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Objectives: This study explores therapists' perspectives on experiential learning, competencies, and training in ketamine-assisted therapy (KAT), a form of psychedelic-assisted therapy (PAT). We aim to understand how therapists' personal psychedelic experiences influence their self-perceived competency and therapeutic relationships regarding KAT. Methods: Licensed therapists from Numinus Wellness clinics in Canada and the USA who were trained in KAT were invited to participate in the study. Participation included a 60–90-minute semi-structured interview conducted remotely via secure videoconferencing. The interviews focused on the professional and personal impacts of providing KAT, its mechanisms, and the role of therapists' personal psychedelic experiences in delivering KAT. Data analysis utilized Interpretative Phenomenological Analysis (IPA) and a mix of deductive and inductive coding with Nvivo software. Results: Eight therapists (62.5% female, 37.5% male) were interviewed. All had formal training in KAT, with many also trained in other forms of PAT. All respondents endorsed the value of personal psychedelic experience for deepening understanding of clients' experiences and strengthening the therapeutic alliance. They all also expressed a desire for formal experiential training in KAT, which they viewed as a missing element in their training. Additional themes identified included the importance of relational safety and the therapeutic container, KAT's impact on professional development, competency, and purpose, and navigating risks and challenges in KAT, particularly with complex trauma clients. Conclusions: Our findings highlight the need for enhanced therapist training and evidence-based standardization of PAT programs that incorporate experiential learning. Such training has the potential to optimize safety and therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Many individuals living with HIV use natural health products (NHPs) in an effort to decrease medication side effects and to enhance overall well‐being. Methods: An active surveillance study of adult patients (≥ 18 years) with HIV was conducted between 2012 and 2014 to detect prescription drug and NHP use and associated adverse events (AEs) in the last month. Results: Of the 167 participants, 85 (50.9%) took prescription medications only, three (1.8%) took NHPs only, 75 (44.9%) took NHPs and prescription medications concurrently, and four (2.4%) took neither. Patients who used both prescription drugs and NHPs concurrently were more than three times more likely to experience an AE compared with those who used prescription drugs only (OR, P = 0.003, 95% CI: 1.47–6.91). Conclusions: Increased AEs are reported in patients with HIV who combine NHPs and prescription medications, and no serious AEs were reported. Active surveillance was found to be feasible in this clinical setting. [ABSTRACT FROM AUTHOR]

Aims: The association between depression and poor medication adherence is based on cross‐sectional studies and cohort studies that measure adherence rates after depression status is determined. However, depressive symptoms occur well before diagnosis. This study examined adherence patterns in the year before a depressive episode. Methods: This retrospective cohort study followed new metformin users identified in Alberta Health's administrative data between 2008 and 2018. Depressive episodes starting ≥1 year after metformin initiation were identified using a validated case definition. Controls were randomly assigned a pseudo depression date. Adherence to oral antihyperglycemic medications was estimated using proportion of days covered (PDC) and group‐based trajectory models to explore the association between depression and poor adherence (PDC<0.8). Results: A depressive episode occurred in 17,418 (10.6%) of 165,056 new metformin users. Individuals with depression were more likely to have poor adherence compared to controls (adjusted odds ratio 1.21; 95% CI 1.17, 1.26). Five trajectories were identified: nearly perfect adherence (PDC >0.95 [34.8% of cohort]), discontinued (PDC=0 [18.3% of cohort], poor initial adherence (PDC 0.75) that declined either rapidly (9.2% of cohort) or gradually (30.1% of cohort), and poor initial adherence (PDC 0.26) that increased gradually (7.6% of cohort). Individuals with depression were more likely to be in one of the four trajectories of poor adherence compared to controls (adjusted odds ratio 1.24; 95% CI 1.19‐1.29). Conclusions: Poor medication adherence occurs in the year before a depressive episode; therefore, poor medication use patterns could be used as an early warning sign for depression. [ABSTRACT FROM AUTHOR]

Background: In 2012, the Government of Alberta introduced a funding program to remunerate pharmacists to develop a comprehensive annual care plan (CACP) for patients with complex needs. The objective of this study is to explore patients' perceptions of the care they received through the pharmacist CACP program in Alberta., Methods: We invited 3442 patients who received a pharmacist-billed CACP within the previous 3 months and 6888 matched controls across Alberta to complete an online questionnaire. The questionnaire consisted of the short version Patient Assessment of Chronic Illness Care (PACIC-11), with 3 additional pharmacy-specific assessment questions added. Additional questions related to health status and demographics were also included., Results: Overall, most patients indicated a low level of chronic illness care by pharmacists, with few differences noted between CACP patients and non-CACP controls. Of note, controls reported higher quality of care for 5 domains within the adapted PACIC-like tool compared with CACP patients ( p < 0.05 for all). Interestingly, only 79 (44%) of CACP patients reported that they had received a CACP, whereas only 192 (66%) of control patients reported that they did not receive a care plan. In a sensitivity analysis including only these respondents, individuals who received a CACP perceived a significantly higher quality of chronic illness care across all PACIC domains., Conclusion: Overall, chronic illness care incentivized by the pharmacist CACP program in Alberta is perceived to be moderate to low. When limited to respondents who explicitly recognized receiving the service or not, the perceptions of quality of care were more positive. This suggests that better implementation of CACP by pharmacists may be associated with improved quality of care and that some redesign is needed to engage patients more. Can Pharm J (Ott) 2021;154:xx-xx., Competing Interests: Declaration of Conflicting Interests: Dr. Tsuyuki has received grants for investigator-initiated research from Merck Canada and Sanofi Canada and has consulted for Shoppers Drug Mart and Emergent BioSolutions. All other authors declare no relevant conflicts of interest or financial relationships., (© The Author(s) 2021.)

Background: Pharmacists play an important role in managing patients with prescription drug abuse and addiction (PDAA). The objective of this study was to explore Alberta pharmacists' practices, views and confidence in the management of patients at risk of or living with PDAA in their practice setting., Methods: A 26-question online questionnaire was distributed to 4261 pharmacists across Alberta, of whom 656 (15%) participated. The questionnaire consisted of 17 multiple-choice, 6 multipart and 3 free-response questions. Questionnaire responses were collected and analyzed in Qualtrics., Results: Sixty-six percent ( n = 408) of pharmacists indicated that PDAA was prevalent in their practice setting, with 55% ( n = 340) of respondents encountering more than 6 patients with suspected or known PDAA a month. Thirty-five percent ( n = 198) of pharmacists indicated they were moderately confident at identifying patients with potential PDAA. However, 41% ( n = 235) of the pharmacists indicated that they only discuss PDAA with identified patients less than half of the time. Pharmacists lacked confidence in their ability to discuss PDAA treatment options with their patients as well as collaborate with addiction treatment facilities. Lack of training or knowledge in PDAA (48%) and uncertainty of how to initiate discussion or effectively communicate with patients about PDAA (39%) were identified as barriers that significantly or very significantly hindered respondents from managing PDAA in their practice., Conclusions: Although many pharmacists are moderately confident in identifying patients with potential PDAA, several barriers hinder intervention. Providing pharmacists with additional training and resources may better equip them to manage PDAA within their practice settings. Can Pharm J (Ott) 2019;152:xx-xx., Competing Interests: Declaration of Conflicting Interests:The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2019.)