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Item Canadian Institute for Substance Use Research Annual Report 2023-2024(Canadian Institute for Substance Use Research (CISUR), 2024) Canadian Institute for Substance Use Research (CISUR)Item Canadian Institute for Substance Use Research Annual Report 2022-2023(Canadian Institute for Substance Use Research (CISUR), 2023) Canadian Institute for Substance Use Research (CISUR)Item Canadian Institute for Substance Use Research Annual Report 2021-2022(Canadian Institute for Substance Use Research (CISUR), 2022) Canadian Institute for Substance Use Research (CISUR)Item Canadian Institute for Substance Use Research Annual Report 2019-2020(Canadian Institute for Substance Use Research (CISUR), 2020) Canadian Institute for Substance Use Research (CISUR)Item Canadian Institute for Substance Use Research Annual Report 2018-2019(Canadian Institute for Substance Use Research (CISUR), 2019) Canadian Institute for Substance User Research (CISUR)Item Canadian Institute for Substance Use Research Annual Report 2017-2018(Canadian Institute for Substance Use Research (CISUR), 2018) Canadian Institute for Substance Abuse Research (CISUR)Item Centre for Addictions Research of BC Annual Report 2016-2017(Centre for Addictions Research of BC, 2017) Centre for Addictions Research of BC (CARBC)Item Centre for Addictions Research of BC Annual Report 2015-2016(Centre for Addictions Research of BC, 2016) Centre for Addictions Research of BC (CARBC)Item Centre for Addictions Research of BC Annual Report 2014-2015(Centre for Addictions Research of BC, 2015) Centre for Addictions Research of BC (CARBC)Item Centre for Addictions Research of BC Annual Report 2013-2014(Centre for Addictions Research of BC (CARBC), 2014) Centre for Addictions Research of BC (CARBC)Item Centre for Addictions Research of BC Annual Report 2012-2013(Centre for Addictions Research of BC (CARBC), 2013) Centre for Addictions Research of BC (CARBC)Item A distributed model to expand the reach of drug checking(Drugs Habits and Social Policy, 2022) Wallace, Bruce; Gozdzialski, Lea; Qbaich, Abdelhakim; Azam, Md. Shafiul; Burek, Piotr; Hutchison, Abby; Teal, Taylor; Louw, Rebecca; Kielty, Collin; Robinson, Derek; Moa, Belaid; Storey, Margaret-Anne; Gill, Chris; Hore, Dennis K.Purpose – While there is increasing interest in implementing drug checking within overdose prevention, we must also consider how to scale-up these responses so that they have significant reach and impact for people navigating the unpredictable and increasingly complex drug supplies linked to overdose. The purpose of this paper is to present a distributed model of community drug checking that addresses multiple barriers to increasing the reach of drug checking as a response to the illicit drug overdose crisis. Design/methodology/approach – A detailed description of the key components of a distributed model of community drug checking is provided. This includes an integrated software platform that links a multi-instrument, multi-site service design with online service options, a foundational database that provides storage and reporting functions and a community of practice to facilitate engagement and capacity building. Findings – The distributed model diminishes the need for technicians at multiple sites while still providing point-of-care results with local harm reduction engagement and access to confirmatory testing online and in localized reporting. It also reduces the need for training in the technical components of drug checking (e.g. interpreting spectra) for harm reduction workers. Moreover, its real-time reporting capability keeps communities informed about the crisis. Sites are additionally supported by a community of practice. Originality/value – This paper presents innovations in drug checking technologies and service design that attempt to overcome current financial and technical barriers towards scaling-up services to a more equitable and impactful level and effectively linking multiple urban and rural communities to report concentration levels for substances most linked to overdose.Item Distributions of alcohol use and alcohol-caused death and disability in Canada: Defining alcohol harm density functions and new perspectives on the prevention paradox(Addiction, 2024) Sherk, Adam; Churchill, Samuel; Cukier, Samantha; Grant, Sierra C.; Shield, Kevin; Stockwell, TimAims: The aims of this study were to examine the distribution of alcohol use and to define ‘harm density functions’ representing distributions of alcohol-caused health harm in Canada, by sex, towards better understanding which groups of drinkers experience the highest aggregate harms. Design: This was an epidemiological modeling study using survey and administrative data on alcohol exposure, death and disability and risk relationships from epidemiological meta-analyses. Setting: This work took place in Canada, 2019. Participants: Canadians aged 15 years or older participated. Measurements: Measures included modeled life-time mean daily alcohol use in grams of pure alcohol (ethanol) per