1
|
Dobischok S, Guh D, Marchand K, MacDonald S, Lock K, Harrison S, Lajeunesse J, Schechter MT, Oviedo-Joekes E. The Impact of Injectable Opioid Agonist Treatment (iOAT) on Involvement in Criminalized Activities: A Secondary Analysis from a Clinical Trial in Vancouver, BC. Subst Abuse Rehabil 2023; 14:147-156. [PMID: 38026787 PMCID: PMC10657756 DOI: 10.2147/sar.s438451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose A significant portion of the economic consequences of untreated Opioid Use Disorder (OUD) relate to individuals' involvement in the criminal justice system. The present study uncovers if treatment with iOAT is related to the number of criminal charges amongst participants, what type of crime participants were involved in, and the frequency with which participants were victims of crime. This study contributes to the body of research on the effectiveness of iOAT reducing criminal involvement. Patients and Methods This is a secondary analysis of police record data obtained from the Vancouver Police Department over a three-year period during the Study to Assess Longer-term Opioid Medication Effectiveness clinical trial. The data was obtained from participants (N = 192) enrolled in the trial through a release of information form. Results During the three-year period, most charges (45.6%) were property offences, and 25.5% of participants were victims of crime. Participants with no treatment prior to randomization into the SALOME trial were 2.61 (95% CI = 1.64-4.14) more likely to have been charged with a crime than during the iOAT state. Conclusion IOAT can reduce individuals' involvement with the criminal justice system and is thus a crucial part of the continuum of care. Addiction should be conceptualized as a healthcare rather than criminal issue.
Collapse
Affiliation(s)
- Sophia Dobischok
- Department of Education and Counselling Psychology, McGill University, Montreal, QC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
| | - Daphne Guh
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
| | - Kirsten Marchand
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Kurt Lock
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Martin T Schechter
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
2
|
Blawatt S, Harrison S, Byres D, Foreman J, Amara S, Burdge W, MacDonald S, Schechter MT, Oviedo-Joekes E. The mobilization of nurse-client therapeutic relationships in injectable opioid agonist treatment: Autonomy, advocacy and action. J Subst Use Addict Treat 2023; 154:209154. [PMID: 37652211 DOI: 10.1016/j.josat.2023.209154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/07/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Injectable opioid agonist treatment (iOAT) is an evidence-based treatment that serves an important minority of people with opioid use disorder who require specialized care. Unique to iOAT care is the consistency with which clients access treatment (up to three times daily), a condition that creates repeated opportunities for health care engagement. To date, no study has examined therapeutic relationships in this life saving, nurse-led treatment that can have lasting implications in the equitable delivery of other forms of addictions care. METHODS This study used grounded theory to generate a dynamic framework for therapeutic relationship building in iOAT. Researchers collected semi-structured interviews from registered nurses working in iOAT sites (n=24) form January 2020 through June 2022. The study analyzed collected data through a constant comparative analysis; explored through open, axial, and selective coding; and assessed in a conditional relationship matrix. The team reviewed key findings with stakeholders through formalized processes of engagement to confirm saturation of coding categories. Throughout data collection and analysis, researchers integrated feedback from additional knowledge users and member checking. Reported findings adhered to the COREQ1 standardized checklist. RESULTS We identified five interrelated categories that created a distinct culture of care for iOAT nurses: Ways of Knowing, Personal Investment, Leveraging Empathy, Finding Flexibility, and Collaborating to Overcome. Through creating a safe, nonjudgmental environment, nurses establish therapeutic relationships that build trust to identify client needs outside of medication administration. In turn, nurses participate in team-based problem solving to advocate for client needs. If nurses cannot find flexibility within and outside of the health care system to improve client engagement, tensions can arise and therapeutic relationships can be strained. CONCLUSIONS Therapeutic relationships are an integral part of building and maintaining trust with a population that has been precariously involved with other forms of health care. Nurses make a substantial effort to create a safe and nonjudgmental environment to manifest a culture of care that bridges client needs and program access. Without the expansion of access to iOAT programs and their embedded services, nurses are limited in their ability to provide individualized care for clients with diverse needs.
