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Abbott K, Hyrsak R, Bolton JM, Sareen J, Enns MW, Konrad G, Knight E, Eltonsy S, Kowalec K, Falk J, Alessi-Severini S, Liu K, Prior H, Leong C. Trend in Prescription Medication Utilization for Opioid Use Disorder and Alcohol Use Disorder From 2015 to 2021: A Population-wide Study in a Canadian Province. J Addict Med 2024:01271255-990000000-00345. [PMID: 39012008 DOI: 10.1097/adm.0000000000001348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
OBJECTIVE To examine the quarterly incidence and prevalence of medications for opioid use disorder (OUD) and alcohol use disorder (AUD) from 2015 to 2021. METHODS A retrospective population-wide observational study in Manitoba, Canada, was conducted using administrative claims data from the Manitoba Centre for Health Policy to examine the incidence and prevalence of OUD (methadone, buprenorphine-naloxone, buprenorphine) or AUD medications (naltrexone, acamprosate, disulfiram) per 10,000 individuals in each quarter between January 1, 2015, and December 31, 2021. RESULTS There were 1179 and 451 individuals who received at least one prescription for OUD and AUD, respectively, in the first quarter of 2020. The prevalence of OUD medications more than doubled from 6.3 to 14.3 per 10,000 from January 1, 2015, to December 31, 2021. Likewise, AUD medication prevalence increased almost 10-fold from 0.68 to 6.5 per 10,000 from January 1, 2015, to December 31, 2021, primarily due to naltrexone. The incidence of AUD prescription use increased 8.6-fold from 0.29 to 2.51 per 10,000 during the study period. In contrast, the incidence of opioid agonist therapy declined from 2.1 per 10,000 in the first quarter of 2015 to 0.53 per 10,000 the first quarter of 2016, primarily due to methadone. Whereas methadone incidence declined, buprenorphine-naloxone incidence increased almost 15-fold during the study period. CONCLUSION An increase in both AUD medication prevalence and incidence in addition to an increase in buprenorphine-naloxone incidence was observed. These findings reflect an increase in the uptake of medications for treating AUD and OUD following changes to improve coverage and access to these medications.
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Affiliation(s)
- Kearley Abbott
- From the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (KA, RH, SE, KK, JF, SA-S, CL); Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (JMB, JS, MWE, GK, EK, CL); and Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada (KL, HP)
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Bozinoff N, Kleinman RA, Sloan ME, Kennedy MC, Nolan S, Selby P, Kalocsai C, Wood E. Rethinking Substance Use as Social History: Charting a Way Forward. J Gen Intern Med 2024; 39:1227-1232. [PMID: 38286971 PMCID: PMC11116325 DOI: 10.1007/s11606-024-08642-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024]
Abstract
Physicians have traditionally asked about substance use within the Social History section of the consultation note. Drawing on social science theory and using the authors' own experiences as generalists and addiction scholars, we consider the possible unintended harms associated with this approach. The inclusion of the substance use history within the Social History reproduces the discourse of substance use disorders as "life-style choices" rather than medical conditions, and reinforces stigma among healthcare workers through the attribution of personal responsibility for complications associated with problematic substance use. The ongoing placement of the substance use history within the Social History may lead to a failure to diagnose and make appropriate management plans for clients with substance use disorders. These missed opportunities may include inadequate withdrawal management leading to discharge before medically advised, insufficient use of evidence-based pharmacotherapy and psychotherapy, polypharmacy, medical complications, and repeated admissions to hospital. We argue instead that the Substance Use History should be a stand-alone section within the consultation note. This new section would reduce the invisibility of substance use disorders within our medical systems and model that these chronic medical conditions are amenable to prevention, treatment and harm reduction through the application of evidence-based practices.
