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Abstract Background Methods Results Conclusion Mothers whose child’s death is related to substance use have emerged as prominent and outspoken critics of Canadian drug policy in the news media. We examined the extent to which, and who among, the general public has seen or heard mothers bereaved by substance use in the media; predicted factors associated with exposure to such media; and explored associations with public acceptance of harm reduction.We analyzed data from a 2018 online panel survey assessing Canadian views on harm reduction, using randomly-drawn provincially representative (N = 4645) and nationally representative (n = 2002) samples of adults.A majority (58.3%) of Canadians had seen or heard media featuring a mother whose child had died from an overdose. Respondents who had an increased level of familiarity with people who use drugs as well as older respondents were significantly more likely to have reported exposure to bereaved mothers’ media. Respondents who had been exposed to bereaved mothers’ media coverage were less likely to respond ‘don’t know/no opinion’ of harm reduction vs. opposing harm reduction.Additional studies using a variety of methods are required to further evaluate the advocacy work being undertaken by mothers bereaved by substance use. [ABSTRACT FROM AUTHOR]

BackgroundParents play a central role in preventing childhood obesity. There is a need for innovative, scalable, and evidence-based interventions designed to enhance parents’ motivation to support and sustain healthy lifestyle behaviors in their children, which can facilitate obesity prevention. Objective(1) Develop an online screening, brief intervention, and referral to treatment (SBIRT) eHealth tool to enhance parents’ concern for, and motivation to, support children’s healthy lifestyle behaviors, (2) refine the SBIRT eHealth tool by assessing end-user acceptability, satisfaction, and usability through focus groups, and (3) determine feasibility and preliminary effectiveness of the refined SBIRT eHealth tool through a randomized controlled trial. MethodsThis is a three-phase, multi-method study that includes SBIRT eHealth tool development (Phase I), refinement (Phase II), and testing (Phase III). Phase I: Theoretical underpinnings of the SBIRT tool, entitled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), will be informed by concepts applied within existing interventions, and content will be based on literature regarding healthy lifestyle behaviors in children. The SBIRT platform will be developed in partnership between our research team and a third-party intervention development company. Phase II: Focus groups with parents, as well as health care professionals, researchers, and trainees in pediatrics (n=30), will explore intervention-related perceptions and preferences. Qualitative data from the focus groups will inform refinements to the aesthetics, content, structure, and function of the SBIRT. Phase III: Parents (n=200) of children—boys and girls, 5 to 17 years old—will be recruited from a primary care pediatric clinic while they await their children’s clinical appointment. Parents will be randomly assigned to one of five groups—four intervention groups and one control group—as they complete the SBIRT. The randomization function is built into the tool. Parents will complete the eHealth SBIRT using a tablet that will be connected to the Internet. Subsequently, parents will be contacted via email at 1-month follow-up to assess (1) change in concern for, and motivation to, support children’s dietary and physical activity behaviors (primary outcome), and (2) use of online resources and referrals to health services for obesity prevention (secondary outcome). ResultsThis research was successfully funded and received ethics approval. Development of the SBIRT started in summer 2012, and we expect all study-related activities to be completed by fall 2016. ConclusionsThe proposed research is timely and applies a novel, technology-based application designed to enhance parents concern for, and motivation to, support children’s healthy lifestyle behaviors and encourage use of online resources and community services for childhood obesity prevention. Overall, this research builds on a foundation of evidence supporting the application of SBIRTs to encourage or “nudge” individuals to make healthy lifestyle choices. Findings from Phase III of this project will directly inform a cluster randomized controlled trial to study the effectiveness of our intervention across multiple primary care-based settings. Trial RegistrationClinicalTrials.gov NCT02330588; http://clinicaltrials.gov/ct2/show/NCT02330588 (Archived by WebCite at http://www.webcitation.org/6WyUOeRlr).

