Browsing by Author "Kolla, Gillian"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis
    (International Journal of Drug Policy, 2023) Karamouzian, Mohammad; Rafat, Bijan; Kolla, Gillian; Urbanoski, Karen; Atkinson, Kate; Bardwell, Geoff; Bonn, Matthew; Touesnard, Natasha; Henderson, Nancy; Bowles, Jeanette; Boyd, Jade; Brunelle, Caroline; Eeuwes, Jolene; Fikowski, Jill; Gomes, Tara; Guta, Adrian; Hyshka, Elaine; Ivsins, Andrew; Kennedy, Mary Clare; Laurence, Gab; Martignetti, Lucas; Nafeh, Frishta; Salters, Kate; Tu, David; Strike, Carol; Pauly, Bernie; Werb, Dan
    Background Canada is experiencing an unprecedented drug toxicity crisis driven by a highly toxic unregulated drug supply contaminated with fentanyl, benzodiazepine, and other drugs. Safer supply pilot programs provide prescribed doses of pharmaceutical alternatives to individuals accessing the unregulated drug supply and have been implemented to prevent overdose and reduce related harms. Given the recent emergence of these pilot programs and the paucity of data on implementation challenges, we sought to document challenges in their initial implementation phase. Methods We obtained organizational progress reports from Health Canada, submitted between 2020 and 2022 by 11 pilot programs located in British Columbia, Ontario, and New Brunswick. We analyzed the data using deductive and inductive approaches via thematic analysis. Analyses were informed by the consolidated framework for implementation research. Results We obtained 45 progress reports from 11 pilot programs. Six centres were based in British Columbia, four in Ontario, and one in New Brunswick. Four overarching themes were identified regarding the challenges faced during the establishment and implementation of pilot programs: i) Organizational features (e.g., physical space constraints, staff shortages); ii) Outer contexts (e.g., limited operational funds and resources, structural inequities to access, public perceptions); iii) Intervention characteristics (e.g., clients’ unmet medication needs); and iv) Implementation process (e.g., pandemic-related challenges, overly medicalized and high-barrier safer supply models). Conclusions Safer supply pilot programs in Canada face multiple inner and outer implementation challenges. Given the potential role of safer supply programs in addressing the drug toxicity crisis in Canada and the possibility of future scale-up, services should be well-supported during their implementation phases. Refining service provision within safer supply programs based on the feedback and experiences of clients and program administrators is warranted, along with efforts to ensure that appropriate medications are available to meet the clients’ needs.
  • Thumbnail Image
    Item
    Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis
    (International Journal of Drug Policy, 2023) Karamouzian, Mohammad; Rafat, Bijan; Kolla, Gillian; Urbanoski, Karen; Atkinson, Kate; Bardwell, Geoff; Bonn, Matthew; Touesnard, Natasha; Henderson, Nancy; Bowles, Jeanette; Boyd, Jade; Brunelle, Caroline; Eeuwes, Jolene; Fikowski, Jill; Gomes, Tara; Guta, Adrian; Hyshka, Elaine; Ivsins, Andrew; Kennedy, Mary Clare; Laurence, Gab; et al.
    Background: Canada is experiencing an unprecedented drug toxicity crisis driven by a highly toxic unregulated drug supply contaminated with fentanyl, benzodiazepine, and other drugs. Safer supply pilot programs provide prescribed doses of pharmaceutical alternatives to individuals accessing the unregulated drug supply and have been implemented to prevent overdose and reduce related harms. Given the recent emergence of these pilot programs and the paucity of data on implementation challenges, we sought to document challenges in their initial implementation phase. Methods: We obtained organizational progress reports from Health Canada, submitted between 2020 and 2022 by 11 pilot programs located in British Columbia, Ontario, and New Brunswick. We analyzed the data using deductive and inductive approaches via thematic analysis. Analyses were informed by the consolidated framework for implementation research. Results: We obtained 45 progress reports from 11 pilot programs. Six centres were based in British Columbia, four in Ontario, and one in New Brunswick. Four overarching themes were identified regarding the challenges faced during the establishment and implementation of pilot programs: i) Organizational features (e.g., physical space constraints, staff shortages); ii) Outer contexts (e.g., limited operational funds and resources, structural inequities to access, public perceptions); iii) Intervention characteristics (e.g., clients’ unmet medication needs); and iv) Implementation process (e.g., pandemic-related challenges, overly medicalized and high-barrier safer supply models). Conclusions: Safer supply pilot programs in Canada face multiple inner and outer implementation challenges. Given the potential role of safer supply programs in addressing the drug toxicity crisis in Canada and the possibility of future scale-up, services should be well-supported during their implementation phases. Refining service provision within safer supply programs based on the feedback and experiences of clients and program administrators is warranted, along with efforts to ensure that appropriate medications are available to meet the clients’ needs.