Collapse
Affiliation(s)
- Sarin Blawatt
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC V6H 4C1, Canada
| | - Julie Foreman
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Sherif Amara
- Fraser Health, Suite 400, Central City Tower, 13450 - 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Wistaria Burdge
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
| |
Collapse
|
3
|
Muyinda H, Jongbloed K, Zamar DS, Malamba SS, Ogwang MD, Katamba A, Oneka A, Atim S, Odongpiny TO, Sewankambo NK, Schechter MT, Spittal PM. Cango Lyec (Healing the Elephant): HIV Prevalence and Vulnerabilities Among Adolescent Girls and Young Women in Postconflict Northern Uganda. J Acquir Immune Defic Syndr 2023; 94:95-106. [PMID: 37276188 PMCID: PMC10497204 DOI: 10.1097/qai.0000000000003234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/21/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Adolescent girls and young women younger than 25 years (AGYW) account for disproportionate HIV infections in sub-Saharan Africa. Impacts of war in Northern Uganda continue to affect HIV-related health and wellbeing of young people postconflict. Prevalence and incidence of HIV infection were estimated, and factors associated with HIV prevalence among sexually active AGYW in Northern Uganda were investigated. METHODS Cango Lyec is a cohort involving conflict-affected populations in Northern Uganda. Nine randomly selected communities in Gulu, Nwoya, and Amuru districts were mapped. House-to-house census was conducted. Consenting participants aged 13-49 years were enrolled over 3 study rounds (2011-2015), of whom 533 were AGYW and had ever had sex. Data were collected on trauma, depression, and sociodemographic-behavioral characteristics. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression determined baseline factors associated with HIV prevalence. RESULTS HIV prevalence among AGYW was 9.7% (95% CI: 7.3 to 12.6). AGYW living in Gulu (adjusted risk ratio, aRR: 2.48; 95% CI: 1.12 to 5.51) or Nwoya (aRR: 2.65; 95% CI: 1.03 to 6.83) were more likely than in Amuru to be living with HIV. Having self-reported genital ulcers (aRR: 1.93; 95% CI: 0.97 to 3.85) or active syphilis (aRR: 3.79; 95% CI: 2.35 to 6.12) was associated with increased risk of HIV infection. The likelihood of HIV was higher for those who experienced sexual violence in the context of war (aRR: 2.37; 95% CI: 1.21 to 4.62) and/or probable depression (aRR: 1.95; 95% CI: 1.08 to 3.54). HIV incidence was 8.9 per 1000 person-years. CONCLUSION Ongoing legacies of war, especially gender violence and trauma, contribute to HIV vulnerability among sexually active AGYW. Wholistic approaches integrating HIV prevention with culturally safe initiatives promoting sexual and mental health in Northern Uganda are essential.
Collapse
Affiliation(s)
- Herbert Muyinda
- Child Health Development Center, Makerere University, Kampala, Uganda
| | - Kate Jongbloed
- BC Office of the Provincial Health Officer, Victoria, Canada
| | - David S. Zamar
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
| | | | | | - Achilles Katamba
- College of Health Sciences, Makerere University, Kampala, Uganda; and
| | | | | | | | | | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Patricia M. Spittal
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
| |
Collapse
|
4
|
Adams A, Blawatt S, Magel T, MacDonald S, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. The impact of relaxing restrictions on take-home doses during the COVID-19 pandemic on program effectiveness and client experiences in opioid agonist treatment: a mixed methods systematic review. Subst Abuse Treat Prev Policy 2023; 18:56. [PMID: 37777766 PMCID: PMC10543348 DOI: 10.1186/s13011-023-00564-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to an unprecedented relaxation of restrictions on take-home doses in opioid agonist treatment (OAT). We conducted a mixed methods systematic review to explore the impact of these changes on program effectiveness and client experiences in OAT. METHODS The protocol for this review was registered in PROSPERO (CRD42022352310). From Aug.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, Cochrane Register of Controlled Trials, and the grey literature. We included studies reporting quantitative measures of retention in treatment, illicit substance use, overdose, client health, quality of life, or treatment satisfaction or using qualitative methods to examine client experiences with take-home doses during the pandemic. We critically appraised studies using the Mixed Methods Appraisal Tool. We synthesized quantitative data using vote-counting by direction of effect and presented the results in harvest plots. Qualitative data were analyzed using thematic synthesis. We used a convergent segregated approach to integrate quantitative and qualitative findings. RESULTS Forty studies were included. Most were from North America (23/40) or the United Kingdom (9/40). The quantitative synthesis was limited by potential for confounding, but suggested an association between take-home doses and increased retention in treatment. There was no evidence of an association between take-home doses and illicit substance use or overdose. Qualitative findings indicated that take-home doses reduced clients' exposure to unregulated substances and stigma and minimized work/treatment conflicts. Though some clients reported challenges with managing their medication, the dominant narrative was one of appreciation, reduced anxiety, and a renewed sense of agency and identity. The integrated analysis suggested reduced treatment burden as an explanation for improved retention and revealed variation in individual relationships between take-home doses and illicit substance use. We identified a critical gap in quantitative measures of patient-important outcomes. CONCLUSION The relaxation of restrictions on take-home doses was associated with improved client experience and retention in OAT. We found no evidence of an association with illicit substance use or overdose, despite the expansion of take-home doses to previously ineligible groups. Including patient-important outcome measures in policy, program development, and treatment planning is essential to ensuring that decisions around take-home doses accurately reflect their value to clients.
