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People who use substances (PWUS) (e.g. inject substances) are at risk of many harms. Various services help reduce risks including drug treatment programs such as withdrawal management and opioid agonist treatment. Much of the research on PWUS' experiences of treatment programs is set in large urban centers creating a knowledge gap of experiences in other places. Our study helps address this gap by exploring PWUS' experiences of treatment programs in Atlantic Canada which is a region with many small urban centers and rural areas. One-on-one qualitative interviews were conducted with 55 PWUS focusing on their experiences of treatment program facilitators (or what helped with access and retention), and/or barriers to treatment access and retention (or what was not helpful). Data were analyzed for key themes/subthemes and organized using a slightly modified Rhodes' risk environment framework. PWUS' experiences of facilitators and barriers cross all four environments of treatment programs: policy and practice, physical, social, and resource environments. For some PWUS, barriers impacted their access to or retention in treatment, and hence are of serious concern given the current toxic illicit drug supply in Canada. Several barriers are shaped by drug criminalization and thus this research points to the need for decriminalization to help reduce barriers. [ABSTRACT FROM AUTHOR]

Introduction: We present a 1-year program evaluation of the Medical Withdrawal Support Service (MWSS) provided at the Sioux Lookout Meno Ya Win Health Centre. The centre's service area includes 4 rural municipalities and 28 First Nations communities. The program involves inpatient detoxification for opioid dependence with the use of buprenorphine--naloxone. Methods: Data were collected from preadmission interviews (i.e., medical history, substance use history, previous counselling, social history, previous addiction treatment and screening tools used during the interview); discharge forms (i.e., length of stay, maximum dose of prescribed buprenorphine--naloxone and client goals); and postdischarge interviews. Results: Overall, 81% of the clients successfully completed the program. Two weeks after discharge, 48% of clients reported continued abstinence. At 3-month follow-up, 32% were abstinent, and at 6 months, 30% were abstinent. Conclusion: The MWSS shows positive outcomes for many clients, their families and communities. Clients returned to work and school, became more engaged in healthy meal preparation and exercise, spent more time with family and were more involved as leaders in their communities. Introduction : Nous presentons levaluation dun programme dun an offert par les Medical Withdrawal Support Services (MWSS) au Centre de sante Sioux Lookout Meno Ya Win. La zone desservie par le Centre englobe 4 municipalites rurales et 28 communautes des Premieres Nations. Il s'agit dun programme de desintoxication au moyen de buprenorphine--naloxone offert en etablissement a des patients qui souffrent dune dependance aux opiaces. Methodes : Des donnees ont ete recueillies a partir d'entrevues precedant l'admission (incluant antecedents medicaux, antecedents de toxicomanie, therapies anterieures, histoire sociale, traitements anterieurs contre les dependances et outils de depistage appliques en cours d'entrevue), des sommaires d'hospitalisation (c.-a-d., duree du sejour, dose maximum de buprenorphine--naloxone prescrite et objectifs du client) et d'entrevues consecutives au conge. Resultats : Dans l'ensemble, 81 % des clients ont termine le programme avec succes. Deux semaines apres leur conge, 48 % des clients disaient etre demeures abstinents. Au suivi de 3 mois, 32 % etaient encore abstinents et apres 6 mois, 30 % l'etaient toujours. Conclusion : Les MWSS donnent des resultats positifs pour de nombreux clients, leurs familles et les communautes. Les clients sont retournes au travail ou a lecole, ont adopte de meilleures habitudes en ce qui concerne la preparation de repas sante et la pratique d'exercice, ont passe plus de temps en famille et ont davantage agi comme leaders dans leur communaute., INTRODUCTION This article presents the findings of a 1-year inpatient program evaluation of the Medical Withdrawal Support Service (MWSS) provided at the Sioux Lookout Meno Ya Win Health Centre in [...]