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Affiliation(s)
- Nikki Bozinoff
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- British Columbia Centre On Substance Use, Vancouver, Canada.
| | - Robert A Kleinman
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Matthew E Sloan
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, Canada
- Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Mary Clare Kennedy
- British Columbia Centre On Substance Use, Vancouver, Canada
- School of Social Work, University of British Columbia Okanagan, Kelowna, Canada
| | - Seonaid Nolan
- British Columbia Centre On Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Peter Selby
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Csilla Kalocsai
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Evan Wood
- British Columbia Centre On Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Wood E, Bright J, Hsu K, Goel N, Ross JWG, Hanson A, Teed R, Poulin G, Denning B, Corace K, Chase C, Halpape K, Lim R, Kealey T, Rehm J. Ligne directrice canadienne pour la prise en charge clinique de la consommation d’alcool à risque élevé et du trouble d’utilisation de l’alcool. CMAJ 2024; 196:E303-E321. [PMID: 38467412 PMCID: PMC10927286 DOI: 10.1503/cmaj.230715-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Contexte: Au Canada, on note que les équipes soignantes et les personnes qui bénéficieraient de soins ciblés connaissent peu les interventions fondées sur des données probantes pour la prise en charge clinique du trouble d’utilisation de l’alcool. Pour combler cette lacune, l’Initiative canadienne de recherche sur l’abus de substances a créé un comité national dans le but d’élaborer une ligne directrice pour la prise en charge clinique de la consommation d’alcool à risque élevé et du trouble lié à la consommation d’alcool. Méthodes: L’élaboration de cette ligne directrice s’est faite selon le processus ADAPTE, et est inspirée par une ligne directrice britanno-colombienne de 2019 pour le trouble lié à la consommation d’alcool. Un comité national de rédaction de la ligne directrice (composé de 36 membres de divers horizons, notamment des universitaires, des médecins, des personnes ayant ou ayant eu des expériences de consommation d’alcool et des personnes s’identifiant comme Autochtones ou Métis) a choisi les thèmes prioritaires, a passé en revue les données probantes et atteint un consensus relatif aux recommandations. Nous avons utilisé l’outil AGREE II (Appraisal of Guidelines for Research and Evaluation Instrument II) et les principes de divulgation des intérêts et de gestion des conflits lors du processus de rédaction des lignes directrices (Principles for Disclosure of Interests and Management of Conflicts in Guidelines) publiés en anglais par le Réseau international des lignes directrices (Guidelines International Network) pour nous assurer que la ligne directrice répondait aux normes internationales de transparence, de qualité élevée et de rigueur méthodologique. Nous avons évalué les recommandations finales à l’aide de l’approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Les recommandations ont fait l’objet d’une revue externe par 13 spécialistes et parties prenantes d’ici et de l’étranger. Recommandations: La ligne directrice comprend 15 recommandations qui concernent le dépistage, le diagnostic, la prise en charge du sevrage et le traitement continu, y compris les interventions psychosociales, les pharmacothérapies et les programmes communautaires. Le comité de rédaction de la ligne directrice a reconnu la nécessité d’insister sur la sous-utilisation des interventions qui pourraient être bénéfiques et sur les modes de prescription et autres pratiques d’usage courant qui ne reposent pas sur des données probantes et pourraient aggraver les effets de la consommation d’alcool. Interprétation: La ligne directrice se veut une ressource à l’intention des médecins, des responsables des orientations politiques et des membres des équipes cliniques et autres, de même que des personnes, des familles et des communautés affectées par la consommation d’alcool. Ces recommandations proposent un cadre fondé sur des données probantes pour alléger le lourd fardeau du trouble d’utilisation de l’alcool au Canada et combler les besoins en matière de traitements et de soins.
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Affiliation(s)
- Evan Wood
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont.