day, alcohol-caused deaths and alcohol-caused disability-adjusted life-years. Findings: As a life-time average, more than half of Canadians aged 15+ (62.8% females, 46.9% males) use fewer than 10 g of pure alcohol per day (g/day). By volume, the top 10% of the population consume 45.9% of the total ethanol among males and 47.1% of the total ethanol among females. The remaining 90% of the population experience a slim majority of alcohol-caused deaths (males 55.3%, females 46.9%). Alcohol harm density functions compose the size of the using population and the risk experienced at each volume level to show that the population-level harm experienced is highest for males at 25 g/day and females at 13 g/day. Conclusions: Almost 50% of alcohol use in Canada is concentrated among the highest 10% of drinkers, but more than half of the alcohol-caused deaths in Canada in 2019 were experienced by the bottom 90% of the population by average volume, providing evidence for the prevention paradox. New alcohol harm density functions provide insight into the aggregate health harm experienced across the mean alcohol use spectrum and may therefore be used to help determine where alcohol policies should be targeted for highest efficacy.Item Trends in alcohol-attributable hospitalisations and emergency department visits by age, sex, drinking group and health condition in Ontario, Canada(Drug and Alcohol Review, 2023) Smith, Brendan T.; Schoer, Nicole; Sherk, Adam; Thielman, Justin; McKnight, Anthony; Hobin, ErinIntroduction: Alcohol-attributable harms are increasing in Canada. We described trends in alcohol-attributable hospitalisations and emergency department (ED) visits by age, sex, drinking group, attribution and health condition. Methods: Hospitalisation and ED visits for partially or wholly alcohol-attributable health conditions by age and sex were obtained from population-based health administrative data for individuals aged 15+ in Ontario, Canada. Population-level alcohol exposure was estimated using per capita alcohol sales and alcohol use data. We estimated the number and rate of alcohol-attributable hospitalisations (2008–2018) and ED visits (2008–2019) using the International Model of Alcohol Harms and Policies (InterMAHP). Results: Over the study period, the modelled rates of alcohol-attributable health-care encounters were higher in males, but increased faster in females. Specifically, rates of alcohol-attributable hospitalisations and ED visits increased by 300% (19–76 per 100,000) and 37% (774–1,064 per 100,000) in females, compared to 20% (322–386 per 100,000) and 2% (2563–2626 per 100,000) in males, respectively. Alcohol-attributable ED visit rates were highest among individuals aged 15–34, however, increased faster among individuals aged 65+ (females: 266%; males: 44%) than 15–34 years (females:+17%; males: −16%). High-volume drinkers had the highest rates of alcohol-attributable health-care encounters; yet, low-/medium-volume drinkers contributed substantial hospitalisations (11%) and ED visits (36%), with increasing rates of ED visits in females drinking low/medium volumes. Discussion and Conclusions: Alcohol-attributable health-care encounters increased overall, and faster among females, adults aged 65+ and low-/medium-volume drinkers. Monitoring trends across subpopulations is imperative to inform equitable interventions to mitigate alcohol-attributable harms.Item Cost-effectiveness of a police education program on HIV and overdose among people who inject drugs in Tijuana, Mexico(The Lancet Regional Health - Americas, 2024) Cepeda, Javier A.; Beletsky, Leo; Abramovitz, Daniela; Saldana, Carlos Rivera; Kahn, James G.; Bañuelos, Arnulfo; Rangel, Gudelia; Arredondo, Jaime; Vickerman, Peter; Bórquez, Annick; Strathdee, Steffanie A.; Martin, Natasha K.Background: Incarceration is associated with drug-related harms among people who inject drugs (PWID). We trained >1800 police officers in Tijuana, Mexico on occupational safety and HIV/HCV, harm reduction, and decriminalization reforms (Proyecto Escudo). We evaluated its effect on incarceration, population impact and cost-effectiveness on HIV and fatal overdose among PWID. Methods: We assessed self-reported recent incarceration in a longitudinal cohort of PWID before and after Escudo. Segmented regression was used to compare linear trends in log risk of incarceration among PWID pre-Escudo (2012-2015) and post-Escudo (2016-2018). We estimated population impact using a dynamic model of HIV transmission and fatal overdose among PWID, with incarceration associated with syringe sharing and fatal overdose. The model was calibrated to HIV and incarceration patterns in Tijuana. We compared a scenario with Escudo (observed incarceration declines for 2 years post-Escudo among PWID from the segmented regression) compared to a counterfactual of no Escudo (continuation of stable pre-Escudo trends), assessing cost-effectiveness from a societal perspective. Using a 2-year intervention effect and 50-year time horizon, we determined the incremental cost-effectiveness ratio (ICER, in 