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Henderson N, Marris J, Woodend K. "And this is the life jacket, the lifeline they've been wanting": Participant perspectives on navigating challenges and successes of prescribed safer supply. PLoS One 2024; 19:e0299801. [PMID: 38517923 PMCID: PMC10959334 DOI: 10.1371/journal.pone.0299801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/04/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND In 2021, 43% of drug toxicity deaths in Ontario were reported by public health units serving medium-sized urban and rural communities. Safer supply programs (SSPs) have been primarily established in large urban centres. Given this, the current study is based on an evaluation of a SSP based in a medium-sized urban centre with a large catchment area that includes rural and Indigenous communities. The aim of this research paper is to understand the challenges and successes of the nurse practitioner-led SSP from the perspective of program participants. METHODS Interpretive description was used to understand the experiences of 14 participants accessing a SSP. Each participant was interviewed using a semi-structured approach, and 13 of the interviewees also completed surveys accessed through Qualtrics. An iterative process using NVivo software was used to code interviews, and a constant comparative data analysis approach was used to refine and categorize codes to themes. FINDINGS Three overarching themes were the result of this analysis: feeling better, renewed hope, and safety. These three themes capture the experiences of participants in the SSP, including both the challenges and successes they faced. CONCLUSION The findings and subsequent discussion focus on both the key best practices of the program, and areas for future development and improvement. Despite barriers to services, prescribed SSPs are improving the lives of people who use drugs, and the current outcomes align with reports and evaluations from other SSPs across Canada.
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Affiliation(s)
- Nancy Henderson
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | - John Marris
- John Marris Consulting, Peterborough, ON, Canada
| | - Kirsten Woodend
- School of Nursing, Trent University, Peterborough, ON, Canada
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Perri M, Khorasheh T, Poon DEO, Kaminski N, LeBlanc S, Mizon L, Smoke A, Strike C, Leece P. A rapid review of current engagement strategies with people who use drugs in monitoring and reporting on substance use-related harms. Harm Reduct J 2023; 20:169. [PMID: 37964286 PMCID: PMC10648706 DOI: 10.1186/s12954-023-00902-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The Canadian drug supply has significantly increased in toxicity over the past few years, resulting in the worsening of the overdose crisis. A key initiative implemented during this crisis has been data monitoring and reporting of substance use-related harms (SRH). This literature review aims to: (1) identify strategies used for the meaningful engagement of people who use drugs (PWUD) in local, provincial, and national SRH data system planning, reporting, and action and (2) describe data monitoring and reporting strategies and common indicators of SRH within those systems. METHODS We searched three academic and five gray literature databases for relevant literature published between 2012 and 2022. Team members who identify as PWUD and a librarian at Public Health Ontario developed search strings collaboratively. Two reviewers screened all search results and applied the eligibility criteria. We used Microsoft Excel for data management. RESULTS Twenty-two articles met our eligibility criteria (peer-reviewed n = 10 and gray literature reports n = 12); most used qualitative methods and focused on the Canadian context (n = 20). There were few examples of PWUD engaged as authors of reports on SRH monitoring. Among information systems involving PWUD, we found two main strategies: (1) community-based strategies (e.g., word of mouth, through drug sellers, and through satellite workers) and (2) public health-based data monitoring and communication strategies (e.g., communicating drug quality and alerts to PWUD). Substance use-related mortality, hospitalizations, and emergency department visits were the indicators most commonly used in systems of SRH reporting that engaged PWUD. CONCLUSION This review demonstrates limited engagement of PWUD and silos of activity in existing SRH data monitoring and reporting strategies. Future work is needed to better engage PWUD in these processes in an equitable manner. Building SRH monitoring systems in partnership with PWUD may increase the potential impact of these systems to reduce harms in the community.
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Affiliation(s)
- Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Triti Khorasheh
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
| | - David Edward-Ooi Poon
- Dalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Nat Kaminski
- Ontario Network of People Who Use Drugs, ON, Canada
| | - Sean LeBlanc
- Ontario Network of People Who Use Drugs, ON, Canada
| | | | - Ashley Smoke
- Ontario Network of People Who Use Drugs, ON, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Pamela Leece
- Dalla Lana School of Public Health, University of Toronto, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada.
