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5. An emergency-department-initiated outreach program for patients with opioid use disorder is associated with an increase in agonist therapy and engagement in addictions care: a one-year cohort study

Author

Lakkadghatwala, Rukaiyah, Lane, Daniel, Scheuermeyer, Frank, Hilburt, Jesse, Buxton, Jane, Johnson, Cheyenne, Nolan, Seonaid, Sutherland, Christy, Moe, Jessica, Daoust, Raoul, Dong, Kathryn, Christenson, Jim, Miles, Isabelle, Orkin, Aaron, Whyte, Madelyn, and Kestler, Andrew

Published
2024
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8. The Cannabis-Dependent Relationship Between Methadone Treatment Dose and Illicit Opioid Use in a Community-Based Cohort of People Who Use Drugs.

Author

Lake, Stephanie, Kerr, Thomas, Buxton, Jane, Walsh, Zach, Cooper, Ziva, Socías, M, Fairbairn, Nadia, Hayashi, Kanna, and Milloy, M-J

Subjects
cannabis, cohort study, methadone, opioid agonist treatment, opioid use disorder, opioids, Humans, Adolescent, Methadone, Analgesics, Opioid, Cannabis, Opiate Substitution Treatment, Opioid-Related Disorders, Narcotics, Hallucinogens, Cannabinoid Receptor Agonists, Substance Withdrawal Syndrome, Cannabinoids
Abstract

Background: Methadone maintenance treatment (MMT) is an effective treatment for opioid use disorder. However, subtherapeutic dosing may lead to continued opioid use by failing to suppress opioid withdrawal and craving. Preclinical and pilot experimental research suggests that cannabinoids may reduce opioid withdrawal and craving. We sought to test whether the association between low methadone dose and illicit opioid use differs according to concurrent cannabis use patterns. Methods: Data for this study were derived from two community-recruited cohorts of people (≥18 years old) who use illicit drugs in Vancouver, Canada. We used generalized estimating equations to estimate the adjusted association between lower daily MMT dose (

Published
2023

9. Methadone Dose, Cannabis Use, and Treatment Retention: Findings From a Community-based Sample of People Who Use Unregulated Drugs.

Author

Lake, Stephanie, Buxton, Jane, Walsh, Zach, Cooper, Ziva, Socías, M, Fairbairn, Nadia, Hayashi, Kanna, and Milloy, M-J

Subjects
Humans, Methadone, Cannabis, Analgesics, Opioid, Opiate Substitution Treatment, Prospective Studies, Opioid-Related Disorders
Abstract

OBJECTIVES: Lower daily methadone dose is negatively associated with retention in methadone maintenance treatment (MMT). Cannabis use during MMT is common, with many patients reporting its use for opioid withdrawal mitigation. We sought to test whether the association between lower MMT dose and treatment retention differs by concurrent high-frequency cannabis use in a community sample of people on MMT. METHODS: We obtained data from participants initiating MMT in 2 community-recruited prospective cohorts of people who use drugs in Vancouver, Canada. We built multivariable Cox frailty models to estimate the relationships between MMT dose ( 0.05). Structural factors including homelessness and incarceration were significantly and positively associated with treatment discontinuation. CONCLUSIONS: Although we previously found the magnitude and strength of the relationship between lower MMT dose and high-frequency unregulated opioid use to be tempered during high-frequency cannabis use periods, this effect measure modification does not appear to translate to time retained in treatment. Cannabis-based interventions to promote retention in MMT are unlikely to produce long-term benefit without addressing external factors that place MMT patients at increased risk of treatment discontinuation.

Published
2023

14. Document d'orientation sur la distribution et l'utilisation de trousses de naloxone a emporter par les intervenants et intervenantes communautaires en cas de surdose au Canada

Author

Ferguson, Max, Rittenbach, Katherine, Leece, Pamela, Adams, Alison, Ali, Farihah, Elton-Marshall, Tara, Burmeister, Charlene, Brothers, Thomas D., Medley, Andrea, Choisil, Paul, Strike, Carol, Ng, Justin, Lorenzetti, Diane L., Gallant, Kat, and Buxton, Jane A.