2022 USD per disability-adjusted life years [DALYs] averted). Findings: Compared to stable incarceration pre-Escudo, for every three-month interval in the post-Escudo period, recent incarceration among PWID declined by 21% (adjusted relative risk = 0.79, 95% CI: 0.68-0.91). Based on these declines, we estimated 1.7% [95% interval: 0.7%-3.5%] of new HIV cases and 12.2% [4.5%-26.6%] of fatal overdoses among PWID were averted in the 2 years post-Escudo, compared to a counterfactual without Escudo. Escudo was cost-effective (ICER USD 3746/DALY averted compared to a willingness-to-pay threshold of $4842-$13,557). Interpretation: Escudo is a cost-effective structural intervention that aligned policing practices and human-rights-based public health practices, which could serve as a model for other settings where policing constitutes structural HIV and overdose risk among PWID.Item Reducing alcohol use to prevent cancer deaths: Estimated effects among U.S. adults(American Journal of Preventive Medicine, 2024) Esser, Marissa B.; Sherk, Adam; Liu, Yong; Henley, S. Jane; Naimi, TimothyIntroduction: The Dietary Guidelines for Americans, 2020–2025 recommends non-drinking or no more than 2 drinks for men or 1 drink for women in a day. However, even at lower levels, alcohol use increases the risk for certain cancers. This study estimated mean annual alcohol-attributable cancer deaths and the number of cancer deaths that could potentially be prevented if all U.S. adults who drank in excess of the Dietary Guidelines had instead consumed alcohol to correspond with typical consumption of those who drink within the recommended limits. Methods: Among U.S. residents aged ≥20 years, mean annual alcohol-attributable cancer deaths during 2020–2021 that could have been prevented with hypothetical reductions in alcohol use were estimated. Mean daily alcohol consumption prevalence estimates from the 2020–2021 Behavioral Risk Factor Surveillance System, adjusted to per capita alcohol sales to address underreporting of drinking, were applied to relative risks to calculate population-attributable fractions for cancers that can occur from drinking alcohol. Analyses were conducted during February–April 2023. Results: In the U.S., an estimated 20,216 cancer deaths were alcohol-attributable/year during 2020–2021 (men: 14,562 [72.0%]; women: 5,654 [28.0%]). Approximately 16,800 deaths (83% of alcohol-attributable cancer deaths, 2.8% of all cancer deaths) could have been prevented/year if adults who drank alcohol in excess of the Dietary Guidelines had instead reduced their consumption to ≤2 drinks/day for men or ≤1 drink/day for women. Approximately 650 additional deaths could have been prevented annually if men consumed 1 drink/day, instead of 2. Conclusions: Implementing evidence-based alcohol policies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to decrease drinking could reduce alcohol-attributable cancers, complementing clinical interventions.Item Prescribed safer opioid supply: A scoping review of the evidence(International Journal of Drug Policy, 2024) Ledlie, Shaleesa; Garg, Ria; Cheng, Clare; Kolla, Gillian; Antoniou, Tony; Bouck, Zachary; Gomes, TaraBackground: Safer opioid supply programs provide prescription pharmaceutical opioids, often with supportive services, to people at high risk of experiencing harms related to substance use. However, questions regarding the effectiveness and safety of this practice remain. We conducted a scoping review of literature describing client outcomes from formal opioid supply programs providing prescriptions for pharmaceutical opioids, and the perceptions of involved clients/providers. Methods: We performed a scoping review of peer-reviewed studies and grey literature published between January 1, 2012, to September 12, 2023. We included articles reporting either safer opioid supply client outcomes or clients/providers perspectives. Extracted data included study objectives, substance use patterns, client outcomes, client/provider perspectives, and estimates of effectiveness and/or harm. Results: Our search yielded 1,597 articles. Following removal of duplicates and application of exclusion criteria, 24 publications comprising 17 peer-reviewed and seven grey literature publications were included in our study. We generated eight themes summarizing topics in the available literature: opioid-related toxicities, infectious complications, other clinical outcomes, client-reported outcomes, program access barriers, diversion, program retention, and costs to the healthcare system. Specific findings included low rates of opioid toxicities, improved physical and mental health, and improved quality of life among clients. A lack of access to adequate opioid doses and the limited range of opioid options offered within safer opioid supply programs was described by clients and providers as a potential reason for diversion and a barrier to program access. Conclusions: Generally, evidence suggests that safer opioid supply programs are beneficial to clients through measurable outcomes. However, the available