| | - Jessica Bright
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Katrina Hsu
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Nirupa Goel
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Josey W G Ross
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Averill Hanson
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Rand Teed
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Ginette Poulin
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Bryany Denning
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Kim Corace
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Corrina Chase
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Katelyn Halpape
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Ronald Lim
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Tim Kealey
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
| | - Jürgen Rehm
- Département de médecine (Wood), Université de la Colombie-Britannique; Centre sur la toxicomanie de la Colombie-Britannique (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, C.-B.; Programme sur les classes de médicaments (Teed), Craven, Sask.; Département de psychiatrie (Poulin), Université du Manitoba; Centre Waypoint de santé mentale (Poulin), Winnipeg, Man.; Programme de lutte contre la consommation problématique de substances toxiques, ministère de la Santé et des Services sociaux, Gouvernement des Territoires du Nord-Ouest (Denning), Yellowknife, T.N.-O.; Centre de santé mentale Royal Ottawa (Corace); Département de psychiatrie (Corace), Université d'Ottawa, Ottawa, Ont.; Régie de la santé des Premières Nations (Chase), Vancouver, C.-B.; École de pharmacie et de nutrition (Halpape), Université de la Saskatchewan, Saskatoon, Sask.; Université de Calgary (Lim), Calgary, Alb.; Société d'assurance Knight Archer (Kealey), Regina, Sask.; Institut de recherche sur les politiques en santé mentale (Rehm), Centre de toxicomanies et de santé mentale; École Dalla Lana de santé publique (Rehm), Université de Toronto, Toronto, Ont
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Friesen EL, Mataruga A, Nickel N, Kurdyak P, Bolton JM. Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations. JAMA Netw Open 2024; 7:e2353971. [PMID: 38294814 PMCID: PMC10831574 DOI: 10.1001/jamanetworkopen.2023.53971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
Importance Alcohol-related hospitalizations are common and associated with significant cost to the health care system. We have a limited understanding of the characteristics of individuals who experience alcohol-related hospitalizations, which limits our capacity to prioritize those at the highest risk of postdischarge harm. Objective To identify and characterize the clinical subgroups of individuals who are hospitalized for alcohol-related harms. Design, Setting, and Participants This cohort study used latent class analysis (LCA) to identify clinical subgroups of individuals experiencing alcohol-related hospitalizations in 2 provinces in Canada. All individuals between ages 10 and 105 years who were hospitalized for an alcohol-related harm between January 2017 and December 2018 (ie, the index hospitalization) were eligible. Data were analyzed between June 2023 and August 2023. Exposures The exposure of interest was the clinical subgroup that an individual belonged to. These subgroups were identified using an LCA based on (1) the characteristics of the index hospitalization and (2) the history of alcohol-related health service use. Main Outcomes and Measures In-hospital mortality, alcohol-related hospital readmission, and all-cause mortality in the year following discharge from the index hospitalization. The association between subgroup membership and the risk of in-hospital and postdischarge outcomes was evaluated using multivariable regression. Results A total of 34 043 individuals were included in analysis, 4753 from Manitoba (median [IQR] age, 49 [40-58] years; 1786 female [37.6%]) and 29 290 from Ontario (median [IQR] age, 57 [45-67] years; 8527 female [29.1%]). Seven subgroups were identified following a gradient from low-frequency service use for acute intoxication to high-frequency service use for severe alcohol use disorder and liver disease. In Ontario, there were 4431 individuals in the liver disease subgroup representing 15.5% of the cohort who were at the highest risk of 1-year mortality (1382 [31.2%]) relative to the acute intoxication subgroup (42 [4.0%]) (adjusted hazard ratio [aHR], 3.83; 95% CI, 2.80-5.24). There was also a small subgroup (10.6%) of individuals with high-frequency alcohol-related health service use who had a much higher hazard of readmission following the index hospitalization (1-year readmission: 703 of 1526 [46.1%] vs 104 of 1058 [9.8%] in the acute intoxication subgroup; aHR, 5.09; 95% CI, 4.11-6.31). Conclusions and Relevance In this population-based cohort study of individuals experiencing alcohol-related hospitalizations, we identified several small, clinically distinct subgroups that were at a disproportionately high risk of readmission and mortality. These groups could merit prioritization in strategies aimed at reducing the risk of adverse outcomes following alcohol-related hospitalizations.