  • Thumbnail Image
    Item
    Characteristics, treatment patterns and retention with extended-release subcutaneous buprenorphine for opioid use disorder: A population-based cohort study in Ontario, Canada
    (Drug and Alcohol Dependence, 2023) Iacono, Anita; Wang, Tianru; Tadrous, Mina; Campbell, Tonya; Kolla, Gillian; Leece, Pamela; Sproule, Beth; Kleinman, Robert A.; Besharah, Jes; Munro, Charlotte; Doolittle, McCaffrey; Gomes, Tara
    Background: Uptake and retention for opioid agonist treatment (OAT) remains low. Novel extended-release formulations may improve OAT accessibility by reducing the frequency of healthcare visits. Our aim was to examine uptake, characteristics, treatment patterns and retention of individuals initiating extended-release subcutaneous buprenorphine (BUP-ER), a monthly injectable OAT. Methods: We conducted a population-based cohort study among adults aged 18+ initiated on BUP-ER between February 3, 2020 and March 31, 2022 in Ontario, Canada. Using administrative health data, we defined continuous BUP-ER use based on repeat injections within a 56-day period and used Kaplan-Meier curves to estimate time on treatment. Among new BUP-ER recipients, we described individual and prescriber characteristics, healthcare utilization and treatment patterns. Results: 2366 individuals initiated BUP-ER. The median time to BUP-ER discontinuation was 183 days (interquartile range: 66–428 days) and 52.0% of individuals were co-prescribed buprenorphine/naloxone at least once throughout the period of BUP-ER receipt. Among individuals who initiated on a dose of 300mg BUP-ER and had three or more injections, 18.8% continued to receive only 300mg doses (N=276 of 1470). Furthermore, 28.6% of those whose dose was reduced to 100mg (N=341 of 1194) had a subsequent dose increase to 300mg. Conclusions: On average, people initiating BUP-ER discontinue within the first 6 months of treatment. While BUP-ER is likely providing an important OAT option, the high occurrence of discontinuation, supplementation with buprenorphine/naloxone, and frequent dose increases suggest inadequacy of current dosing recommendations among a proportion of individuals.
  • Thumbnail Image
    Item
    Disease-related stigma among people who inject drugs in Toronto amidst the COVID-19 pandemic
    (Drug and Alcohol Dependence Reports, 2023) Bowles, Jeanette M.; Kolla, Gillian; Smith, Laramie R.; Scheim, Ayden; Dodd, Zoe; Werb, Dan
    Background: Stigma overwhelmingly affects people who inject drugs. The COVID-19 pandemic posed unique challenges for people who inject drugs, who are already stigmatized as being “dangerous and spreading disease.” The present study explored ways in which stigma was experienced by a sample of people who inject drugs in Toronto, Canada following COVID-related public health precaution measures. Methods: Qualitative interviews were conducted with people who inject drugs (n = 24) recruited from supervised consumption sites in Toronto, Canada. The semi-structured interview guide focused on the impact of COVID-19 on participants’ health and social well-being. Interviews took place six-months after initial COVID-19 precautions (September-October 2020). We used thematic analysis to examine findings, with stigma being an emergent theme. Results: Participants described heightened acts of stigma after COVID-19 restrictions were implemented, including feeling treated as “diseased” and the cause of COVID-19′s spread. They reported being less likely to receive emergency care during events such as overdoses. Participants perceived increased disease-related stigma evident through actions of stigma, including amplified dehumanization by the public, others avoiding all contact with them, and more discrimination by police and hospital systems. Conclusion: Participants provided specific examples of how stigmatizing behaviors harmed them after COVID-19 precautions began. It is plausible that stigma contributed to the dramatic increase in fatal overdoses, difficulty accessing housing, and further difficulty accessing needed healthcare in our setting. Integrating evidence-based harm reduction approaches in areas where stigma is evident might offset harms stemming from disease-related stigma and mitigate these harms during future public health emergencies.
  • Thumbnail Image
    Item
    “If it wasn’t for them, I don’t think I would be here”: Experiences of the first year of a safer supply program during the dual public health emergencies of COVID-19 and the drug toxicity crisis
    (Harm Reduction Journal, 2024) Kolla, Gillian; Pauly, Bernie; Cameron, Fred; Hobbs, Heather; Ranger, Corey; McCall, Jane; Majalahti, Jerry; Toombs, Kim; LeMaistre, Jack; Selfridge, Marion; Urbanoski, Karen
    In response to the devastating drug toxicity crisis in Canada driven by an unregulated opioid supply predominantly composed of fentanyl and analogues, safer supply programs have been introduced. These programs provide people using street-acquired opioids with prescribed, pharmaceutical opioids. We use six core components of safer supply programs identified by people who use drugs to explore participant perspectives on the first year of operations of a safer supply program in Victoria, BC, during the dual public health emergencies of COVID-19 and the drug toxicity crisis to examine whether the program met drug-user defined elements of an effective safer supply model.
 
University of Victoria Libraries

We acknowledge and respect the Lək̓ʷəŋən (Songhees and Esquimalt) Peoples on whose territory the university stands, and the Lək̓ʷəŋən and W̱SÁNEĆ Peoples whose historical relationships with the land continue to this day.