addiction are often hospitalised, hospitals typically employ abstinence-based policies specific to illicit drug use. Although illicit drug use is known to occur within hospitals, this problem has not been well characterised. Therefore, we sought to investigate the prevalence of and factors associated with having ever used drugs in hospital among people who use drugs in Vancouver, Canada.Design and Methods: Data were derived from prospective cohort studies of people who use drugs between December 2012 and May 2013. Multivariable logistic regression was used to identify demographic and behavioural factors associated with having ever used illicit drugs in hospital.Results: Among 1028 participants who had experienced ≥1 hospitalisation, 43.9% reported having ever used drugs while hospitalised. In multivariable analyses, factors positively associated with having ever used drugs in hospital included daily cocaine injection and daily crack non-injection (both P < 0.05). Factors negatively associated with the outcome included older age and male gender (both P < 0.05). The most common reasons for drug use in hospital were 'wanting to use' and 'being in withdrawal'. Drugs were most commonly used in patient washrooms.Discussion and Conclusions: Our findings demonstrate that an abstinence-based approach to drug use in hospitals may be ineffective at prohibiting drug consumption. High-risk drug use behaviours arising from ongoing drug use may pose risks for further harm and illness. Efforts to minimise the harms associated with using drugs in hospital are urgently needed. [Grewal HK, Ti L, Hayashi K, Dobrer S, Wood E, Kerr T. Illicit drug use in acute care settings. Drug Alcohol Rev 2015;34:499-502]. [ABSTRACT FROM AUTHOR]

Introduction and Aims Strategies to promote the reduction and cessation of injection drug use are central to human immunodeficiency virus prevention and treatment efforts globally. Though drug use cessation is a major focus of drug policy in Thailand, little is known about factors associated with injection cessation and relapse in this setting. Design and Methods A cross-sectional study was conducted between July and October 2011 of a community-recruited sample of people who inject drugs in Bangkok, Thailand. Using multivariate logistic regression, we examined the prevalence and correlates of injection drug use cessation with subsequent relapse. Results Among 422 participants, 209 (49.5%) reported a period of injection drug use cessation of at least one year. In multivariate analyses, incarceration (adjusted odds ratio [ AOR] 13.07), voluntary drug treatment ( AOR 2.75), midazolam injection ( AOR 2.48) and number of years since first injection ( AOR 1.07) were positively associated with injection cessation of duration greater than a year (all P < 0.05). Exposure to compulsory drug detention was positively associated ( AOR 2.61) and methadone treatment was negatively associated ( AOR 0.38) with short-term cessation only. Injection drug use cessation was most often due to incarceration (74%), and relapse was associated with release from prison (66%). Discussion and Conclusion Half of the study participants had previously stopped injecting drugs for more than a year, and this was strongly associated with incarceration. Compulsory drug detention was associated with short-term cessation and relapse. A range of evidence-based strategies should be made available to facilitate sustained cessation of injection drug use in Thailand. [Fairbairn N, Hayashi K, Ti L, Kaplan K, Suwannawong P, Wood E, Kerr T. Compulsory drug detention and injection drug use cessation and relapse in Bangkok, Thailand. Drug Alcohol Rev 2015;34:74-81] [ABSTRACT FROM AUTHOR]

Introduction and Aims The injection of illicit drugs in public spaces is known to pose significant health risks to people who inject drugs ( IDU). However, to our knowledge this practice has not been explored in the Asian context. Therefore, we sought to characterise the prevalence of and factors associated with public injecting among a community-recruited sample of IDU in Bangkok, Thailand. Design and Methods Data were derived from the Mitsampan Community Research Project between July and October 2011. Using multivariate logistic regression, this cross-sectional study examined the prevalence and correlates of public injecting within the past six months among 437 IDU participants. Results In total, 121 (27.7%) participants reported injecting drugs in a public space within the past six months. In multivariate analyses, public drug injection was independently associated with male gender [adjusted odds ratio ( AOR) 2.51, 95% confidence interval ( CI)) 1.29-5.22], weekly heroin injection ( AOR 2.19, 95% CI 1.27-3.77), assisted injection ( AOR 1.93, 95% CI 1.06-3.49), rushed injection ( AOR 4.36, 95% CI 2.65-7.24), incarceration ( AOR 2.27, 95% CI 1.01-5.04) and noticing police presence where drugs are bought or used ( AOR 1.83, 95% CI 1.06-3.19). Discussion and Conclusion A substantial proportion of Thai IDU in our sample reported recent public drug injection. This behaviour was independently associated with a wide range of individual and contextual factors that pose significant health and safety risks to the IDU. These findings highlight the importance of addressing the broader social and physical risk environment surrounding IDU as a means of preventing negative health outcomes among this population. [Leung LTF, Ti L, Hayashi K, Suwannawong P, Kaplan K, Wood E, Kerr T. Health and safety risks associated with public injecting among people who inject drugs in Bangkok, Thailand. Drug Alcohol Rev 2013;32:582-587] [ABSTRACT FROM AUTHOR]

