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Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To evaluate the impact of depressive symptom severity on opioid use and treatment retention in individuals with prescription-type opioid use disorder (POUD). We analyzed data from a multi-centric, pragmatic, open-label, randomized controlled trial comparing buprenorphine/naloxone to methadone models of care in 272 individuals with POUD. Opioid use was self-reported every two weeks for 24 weeks using the Timeline Followback. Depressive symptom severity was self-reported with the Beck Depression Inventory at baseline, week 12 and week 24. Baseline depressive symptom severity was not associated with opioid use nor treatment retention. At week 12, moderate depressive symptoms were associated with greater opioid use while mild to severe depressive symptoms were associated with lowered treatment retention. At week 24, moderate depressive symptoms were associated with greater opioid use. Ongoing depressive symptoms lead to poorer outcomes in POUD. Clinicians are encouraged to use integrative approaches to optimize treatment outcomes. This study was registered in ClinicalTrials.gov (NCT03033732) on January 27th, 2017, prior to participants enrollment. [ABSTRACT FROM AUTHOR]

This document is a position paper published by the Canadian Journal of Psychiatry, providing updated curriculum guidelines for training in substance use disorders (SUDs) in psychiatry. The paper highlights the limited training in SUDs compared to other psychiatric disorders, despite the increasing prevalence of SUDs in psychiatric care settings. It emphasizes the importance of psychiatry residents developing the necessary knowledge, skills, and attitudes for managing patients with SUDs. The paper also discusses the challenges in training, such as a shortage of experienced faculty and negative attitudes towards patients with SUDs. It provides recommendations for clinical content, seminar content, and clinical rotations and entrustable professional activities (EPAs) related to SUDs. The goal is to promote uniform knowledge, skill, and attitude development for residents nationally. [Extracted from the article]

In this invited commentary, we provide an overview of safer opioid supply (SOS) initiatives, specifically aiming to examine the evidence base for SOS programs and the ensuing implications for clinical practice, particularly in the context of psychiatric care. Plain Language Summary Title: What Psychiatrists Should Know About Prescribed Safer Opioid Supply Plain Language Summary: In this invited commentary, we provide an overview of safer opioid supply (SOS) initiatives, specifically aiming to examine the evidence base for SOS programs and the ensuing implications for clinical practice, particularly in the context of psychiatric care. [ABSTRACT FROM AUTHOR]

Fentanyl and fentanyl analogues, such as carfentanil, are driving an opioid overdose crisis in North America. (1) In 2019 alone, there were 3831 opioid-related deaths in Canada (2) and 47,600 [...]

Background: Prescription-type opioid use disorder (POUD) is often accompanied by comorbid anxiety, yet the impact of anxiety on retention in opioid agonist therapy (OAT) is unclear. Therefore, this study investigated whether baseline anxiety severity affects retention in OAT and whether this effect differs by OAT type (methadone maintenance therapy (MMT) vs. buprenorphine/naloxone (BNX)). Methods: This secondary analysis used data from a pan-Canadian randomized trial comparing flexible take-home dosing BNX and standard supervised MMT for 24 weeks. The study included 268 adults with POUD. Baseline anxiety was assessed using the Beck Anxiety Inventory (BAI), with BAI ≥ 16 indicating moderate-to-severe anxiety. The primary outcomes were retention in assigned and any OAT at week 24. In addition, the impact of anxiety severity on retention was examined, and assigned OAT was considered an effect modifier. Results: Of the participants, 176 (65%) reported moderate-to-severe baseline anxiety. In adjusted analyses, there was no significant difference in retention between those with BAI ≥ 16 and those with BAI < 16 assigned (29% vs. 28%; odds ratio (OR) = 2.03, 95% confidence interval (CI) = 0.94–4.40; P = 0.07) or any OAT (35% vs. 34%; OR = 1.57, 95% CI = 0.77–3.21; P = 0.21). In addition, there was no significant effect modification by OAT type for retention in assigned (P = 0.41) or any OAT (P = 0.71). In adjusted analyses, greater retention in treatment was associated with BNX (vs. MMT), male gender identity (vs. female, transgender, or other), enrolment in the Quebec study site (vs. other sites), and absence of a positive urine drug screen for stimulants at baseline. Conclusions: Baseline anxiety severity did not significantly impact retention in OAT for adults with POUD, and there was no significant effect modification by OAT type. However, the overall retention rates were low, highlighting the need to develop new strategies to minimize the risk of attrition from treatment. Clinical Trial Registration: This study was registered in ClinicalTrials.gov (NCT03033732). [ABSTRACT FROM AUTHOR]