Background and aims: Fentanyl is primarily responsible for the current phase of the overdose epidemic in North America. Despite the benefits of treatment with medications for opioid use disorder (MOUD), there are limited data on the association between fentanyl, MOUD type and treatment engagement. The objectives of this analysis were to measure the impact of baseline fentanyl exposure on initiation and discontinuation of MOUD among individuals with prescription‐type opioid use disorder (POUD). Design, setting and participants: Secondary analysis of a Canadian multi‐site randomized pragmatic trial conducted between 2017 and 2020. Of the 269 randomized participants, 65.4% were male, 67.3% self‐identified as white and 55.4% had a positive fentanyl urine drug test (UDT) at baseline. Fentanyl‐exposed participants were more likely to be younger, to self‐identify as non‐white, to be unemployed or homeless and to be currently using stimulants than non‐fentanyl‐exposed participants. Interventions: Flexible take‐home dosing buprenorphine/naloxone or supervised methadone models of care for 24 weeks. Measurements: Outcomes were (1) MOUD initiation and (2) time to (a) assigned and (b) overall MOUD discontinuation. Independent variables were baseline fentanyl UDT (predictor) and assigned MOUD (effect modifier). Findings Overall, 209 participants (77.7%) initiated MOUD. In unadjusted analyses, fentanyl exposure was associated with reduced likelihood of treatment initiation [odds ratio (OR) = 0.18, 95% confidence interval (CI) = 0.08–0.36] and shorter median times in assigned [20 versus 168 days, hazard ratio (HR) = 3.61, 95% CI = 2.52–5.17] and any MOUD (27 versus 168 days, HR = 3.32, 95% CI = 2.30–4.80). The negative effects were no longer statistically significant in adjusted models, and no interaction between fentanyl and MOUD was observed for any of the outcomes (all P > 0.05). Conclusions: Both buprenorphine/naloxone and methadone may be appropriate treatment options for people with prescription‐type opioid use disorder regardless of fentanyl exposure. Other characteristics of fentanyl‐exposed individuals appear to be driving the association with poorer treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: Extensive exposure to prescription-type opioids has resulted in major harm worldwide, calling for better-adapted approaches to opioid agonist therapy. The authors aimed to determine whether flexible take-home buprenorphine/naloxone is as effective as supervised methadone in reducing opioid use in prescription-type opioid consumers with opioid use disorder.Methods: This seven-site, pan-Canadian, 24-week, pragmatic, open-label, noninferiority, two-arm parallel randomized controlled trial involved treatment-seeking adults with prescription-type opioid use disorder. Participants were randomized in a 1:1 ratio to treatment with sublingual buprenorphine/naloxone (target dosage, 8 mg/2 mg to 24 mg/6 mg per day; flexible take-home dosing) or oral methadone (≈60-120 mg/day; closely supervised). The primary outcome was the proportion of opioid-free urine drug screens over 24 weeks (noninferiority margin, 15%). All randomized participants were analyzed, excluding one who died shortly after randomization, for the primary analysis (modified intention-to-treat analysis).Results: Of 272 participants recruited (mean age, 39 years [SD=11]; 34.2% female), 138 were randomized to buprenorphine/naloxone and 134 to methadone. The mean proportion of opioid-free urine drug screens was 24.0% (SD=34.4) in the buprenorphine/naloxone group and 18.5% (SD=30.5) in the methadone group, with a 5.6% adjusted mean difference (95% CI=-0.3, +∞). Participants in the buprenorphine/naloxone group had 0.47 times the odds (95% CI=0.24, 0.90) of being retained in the assigned treatment compared with those in the methadone group. Overall, 24 drug-related adverse events were reported (12 in the buprenorphine/naloxone group [N=8/138; 5.7%] and 12 in the methadone group [N=12/134; 9.0%]) and mostly included withdrawal, hypogonadism, and overdose.Conclusions: The buprenorphine/naloxone flexible model of care was safe and noninferior to methadone in reducing opioid use among people with prescription-type opioid use disorder. This flexibility could help expand access to opioid agonist therapy and reduce harms in the context of the opioid overdose crisis. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We compared the health-related quality of life (HRQL) of Aboriginal and non-Aboriginal HIV patients after they started highly active antiretroviral therapy (HAART) in Edmonton, Alberta and investigated whether clinical status (CD4 cell count and viral load) might explain any observed differences. METHODS: In 2006-2007, eligible patients who started HAART in 1997-2005 completed the MOS-HIV to measure HRQL. Using multiple linear regression models, we compared physical (PHS) and mental (MHS) health summary scores across four groups: Aboriginals infected with HIV via injection drug use (AB/IDUs); Aboriginal non-IDUs (AB/non-IDUs); non- Aboriginal IDUs (non-AB/IDUs); and non-Aboriginal non-IDUs (non-AB/non-IDUs). To assess whether clinical status could explain any observed group differences, we fitted a model adjusting for socio-demographics (age and sex) and years since starting HAART only and then additionally adjusted for current clinical status. RESULTS: Ninety-six patients were eligible (35% Aboriginal, 42% IDU). Adjusting for socio-demographics and years since starting HAART, AB/IDUs (p=0.008), AB/non-IDUs (p=0.002), and non-AB/IDUs (p=0.002) had lower PHS scores than non- AB/non-IDUs. After additionally adjusting for clinical status, these relationships remained significant for AB/non-IDUs (p=0.027) and non-AB/IDUs (p=0.048) but not for AB/IDUs (p=0.12). AB/IDUs and non AB/IDUs tended to have worse MHS scores than non-AB/non-IDUs, but these relationships were not statistically significant and weakened after adjusting for current clinical status. CONCLUSIONS: AB/IDU, AB/non-IDUs, and non-AB/IDUs had significantly poorer physical HRQL than non-AB/non-IDUs. These differences appear to be partially explained by poorer clinical status, especially for AB/IDUs, which suggests that observed inequalities in physical HRQL may be diminished by improving patients' clinical status; for example, through improved adherence to HAART. KEY WORDS: Aboriginal populations; antiretroviral therapy, highly active; intravenous drug users; treatment outcomes; health-related quality of life OBJECTIF : Nous avons compare la qualite de vie liee a la sante (QVLS) de patients autochtones et non autochtones atteints du VIH apres le debut d'une therapie antiretrovirale hautement active (TAHA) a Edmonton (Alberta) et cherche a savoir si leur etat clinique (numeration des lymphocytes CD4 et charge virale) pouvait expliquer les differences observees. METHODE : En 2006-2007, des patients admissibles ayant entame une TAHA en 1997-2005 ont rempli le questionnaire MOS-HIV, qui mesure la QVLS. A l'aide de modeles de regression lineaire multiple, nous avons compare les cotes sommaires de sante physique (CSP) et de sante mentale (CSM) de quatre groupes : les Autochtones infectes par le VIH via l'utilisation de drogues par injection (Aut./UDI); les Autochtones non-UDI (Aut./non-UDI); les non-Autochtones UDI (non-Aut./UDI); et les non-Autochtones non-UDI (non-Aut./non-UDI). Pour determiner si l'etat clinique pouvait expliquer les differences observees entre ces groupes, nous avons adapte un modele en tenant compte des caracteristiques sociodemographiques (age et sexe) et du nombre d'annees depuis le debut de la TAHA seulement, puis en tenant compte, en plus, de l'etat clinique actuel. RESULTATS : Quatre-vingt-seize patients etaient admissibles (35 % d'Autochtones, 42 % d'UDI). Compte tenu des caracteristiques sociodemographiques et du nombre d'annees depuis le debut de la TAHA, les Aut./UDI (p=0,008), les Aut./non-UDI (p=0,002) et les non-Aut./UDI (p=0,002) avaient des cotes CSP inferieures a celles des non-Aut./non-UDI. En tenant aussi compte de l'etat clinique, ces relations demeuraient significatives pour les Aut./non-UDI (p=0,027) et les non-Aut./UDI (p=0,048), mais pas pour les Aut./UDI (p=0,12). Les Aut./UDI et les non-Aut./UDI avaient tendance a presenter des CSM inferieures a celles des non-Aut./non-UDI, mais ces relations n'etaient pas significatives, et elles s'affaiblissaient apres la prise en consideration de l'etat clinique actuel. CONCLUSION : La QVLS physique des Aut./UDI, des Aut./non-UDI et des non-Aut./UDI etait significativement inferieure a celle des non-Aut./non-UDI. Ces differences semblent s'expliquer en partie par un moins bon etat clinique, surtout pour les Aut./UDI, ce qui laisse entendre que les inegalites observees dans la QVLS physique peuvent etre reduites si l'on ameliore l'etat clinique des patients, par exemple en ameliorant l'observance de la TAHA. MOTS CLES : populations autochtones; therapie antiretrovirale hautement active; toxicomanie intraveineuse; resultat therapeutique; qualite de vie liee a la sante, In Canada, Aboriginals and non-Aboriginals infected with HIV do not appear to receive equal benefit from highly active antiretroviral therapy (HAART). After starting HAART, Aboriginals have been shown to experience [...]