Aims To identify the prevalence and correlates of midazolam injection among injecting drug users in Thailand. Design Serial cross-sectional mixed-methods study. Setting Bangkok, Thailand. Participants A total of 435 adults who had injected drug(s) in the past 6 months were recruited through peer outreach and word of mouth in Bangkok in 2011. Measurements Multivariable logistic regression was used to analyze self-reported data collected through an interviewer-administered survey in July- October 2011 ( n = 435). Additionally, qualitative data were collected in June- July 2009 ( n = 10) and analyzed to explore the health problems attributable to midazolam injection. Findings Among 435 survey participants, the prevalence of daily midazolam injection in the past 6 months was 37.0% (95% confidence interval: 32-42). While 75.8% of the daily midazolam injectors identified heroin as their drug of choice, 91.8% of these individuals reported substituting heroin with midazolam when heroin was unavailable. In multivariable analyses, daily midazolam injection was associated with femoral vein injection [adjusted odds ratio ( AOR) = 4.48], polydrug use ( AOR = 4.94), daily heroin injection ( AOR = 3.25), binge use ( AOR = 1.75) and perceived increase in policing pressure ( AOR = 1.95) (all P < 0.05). Qualitative accounts indicated severe health problems associated with midazolam injection, including nerve and vascular injuries. Conclusion Midazolam misuse is increasing among injecting drug users in Bangkok and appears to be used primarily as a substitute for heroin. Midazolam injection was associated independently with various risk factors for injection-related complications. Given the many deleterious effects of midazolam injection, novel interventions for midazolam injectors are needed urgently. [ABSTRACT FROM AUTHOR]

Introduction and Aims. Crack cocaine pipe sharing is associated with various health-related harms, including hepatitis C transmission. Although difficulty accessing crack pipes has been found to predict pipe sharing, little is known about the factors that limit pipe access in settings where pipes are provided at no cost, albeit in limited capacity. Therefore, we investigated crack pipe access among people who use drugs in Vancouver, Canada. Design and Methods. Data were collected through two Canadian prospective cohort studies. Generalised estimating equations with logit link for binary outcomes were used to identify factors associated with difficulty accessing crack pipes. Results. Among 914 participants who reported using crack cocaine, 33% reported difficulty accessing crack pipes. In multivariate analyses, factors independently associated with difficulty accessing crack pipes included: sex work involvement [adjusted odds ratio (AOR) = 1.57; 95% confidence interval (CI): 1.03-2.39], having shared a crack pipe (AOR = 1.69; 95% CI: 1.32-2.16), police presence where one buys/uses drugs (AOR = 1.47; 95% CI: 1.10-1.95), difficulty accessing services (AOR = 1.74; 95% CI: 1.31-2.32) and health problems associated with crack use (AOR = 1.37; 95% CI: 1.04-1.79). Reasons given for difficulty accessing pipes included sources being closed (48.2%) and no one around selling pipes (18.1%). Discussion and Conclusions. A substantial proportion of people who smoke crack cocaine report difficulty accessing crack pipes in a setting where pipes are available at no cost but in limited quantity. These findings indicate the need for enhanced efforts to distribute crack pipes and address barriers to pipe access.[Ti L, Buxton J, Wood E, Shannon K, Zhang R, Montaner J, Kerr T. Factors associated with difficulty accessing crack cocaine pipes in a Canadian setting. Drug Alcohol Rev 2012;31:890-896] [ABSTRACT FROM AUTHOR]

This study assessed the influences of CVT-E002, a proprietary extract of North American ginseng, Panax quinquefolius (Afexa Life Sciences, Inc., Edmonton, AB, Canada), in vivo, on murine hemopoietic and immune cells when administered as a dietary additive. The extract was given daily to young, adult mice for a period of 4 weeks, immediately following which one group was euthanized and the hemopoietic and immune cells of their bone marrow, spleen and blood were assayed for CVT-E002-mediated alterations in any of five cell lineages (lymphocytes, nucleated erythroid cells, granulocytes, immature granuloid precursors and monocytes). Another group of these mice was left for a subsequent 8 weeks on control diet, following which the same organs and cell lineages were analysed. In another study, juvenile mice immediately upon weaning (age: 4 weeks), were subjected to the above protocol, and their organs/cell lineages assayed. The results revealed that CVT-E002 had a long-lasting, positive quantitative effect on the lymphocytes and monocytes, regardless of age at commencement of daily, dietary CVT-E002. CVT-E002 may therefore have a prophylactic disease defense, immunostimulatory role, or potentially, even a therapeutic role. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Aims: Despite the significant burden of alcohol use disorder (AUD) and availability of safe and effective medications for AUD (MAUD), population-level estimates of access and engagement in AUD-related care are limited. The aims of this study were to generate a cascade of care for AUD in British Columbia (BC), Canada, and to estimate the impacts of MAUD on health outcomes., Design: This was a retrospective population-based cohort study using linked administrative health data., Setting: British Columbia, Canada, 2015-2019., Participants: Using a 20% random sample of BC residents, we identified 7231 people with moderate-to-severe alcohol use disorder (PWAUD; overall prevalence = 0.7%)., Measurements: We developed a six-stage AUD cascade (from diagnosis to ≥6 months retention in MAUD) among PWAUD. We evaluated trends over time and estimated the impacts of access to MAUD on AUD-related hospitalizations, emergency department visits and death., Findings: Between 2015 and 2019, linkage to AUD-related care decreased (from 80.4% to 46.5%). However, rates of MAUD initiation (11.4% to 24.1%) and retention for ≥1 (7.0% to 18.2%), ≥3 (1.2% to 4.3%) or ≥6 months (0.2% to 1.6%) increased significantly. In adjusted analyses, access to MAUD was associated with reduced odds of experiencing any AUD-related adverse outcomes, with longer retention in MAUD showing a trend to greater odds reduction: adjusted odds ratio (95% CI) ranging from 0.59 (0.48-0.71) for MAUD retention <1 month to 0.37 (0.21-0.67) for ≥6 months retention., Conclusions: Access to medications for alcohol use disorder among people with moderate-to-severe alcohol use disorder in British Colombia, Canada increased between 2015 and 2019; however, initiation and retention remained low. There was a trend between longer retention in medications for alcohol use disorder and greater reductions in the odds of experiencing alcohol use disorder-related adverse outcomes., (© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)