Canadian Institute for Substance Use Research (CISUR)
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The Canadian Institute for Substance Use Research (CISUR), formerly CARBC, is a network of individuals and groups dedicated to the study of substance use and addiction in support of community-wide efforts to promote health and reduce harm. Our research is used to inform a broad range of projects, reports, publications and initiatives aimed at providing all people in Canada and beyond with access to happier, healthier lives, whether using substances or not. Read more about CISUR.
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Browsing Canadian Institute for Substance Use Research (CISUR) by Author "Anis, Aslam H"
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Item A chance to stop and breathe: participants’ experiences in the North American Opiate Medication Initiative clinical trial(Addiction Science & Clinical Practice, 2014-09-29) Oviedo-Joekes, Eugenia; Marchand, Kirsten; Lock, Kurt; Chettiar, Jill; Marsh, David C.; Brissette, Suzanne; Anis, Aslam H; Schechter, Martin TBackground: The North American Opiate Medication Initiative (NAOMI) clinical trial compared the effectiveness of injectable diacetylmorphine (DAM) or hydromorphone (HDM) to oral methadone maintenance treatment (MMT). This study aimed to determine participants’ perceptions of treatment delivered in NAOMI. Methods: A qualitative sub-study was conducted with 29 participants (12 female): 18 (62.1%) received injectable DAM or HDM and 11 (37.9%) received MMT. A phenomenological theoretical framework was used. Semi-structured interviews were audio-recorded and transcribed verbatim. A thematic analysis was used over successive phases and was driven by the semantic meanings of the data. Results: Participants receiving injectable medications suggested that the supervised delivery model was stringent but provided valuable stability to their lives. Females discussed the adjustment required for the clinical setting, while males focused on the challenging clinic schedule and its impact on employment abilities. Participants receiving MMT described disappointment with being randomized to this treatment; however, positive aspects, including the quick titration time and availability of auxiliary services, were also discussed. Conclusion: Treatment with injectable DAM (or HDM) is preferred by participants and considered effective in reducing the burden of opioid dependency. Engaging patients in research regarding their perceptions of treatment provides a comprehensive assessment of treatment needs and barriers. Clinical trial registration: NCT00175357Item Differential long-term outcomes for voluntary and involuntary transition from injection to oral opioid maintenance treatment(Substance Abuse Treatment, Prevention, and Policy, 2014-06-08) Oviedo-Joekes, Eugenia; Guh, Daphne; Marchand, Kirsten; Marsh, David C.; Lock, Kurt; Brissette, Suzanne; Anis, Aslam H; Schechter, Martin TBackground: The most widely used maintenance treatment for opioid dependency is substitution with long-acting oral opioids. Treatment with injectable diacetylmorphine provides an opportunity for patients to stabilize and possibly transition to oral treatment, if clinically indicated. The aim of this study was to explore outcomes of individuals that received injectable diacetylmorphine and voluntarily transitioned to oral methadone. Design and methods: The North American Opiate Medication Initiative was a randomized controlled trial that compared the effectiveness of injectable diacetylmorphine (or hydromorphone) to oral methadone for long-term opioid-dependency. Treatment was provided for 12-months with an additional 3 months for transition and weaning. Participants were followed until 24-months from randomization. Among the participants randomized to injectable treatments, a sub-group voluntarily chose to transition to oral methadone (n = 16) during the treatment period. Illicit heroin use and treatment retention were assessed at 24-months for those voluntarily and involuntarily transitioning (n = 95) to oral methadone. Results: At 24-months, the group that voluntarily transitioned to oral methadone had higher odds of treatment retention (adjusted odds ratio = 5.55; 95% confidence interval [CI] = 1.11, 27.81; Chi-square = 4.33, df = 1, p-value = 0.037) than the involuntary transition group. At 24-months, the adjusted mean difference in prior 30 days of illicit heroin use for the voluntary, compared to the involuntary group was −5.58 (95% CI = −11.62, 0.47; t-value = −1.83, df = 97.4, p-value = 0.070). Conclusions: Although the results of this study were based on small groups of self-selected (i.e., non-randomized) participants, our data underlines the critical importance of voluntary and patient-centered decision making. If we had continued offering treatment with diacetylmorphine, those retained to injectable medication may have sustained the achieved improvements in the first 12 months. Diversified opioid treatment should be available so patients and physicians can flexibly choose the best treatment at the time. Trial registration: Clinical Trial Registration: NCT00175357