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
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Abstract
This paper is the forty-fifth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2022 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, USA.
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Karamouzian M, Rafat B, Kolla G, Urbanoski K, Atkinson K, Bardwell G, Bonn M, Touesnard N, Henderson N, Bowles J, Boyd J, Brunelle C, Eeuwes J, Fikowski J, Gomes T, Guta A, Hyshka E, Ivsins A, Kennedy MC, Laurence G, Martignetti L, Nafeh F, Salters K, Tu D, Strike C, Pauly B, Werb D. Challenges of implementing safer supply programs in Canada during the COVID-19 pandemic: A qualitative analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104157. [PMID: 37574645 DOI: 10.1016/j.drugpo.2023.104157] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
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.
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Affiliation(s)
- Mohammad Karamouzian
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bijan Rafat
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Kate Atkinson
- Parkdale Queen West Community Health Centre, Toronto, ON, Canada
| | - Geoff Bardwell
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada; British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, NS, Canada
| | | | - Nancy Henderson
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada; Peterborough 360 Degree Nurse Practitioner-Led Clinic, Peterborough, ON, Canada
| | - Jeanette Bowles
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Caroline Brunelle
- Department of Psychology, University of New Brunswick-Saint John campus, Saint John, NB, Canada
| | - Jolene Eeuwes
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Jill Fikowski
- Changemark Research + Evaluation, Vancouver, BC, Canada
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Alberta, AB, Canada
| | - Andrew Ivsins
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; School of Social Work, University of British Columbia (Okanagan Campus), BC, Canada
| | - Gab Laurence
- Parkdale Queen West Community Health Centre, Toronto, ON, Canada
| | - Lucas Martignetti
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Frishta Nafeh
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - David Tu
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada; Kilala Lelum, Urban Indigenous Health and Healing Co-operative, Vancouver, BC, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bernadette Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Russell C, Law J, Bonn M, Rehm J, Ali F. The increase in benzodiazepine-laced drugs and related risks in Canada: The urgent need for effective and sustainable solutions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103933. [PMID: 36529033 DOI: 10.1016/j.drugpo.2022.103933] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
The overdose crisis in Canada has continuously evolved and is increasingly challenging to contain, while efforts from governments and policymakers to address it have often fallen short and resulted in unintended consequences. One of the main repercussions has been an unprecedented rise in adulterants in the illegal drug supply, including a wide array of pharmacological and psychoactive compounds and chemicals, which has resulted in a progressively toxic drug supply. Most recently, there has been a stark increase in synthetic benzodiazepine-laced opioids (i.e., 'benzodope') in some Canadian jurisdictions. This unique combination carries distinct and amplified risks for people who use drugs including fatal and non-fatal overdoses, increased dependence and withdrawal symptoms, and places them in extremely vulnerable positions. The emergence of benzodiazepines within the illicit drug supply has substantially contributed to drug-related morbidity and mortality in Canada, and has further complicated current public health initiatives and overdose prevention efforts. This reality underscores the need for effective and sustainable policy solutions to address the evolving overdose epidemic including increased knowledge and education on the specific harms of opioid and benzodiazepine co-use (especially in regards to the complexity of opioid/benzodiazepine overdoses), scaling-up harm reduction measures, and eliminating the toxic drug supply altogether.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, Canada M5S 2S1; Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, Canada M5S 2S1.
| | - Justine Law
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, Canada M5S 2S1; Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, Canada M5S 2S1
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, Nova Scotia, Canada B3A 1X4
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, Canada M5S 2S1; Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, Canada M5S 2S1; Department of Psychiatry, University of Toronto, 1 King's College Circle, Toronto, ON, Canada, M5S 1A8; Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, Canada, M5T 3M7; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), 1001 Queen St. West, Toronto, ON, Canada, M6J 1H4; Institute of Medical Science (IMS), University of Toronto, 1 King's College Circle, Toronto, ON, Canada, M5S 1A8; Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Bol'shaya Pirogovskaya Ulitsa, 19с1, Moscow, Russia, 119146; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany
| | - Farihah Ali
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin St., Toronto, ON, Canada M5S 2S1; Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), 33 Ursula Franklin St., Toronto, ON, Canada M5S 2S1
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