literature has important limitations, including limited inferences about the effectiveness, safety, and potential for diversion within safer opioid supply programs. Further research is needed to support the ongoing evaluation of safer opioid supply programs as one component of a multifactorial response to escalating rates of substance-related harms.Item Uncertainty and instability in social and health services impact well-being of mothers with lived and living history of substance use(Child & Family Social Work, 2024) Daari, Laura; Nichol, Emily; Peak, Julia; Urbanoski, Karen; Valeriote, Hanna; Milligan, KarenMothers who use substances often experience gender-based and structural inequities that can jeopardize maternal and family wellness. Instability in the availability of services, particularly during public health crises (e.g., COVID-19 pandemic), often results in changes in population health needs/funding/services, which may magnify experiences of disadvantage. Limited research has focused on times of change/crisis and its impact on maternal and family wellness. We examined the experiences of structural disadvantage, service access, and well-being among mothers who use or formerly used substances during the first year of the COVID-19 pandemic. Semi-structured interviews were conducted with 26 mothers with current or past engagement in outpatient substance use treatment programs for pregnant and parenting women in Ontario, Canada. Transcripts were analysed using reflexive thematic analysis, revealing that instability of services and decreased access to/quality of informal and formal relationships often magnified the mental and affective toll of stressors, both pre-existing and new. The impact on well-being appeared to be greater for families who were actively engaged with child protective services. Findings are discussed in relation to literature examining systemic and societal factors that perpetuate gender-based and structural inequities experienced by mothers with lived and living histories of substance use. The potential impact of changes in public health service delivery requires thoughtful and proactive attention for and by all stakeholders, including integrated attention across systems (e.g., health, social, education) that provide services to support maternal and family well-being.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, TaraBackground: 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.Item Translating the lived experience of illicit drinkers into program guidance for cannabis substitution: Experiences from the Canadian Managed Alcohol Program Study(International Journal of Drug Policy, 2023) Bailey, Aaron; Harps, Myles; Belcher, Clint; Williams, Henry; Amos, Cecil; Donovan, Brent; Sedore, George; SOLID Victoria; Graham, Brittany; Goulet-Stock, Sybil; Cartwright, Jenny; Robinson, Jennifer; Farrell-Low, Amanda; Willson, Mark; Sutherland, Christy; Stockwell, Tim; Pauly, Bernie; The Eastside Illicit Drinkers Group for EducationA small but growing body of research has suggested the potential for cannabis substitution to support Managed Alcohol Program (MAP) service users to reduce acute and chronic alcohol-related harms. In 2022, researchers from the Canadian Managed Alcohol Program Study (CMAPS) noted a dearth of accessible, alcohol-specific educational resources to support service users and program staff to implement cannabis substitution pilots at several MAP sites in Canada. In this essay, we draw on over 10-years of collaboration between CMAPS, and organizations of people with lived experience (the Eastside Illicit Drinkers Group for Education (EIDGE) and SOLID Victoria) to describe our experiences co-creating cannabis education resources where none existed to support MAP sites interested in beginning to provide cannabis to participants. The research team relied on the unique lived experiences and informal cannabis-related harm reduction strategies described by EIDGE and SOLID members to create cannabis education resources that were accurate and relevant to MAP sites. EIDGE was familiar with creating peer-oriented educational resources and convened meetings and focus groups to engage peers. CMAPS research team members created standard cannabis unit equivalencies to support program delivery, and clinical advisors ensured that the stated risks and benefits of cannabis substitution, as well as tapering guidance for withdrawal management, were safe and feasible. The collaboration ultimately produced tailored client-facing and provider-facing resources. Our experience demonstrates that the lived expertise of drinkers can play an integral role in creating alcohol harm reduction informational materials, specifically those related to cannabis substitution, when combined with data from rigorous, community-based programs of research like CMAPS. We close by listing additional considerations for cannabis substitution program design for MAP settings emerging from this process of collaboration between illicit drinkers, service providers, clinicians, and researchers for consideration by other programs.