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Affiliation(s)
- Erik L. Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Mental Health and Addictions Research Program, ICES Central, Toronto, Ontario, Canada
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Andrea Mataruga
- Mental Health and Addictions Research Program, ICES Central, Toronto, Ontario, Canada
| | - Nathan Nickel
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Mental Health and Addictions Research Program, ICES Central, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James M. Bolton
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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5
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Karriker-Jaffe KJ, Bensley KMK. Commentary on Socias et al.: It is time to be serious about AUD treatment disparities. Addiction 2023; 118:2139-2140. [PMID: 37612825 DOI: 10.1111/add.16323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023]
Affiliation(s)
| | - Kara M K Bensley
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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6
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Wood E, Bright J, Hsu K, Goel N, Ross JWG, Hanson A, Teed R, Poulin G, Denning B, Corace K, Chase C, Halpape K, Lim R, Kealey T, Rehm J. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ 2023; 195:E1364-E1379. [PMID: 37844924 PMCID: PMC10581718 DOI: 10.1503/cmaj.230715] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND In Canada, low awareness of evidence-based interventions for the clinical management of alcohol use disorder exists among health care providers and people who could benefit from care. To address this gap, the Canadian Research Initiative in Substance Misuse convened a national committee to develop a guideline for the clinical management of high-risk drinking and alcohol use disorder. METHODS Development of this guideline followed the ADAPTE process, building upon the 2019 British Columbia provincial guideline for alcohol use disorder. A national guideline committee (consisting of 36 members with diverse expertise, including academics, clinicians, people with lived and living experiences of alcohol use, and people who self-identified as Indigenous or Métis) selected priority topics, reviewed evidence and reached consensus on the recommendations. We used the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) and the Guidelines International Network's Principles for Disclosure of Interests and Management of Conflicts to ensure the guideline met international standards for transparency, high quality and methodological rigour. We rated the final recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool; the recommendations underwent external review by 13 national and international experts and stakeholders. RECOMMENDATIONS The guideline includes 15 recommendations that cover screening, diagnosis, withdrawal management and ongoing treatment, including psychosocial treatment interventions, pharmacotherapies and community-based programs. The guideline committee identified a need to emphasize both underused interventions that may be beneficial and common prescribing and other practice patterns that are not evidence based and that may potentially worsen alcohol use outcomes. INTERPRETATION The guideline is intended to be a resource for physicians, policymakers and other clinical and nonclinical personnel, as well as individuals, families and communities affected by alcohol use. The recommendations seek to provide a framework for addressing a large burden of unmet treatment and care needs for alcohol use disorder within Canada in an evidence-based manner.
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Affiliation(s)
- Evan Wood
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont.
| | - Jessica Bright
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Katrina Hsu
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Nirupa Goel
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Josey W G Ross
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Averill Hanson
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Rand Teed
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Ginette Poulin
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Bryany Denning
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Kim Corace
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Corrina Chase
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Katelyn Halpape
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Ronald Lim
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Tim Kealey
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
| | - Jürgen Rehm
- Department of Medicine (Wood), University of British Columbia; British Columbia Centre on Substance Use (Wood, Bright, Hsu, Goel, Ross, Hanson, Chase), Vancouver, BC; Drug Class Program (Teed), Craven, Saskatchewan; Department of Psychiatry (Poulin), University of Manitoba; Waypoint Centre for Mental Health Care (Poulin), Winnipeg, Man.; Problematic Substance Use, Department of Health and Social Services, Government of the Northwest Territories (Denning), Yellowknife, NWT; The Royal Ottawa Mental Health Centre (Corace); Department of Psychiatry (Corace), University of Ottawa, Ottawa, Ont.; First Nations Health Authority (Chase), Vancouver, BC; College of Pharmacy and Nutrition (Halpape), University of Saskatchewan, Saskatoon, Sask.; University of Calgary (Lim), Calgary, Alta.; Knight Archer Insurance (Kealey), Regina, Sask.; Institute for Mental Health Policy Research (Rehm), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Rehm), University of Toronto, Toronto, Ont
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Castaldelli-Maia JM. Urbanicity and alcohol use epidemiology in the 21st century. Curr Opin Psychiatry 2023; 36:243-248. [PMID: 36762642 DOI: 10.1097/yco.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW This review aimed to gather recent studies that could identify the specificities in the relationship between urbanization and alcohol use epidemiology in the current century. RECENT FINDINGS Although we find lower rates of alcohol use among adolescents in urban environments than in rural ones, this difference tends to diminish until it disappears by the time they reach adulthood. In addition to excessive marketing and increased accessibility, several urban environment characteristics have been related to alcohol use. First, problematic alcohol use is linked to stress and mental health problems like depression and anxiety, which are common in metropolitan areas. Second, alcohol use behaviors are influenced by homelessness, loneliness, and deprivation in megacities, where female and male individuals have presented more similar alcohol use behaviors (i.e. gender convergence). Third, treatment levels for alcohol use disorders are very low. SUMMARY There is a new epidemiological wave of alcohol consumption in large urban centers, largely influenced by advertisement and marketing. Social and psychological risk factors and subpopulations of interest were identified for preventive interventions in large urban centers (i.e. advertisement regulation). In addition, increasing the availability of treatment, including specific medications for alcohol use disorder, should be strongly encouraged.