This paper explores Canadian professionals' engagement in licit, illicit, and pharmaceutical substance use, their perspectives on what constitutes professional misconduct and conduct unbecoming in relation to substance use, and the dilemmas they face around self-disclosure in the context of professional regulation and social expectations. The study involved semi-structured, dialogical interviews with n = 52 professionals. Key findings are: (i) professionals do indeed use and have a history of using licit, illicit, and pharmaceutical substances, (ii) there is lack of consensus about expectations for professional conduct of substance use in one's private life and an apparent lack of knowledge about legislation, jurisdiction of regulatory bodies, workplace policy, and workplace rights, and (iii) professionals use high discretion about personal disclosure of substance use to mitigate risk to public reputation and professional standing. Given the real potential for negative consequences associated with self-disclosure of substance use, professionals modify their use to be more consistent with perceived social standards and/or protect knowledge about their use from public disclosure. This can perpetuate assumptions that substance use by professionals is "unbecoming" and risks basing decisions and policies on incomplete and inadequate knowledge. Societally, classist ideologies that position professionals as distinct from non-professionals are reified. [ABSTRACT FROM AUTHOR]

The aim of this research was to explore how the concept of harm is constituted in case law judicial decisions pertaining to the importation, production, possession, and trafficking of drugs in Canada using critical discourse analysis methodology. The research was designed to uncover taken-for-granted assumptions about drugs and associated harms. The data source for this study is judicial decisions. These are published texts where judge(s) summarize details about the factors considered, provide a reasoned interpretation of sentencing principles relevant to the judicial decision, and explain the rationale for their decision. Initially, codes were identified deductively, using words related to drugs and harm. Codes were added when incidents of moralization language were observed to be high. Moralization language was defined as “the usage of language cues referencing moral values”. The selection process resulted in n = 129 judicial decisions meeting the inclusion criteria. Discourse analysis was guided by four tools described by Gee’s study: the significance tool, the why this way and not that way tool, the connections tool, and the intertextuality tool. Emergent themes are: (1) trafficking as an immoral enterprise; (2) scourge to society, (3) fentanyl and harm, and (4) constructing gravity. This study uncovers discursive practices in many judicial decisions that convey the (re)production of institutionalized stigma. High reliance on legal tropes about drug harms, harm of trafficking, moral culpability associated with distribution of some drugs, by some people, in some ways, and a lack of contextual awareness of social inequities that influence the lives of Canadians perpetuates legal interpretations that support rationales for sentence predicated on denunciation and deterrence. [ABSTRACT FROM AUTHOR]

Summary Benzodiazepine receptor agonists are often used for insomnia in older adults contrary to current evidence. The harms outweigh the benefits, which are limited. Cognitive behavioural therapy for insomnia is the first‐line recommended treatment. Sleepwell was created as a repository of evidence‐based resources to promote cognitive behavioural therapy for insomnia and limit benzodiazepine receptor agonist use. This qualitative study uses an interpretive description design and reflexive thematic analysis to explore older adults' perspectives on behavioural change techniques used in Sleepwell resources. It also explores challenges and opportunities towards benzodiazepine receptor agonist discontinuation and cognitive behavioural therapy for insomnia use. Participants were recruited from the Sleepwell arm of a randomized controlled trial. Data were collected from 15 older adults using semi‐structured interviews. Two main themes were developed: (1) sleep should not be this difficult; and (2) whether you know it, or learn it, drugs are bad. Two sub‐themes were created within the first theme: (1) justification of benzodiazepine receptor agonist use to achieve sleep goals; (2) efforts of committing to cognitive behavioural therapy for insomnia. Several behavioural change techniques (e.g. information about consequences, anticipated regret, salience of consequences) were enablers of benzodiazepine receptor agonist‐related behaviour change. For committing to cognitive behavioural therapy for insomnia, several behavioural change techniques (e.g. self‐monitoring of behaviour, distraction, stimulus substitution) were beneficial, but social support, which was perceived as useful, was absent. Older adults experienced tension with benzodiazepine receptor agonist use and deprescribing, despite knowing or learning the potential consequences of benzodiazepine receptor agonists. Cognitive behavioural therapy for insomnia implementation was challenging. Embedded behavioural change techniques in the Sleepwell booklets were identified as helpful, but more (e.g. social support) are needed to optimize cognitive behavioural therapy for insomnia use. [ABSTRACT FROM AUTHOR]