Subjects
Naloxone, Health
Abstract

Contexte: La toxicite croissante des opioides dans le marche illicite des drogues a fait exploser le nombre de surdoses au Canada et ailleurs dans le monde; le programme de naloxone a emporter (NaE) est une intervention fondee sur des donnees probantes qui consiste a distribuer des trousses contenant de la naloxone aux membres de la communaute susceptibles d'etre temoins d'une surdose. L'objectif du present document d'orientation est de formuler des recommandations strategiques a l'intention des programmes federaux, provinciaux et territoriaux de NaE, en s'appuyant sur des donnees probantes issues de la documentation scientifique, de la litterature grise et des communautes, a la lumiere de 11 annees de distribution de NaE au Canada. Methodes: Le groupe d'elaboration des documents d'orientation sur la naloxone, une equipe multidisciplinaire composee de personnes ayant une expertise et une experience vecue en matiere de toxicomanie, a applique l'outil AGREE II (Appraisal of Guidelines for Research & Evaluation) afin d'eclairer l'elaboration du present document d'orientation. En vue de l'elaboration de nos recommandations, nous avons procede entre decembre 2021 et septembre 2022 a une revue systematique de tous les types d'ouvrages dans le but de recueillir les donnees probantes publiees, ainsi que les donnees probantes et l'expertise issues de la communaute. Nous avons sollicite des commentaires sur nos recommandations preliminaires par le biais d'un comite de revision externe et d'un processus de participation du public. Le projet a ete finance par les Instituts de recherche en sante du Canada dans le cadre de l'Initiative canadienne de recherche sur l'abus de substances (ICRAS). Nous avons applique les principes du Reseau international en matiere de lignes directrices (Guidelines International Network) pour gerer les interets concurrents. Recommandations: Les donnees probantes existantes issues de la documentation sur la NaE etaient de faible qualite. Pour elaborer nos recommandations, nous avons incorpore des donnees probantes tirees de la documentation scientifique et de la litterature grise, ainsi que l'expertise de la communaute. Nos recommandations portent sur 3 volets: les voies d'administration de la naloxone, le contenu des trousses de NaE et les interventions en cas de situations de surdose. Les trousses distribuees par les programmes de naloxone a emporter doivent offrir le choix entre les preparations intramusculaire et intranasale. Le contenu recommande de la trousse comprend la naloxone, un dispositif d'administration de la naloxone, un equipement de protection individuelle, des instructions et un etui de transport. Les intervenants et intervenantes communautaires formes a la reponse aux surdoses doivent prioriser la respiration artificielle en cas de depression respiratoire, et la reanimation cardiorespiratoire (RCR) conventionnelle en cas d'arret cardiaque, entre autres interventions. Interpretation: Ce projet d'elaboration d'un document d'orientation vise a guider les programmes de NaE au Canada dans un contexte ou les donnees probantes publiees sont rares; les recommandations ont ete elaborees en collaboration avec diverses parties prenantes., Les opioides soulagent la douleur et causent de l'euphorie en se fixant aux recepteurs opioides p dans le cerveau. Une personne qui absorbe une dose d'opioides (illegaux ou d'ordonnance) qui [...]

Published
2023
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23. Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis.

Author

Lake, Stephanie, Walsh, Zach, Kerr, Thomas, Cooper, Ziva D, Buxton, Jane, Wood, Evan, Ware, Mark A, and Milloy, MJ

Subjects
Humans, Cannabis, Pain, Opioid-Related Disorders, Analgesics, Analgesics, Opioid, Longitudinal Studies, Prospective Studies, Marijuana Smoking, Adult, Middle Aged, Canada, Female, Male, Pain Management, Chronic Pain, Medical Marijuana, Opioid, Pain Research, Clinical Research, Drug Abuse, Neurosciences, Substance Abuse, 2.1 Biological and endogenous factors, Medical and Health Sciences, General & Internal Medicine
Abstract

BACKGROUND:Ecological research suggests that increased access to cannabis may facilitate reductions in opioid use and harms, and medical cannabis patients describe the substitution of opioids with cannabis for pain management. However, there is a lack of research using individual-level data to explore this question. We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain. METHODS AND FINDINGS:This study included data from people in 2 prospective cohorts of PWUD in Vancouver, Canada, who reported major or persistent pain from June 1, 2014, to December 1, 2017 (n = 1,152). We used descriptive statistics to examine reasons for cannabis use and a multivariable generalized linear mixed-effects model to estimate the relationship between daily (once or more per day) cannabis use and daily illicit opioid use. There were 424 (36.8%) women in the study, and the median age at baseline was 49.3 years (IQR 42.3-54.9). In total, 455 (40%) reported daily illicit opioid use, and 410 (36%) reported daily cannabis use during at least one 6-month follow-up period. The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%). After adjusting for demographic characteristics, substance use, and health-related factors, daily cannabis use was associated with significantly lower odds of daily illicit opioid use (adjusted odds ratio 0.50, 95% CI 0.34-0.74, p < 0.001). Limitations of the study included self-reported measures of substance use and chronic pain, and a lack of data for cannabis preparations, dosages, and modes of administration. CONCLUSIONS:We observed an independent negative association between frequent cannabis use and frequent illicit opioid use among PWUD with chronic pain. These findings provide longitudinal observational evidence that cannabis may serve as an adjunct to or substitute for illicit opioid use among PWUD with chronic pain.