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Affiliation(s)
- João Mauricio Castaldelli-Maia
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, SP, Brazil
- Department of Epidemiology, Columbia University, New York, New York, USA
- Department of Medical Psychology, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
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8
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Moe J, Wang YE, Schull MJ, Dong K, McGregor MJ, Hohl CM, Holroyd BR, McGrail KM. Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada. BMC Emerg Med 2022; 22:127. [PMID: 35836121 PMCID: PMC9281237 DOI: 10.1186/s12873-022-00673-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Substance use is common among people who visit emergency departments (EDs) frequently. We aimed to characterize subgroups within this cohort to better understand care needs/gaps, and generalizability of characteristics in three Canadian provinces. Methods This was a retrospective cohort study (April 1st, 2013 to March 31st, 2016) of ED patients in Ontario, Alberta, and British Columbia (B.C.) We included patients ≥ 18 years with substance use-related healthcare contact during the study period and frequent ED visits, defined as those in the top 10% of ED utilization when all patients were ordered by annual ED visit number. We used linked administrative databases including ED visits and hospitalizations (all provinces); mental heath-related hospitalizations (Ontario and Alberta); and prescriptions, physician services, and mortality (B.C.). We compared to cohorts of people with (1) frequent ED visits and no substance use, and (2) non-frequent ED visits and substance use. We employed cluster analysis to identify subgroups with distinct visit patterns and clinical characteristics during index year, April 1st, 2014 to March 31st, 2015. Results In 2014/15, we identified 19,604, 7,706, and 9,404 people with frequent ED visits and substance use in Ontario, Alberta, and B.C (median 37–43 years; 60.9–63.0% male), whose ED visits and hospitalizations were higher than comparison groups. In all provinces, cluster analyses identified subgroups with “extreme” and “moderate” frequent visits (median 13–19 versus 4–6 visits/year). “Extreme” versus “moderate” subgroups had more hospitalizations, mental health-related ED visits, general practitioner visits but less continuity with one provider, more commonly left against medical advice, and had higher 365-day mortality in B.C. (9.3% versus 6.6%; versus 10.4% among people with frequent ED visits and no substance use, and 4.3% among people with non-frequent ED visits and substance use). The most common ED diagnosis was acute alcohol intoxication in all subgroups. Conclusions Subgroups of people with “extreme” (13–19 visits/year) and “moderate” (4–6 visits/year) frequent ED visits and substance use had similar utilization patterns and characteristics in Ontario, Alberta, and B.C., and the “extreme” subgroup had high mortality. Our findings suggest a need for improved evidence-based substance use disorder management, and strengthened continuity with primary and mental healthcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00673-x.
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Affiliation(s)
- Jessica Moe
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. .,Department of Emergency Medicine, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Yueqiao Elle Wang
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Michael J Schull
- Institute for Clinical Evaluative Sciences, G1 06, 075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Margaret J McGregor
- Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Emergency Medicine, Vancouver General Hospital, 920 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Brian R Holroyd
- Department of Emergency Medicine, University of Alberta, 790 University Terrace Building, 8303 - 112 Street, Edmonton, AB, T6G 2T4, Canada.,Emergency Strategic Clinical Network, Alberta Health Services, 14th Floor, North Tower, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Kimberlyn M McGrail
- School of Population and Public Health and Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada
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