Background and aims: This literature review investigates the scope of information regarding self-reported substance use by professionals and students in professional programs, with a focus on anticipated and actual effects of substances. Methods: A review of English, peer-reviewed journals and professional journals was conducted. Articles were included if they reported empirical findings of original research and specifically described an aspect of substance use (e.g. type of substance used, patterns of use, reasons for use) by professionals or students. Results: Of the 130 articles ultimately included, 105 involved anonymous self-administered survey methodology. Self-reported data about the effects of substance use or reasons for use were reported in 35 articles. Reasons for use included positive impact on performance and experience, such as fun, pleasure, sleep, enhanced work performance, improved attention and concentration, and relaxation. Predictive associations were analysed regarding demographic factors, mental health, type of profession, and area of specialisation. Conclusions: Little is known about the effects of substance use on the performance or experience of professionals or students in professional programs. Research is required that incorporates qualitative methodologies, elicits anticipated and actual effects of substance use, including controlled and beneficial patterns of use. Minimisation of research bias is key to future study of the effects of substance use by professionals or students in professional programs. [ABSTRACT FROM AUTHOR]

This article reports the findings of an online survey designed to collect information about substance use (licit, illicit, or pharmaceutical) and mental health (depression or anxiety) among social workers. Among the 489 participants, Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) screenings indicated symptoms of depression and anxiety at a higher prevalence than those of the general Canadian population. There were relatively few correlations between mental health scores and substance use. PHQ-9 total score significantly predicted past-year antidepressant use and past-year sleeping medication use. GAD-7 total score significantly predicted past-year benzodiazepine use and past-year melatonin use. Effects of substances (e.g., cannabis, alcohol, benzodiazepines, cocaine, ecstasy) were predominantly beneficial or nonproblematic (e.g., enjoyment/pleasure; socializing enhanced; concentration/focus improved). Subjective experiences of social workers should be sought to understand potential relationships between mental health scores and enhancement effects of substance use. Substances are being used, at least in part, for their performance-enhancing effects to meet the expectations of day-to-day life. Interventions can shift toward root causes, with institutions held more accountable for supporting social workers and promoting "workplace care.", (© 2024 National Association of Social Workers.)

Background: The responsibility for addressing the healthcare needs of PWUS is the responsibility of all physicians. Within the healthcare system, research consistently reveals inequitable experiences in healthcare with people who use substances (PWUS) reporting stigmatization, marginalization, and a lack of compassion., Objectives: The aim of this scoping review was to find and describe competencies being taught, developed, and fostered within medical education and then to provide recommendations to improve care for this population of patients., Results: Nineteen articles were included. Recommended knowledge competencies tend to promote understanding neurophysiological changes caused by substances, alongside knowing how to evaluate of 'risky' behaviours. Commonly recommended skills relate to the screening and management of substance use disorders. Recommended attitude competencies include identifying personal bias and establishing a patient-centered culture among practice teams. The disease model of addiction informed all papers, with no acknowledgement of potential beneficial or non-problematic experiences of substance use. To enhance knowledge-type competencies, medical education programs are advised to include addiction specialists as educators and prevent stigmatization through the hidden curriculum., Conclusion: To reduce experiences of stigmatization and marginalization among patients who use illicit substances and to improve quality of care, knowledge, skills, and attitudes competencies can be more effectively taught in medical education programs.Résumé., Competing Interests: None, (© 2024 Ausman, Almatar, Kiepek; licensee Synergies Partners.)