Published
2019

34. Receipt of Opioid Agonist Treatment in provincial correctional facilities in British Columbia is associated with a reduced hazard of nonfatal overdose in the month following release.

Author

McLeod, Katherine E., Buxton, Jane A., Karim, Mohammad Ehsanul, Martin, Ruth Elwood, Nosyk, Bohdan, Kurz, Megan, Scow, Marnie, Felicella, Guy, and Slaunwhite, Amanda K.

Subjects
*OPIOID abuse, *DRUG overdose, *OATS, *OPIOIDS, *PROVINCES
Abstract

Background: In many jurisdictions, policies restrict access to Opioid Agonist Treatment (OAT) in correctional facilities. Receipt of OAT during incarceration is associated with reduced risk of fatal overdose after release but little is known about the effect on nonfatal overdose. This study aimed to examine the association between OAT use during incarceration and nonfatal overdose in the 30 days following release. Methods and findings: Using linked administrative healthcare and corrections data for a random sample of 20% of residents of British Columbia, Canada we examined releases from provincial correctional facilities between January 1, 2015 –December 1, 2018, among adults (aged 18 or older at the time of release) with Opioid Use Disorder. We fit Andersen-Gill models to examine the association between receipt of OAT in custody and the hazard of nonfatal following release. We conducted secondary analyses to examine the association among people continuing treatment initiated prior to their arrest and people who initiated a new episode of OAT in custody separately. We also conducted sex-based subgroup analyses. In this study there were 4,738 releases of 1,535 people with Opioid Use Disorder. In adjusted analysis, receipt of OAT in custody was associated with a reduced hazard of nonfatal overdose (aHR 0.55, 95% CI 0.41, 0.74). This was found for prescriptions continued from community (aHR 0.49, 95%CI 0.36, 0.67) and for episodes of OAT initiated in custody (aHR 0.58, 95%CI 0.41, 0.82). The effect was greater among women than men. Conclusions: OAT receipt during incarceration is associated with a reduced hazard of nonfatal overdose after release. Policies to expand access to OAT in correctional facilities, including initiating treatment, may help reduce harms related to nonfatal overdose in the weeks following release. Differences in the effect seen among women and men indicate a need for gender-responsive policies and programming. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Women in the 2019 hepatitis C cascade of care: findings from the British Columbia Hepatitis Testers cohort study

Author

Pearce, Margo E., Bartlett, Sofia R., Yu, Amanda, Lamb, Jess, Reitz, Cheryl, Wong, Stanley, Alvarez, Maria, Binka, Mawuena, Velásquez Garcia, Héctor, Jeong, Dahn, Clementi, Emilia, Adu, Prince, Samji, Hasina, Wong, Jason, Buxton, Jane, Yoshida, Eric, Elwood, Chelsea, Sauve, Laura, Pick, Neora, Krajden, Mel, and Janjua, Naveed Z.

Published
2021
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45. Guidance on take-home naloxone distribution and use by community overdose responders in Canada

Author

Ferguson, Max, primary, Rittenbach, Katherine, additional, Leece, Pamela, additional, Adams, Alison, additional, Ali, Farihah, additional, Elton-Marshall, Tara, additional, Burmeister, Charlene, additional, Brothers, Thomas D., additional, Medley, Andrea, additional, Choisil, Paul, additional, Strike, Carol, additional, Ng, Justin, additional, Lorenzetti, Diane L., additional, Gallant, Kat, additional, and Buxton, Jane A., additional

Published
2023
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48. The impact of poisoning in British Columbia: a cost analysis

Author

Rajabali, Fahra, Turcotte, Kate, Zheng, Alex, Purssell, Roy, Buxton, Jane A., and Pike, Ian

Subjects
General Medicine
Abstract

Poisoning, from substances such as illicit drugs, prescribed and over-the-counter medications, alcohol, pesticides, gases and household cleaners, is the leading cause of injury-related death and the second leading cause for injury-related hospital admission in British Columbia. We examined the health and economic costs of poisoning in BC for 2016, using a societal perspective, to support public health policies aimed at minimizing losses to society.

Published
2023

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