Collapse
Affiliation(s)
- Alison Adams
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Sarin Blawatt
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Tianna Magel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC, V6H 4C1, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| |
Collapse
|
5
|
Sharma R, Pooyak S, Thomas V, Zamar DS, Jongbloed K, Pearce ME, Mazzuca A, Cassidy-Mathews C, Bizzotto RN, Jafari G, Christian KWM, Teegee M, Schechter MT, Spittal PM. The Cedar Project: Racism and its impacts on health and wellbeing among young Indigenous people who use drugs in Prince George and Vancouver, BC. PLOS Glob Public Health 2023; 3:e0001914. [PMID: 37647286 PMCID: PMC10468031 DOI: 10.1371/journal.pgph.0001914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/18/2023] [Indexed: 09/01/2023]
Abstract
Racism continues to drive health disparities between Indigenous and non-Indigenous peoples in Canada. This study focuses on racism experienced by young Indigenous people who have used drugs in British Columbia (BC), and predictors of interpersonal racism. Cedar Project is a community-governed cohort study involving young Indigenous people who use drugs in Vancouver and Prince George, BC. This cross-sectional study included data collected between August 2015-October 2016. The Measure of Indigenous Racism Experiences (MIRE) scale was used to assess experiences of interpersonal racism across 9 unique settings on a 5-point Likert scale, collapsing responses into three categories (none/low/high). Multinomial logistic regression models were used to examine associations between key variables and interpersonal racism. Among 321 participants, 79% (n = 255) experienced racism in at least one setting. Thirty two percent (n = 102) experienced high interpersonal racism from police, governmental agencies (child 'welfare', health personnel), and in public settings. Ever having a child apprehended (AOR:2.76, 95%CI:1.14-6.65), probable post-traumatic stress (AOR:2.64; 95%CI:1.08-6.46), trying to quit substances (AOR:3.69; 95%CI:1.04-13.06), leaving emergency room without receiving treatment (AOR:3.05; 95%CI:1.22-7.64), and having a traditional language spoken at home while growing up (AOR:2.86; 95%CI:1.90-6.90) were associated with high interpersonal racism. Among women, experiencing high interpersonal racism was more likely if they lived in Prince George (AOR:3.94; 95%CI:1.07-14.50), ever had a child apprehended (AOR:5.09; 95%CI:1.50-17.30), and had probable post-traumatic stress (AOR:5.21; 95%CI:1.43-18.95). Addressing racism experienced by Indigenous peoples requires immediate structural systemic, and interpersonal anti-racist reforms.
Collapse
Affiliation(s)
- Richa Sharma
- University of British Columbia, Vancouver, Canada
| | - Sherri Pooyak
- The Cedar Project Partnership and Aboriginal HIV/AIDS Community-Based Research Collaborative Centre (AHA Centre), Vancouver, Canada
| | | | - David S. Zamar
- Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Kate Jongbloed
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Margo E. Pearce
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - April Mazzuca
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Chenoa Cassidy-Mathews
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Riley N. Bizzotto
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ghazal Jafari
- McGill University Department of Psychology, The Cedar Project, Vancouver, Canada
| | | | - Mary Teegee
- The Cedar Project Partnership and Carrier Sekani Family Services, Vancouver, Canada
| | - Martin T. Schechter
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Patricia M. Spittal
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
6
|
Blawatt S, Arreola LAG, Magel T, MacDonald S, Harrison S, Schechter MT, Oviedo-Joekes E. Changes in daily dose in open-label compared to double-blind: The role of clients' expectations in injectable opioid agonist treatment. Addict Behav Rep 2023; 17:100490. [PMID: 37124402 PMCID: PMC10140796 DOI: 10.1016/j.abrep.2023.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Though double-blind studies have indicated that hydromorphone and diacetylmorphine produce similar effects when administered through injectable opioid agonist treatment (iOAT) programs, participant preference may influence some aspects of medication dispensation such as dose. Methods This is a retrospective longitudinal analysis. Participants (n = 131) were previously enrolled in a double-blind clinical trial for iOAT who continued to receive treatment in an open-label follow up study. Data included medication dispensation records from 2012 to 2020. Using linear regression and paired t-tests, average daily dose totals of hydromorphone and diacetylmorphine were examined comparatively between double-blind and open-label periods. A subgroup analysis explored dose difference by preference using the proxy, blinding guess, a variable used to facilitate the measurement of treatment masking during the clinical trial by asking which medication the participant thought they received. Results During the open-label period, participants prescribed diacetylmorphine received 49.5 mg less than during the double-blind period (95% CI -12.6,-86.4). Participants receiving hydromorphone did not see a significant dose decrease. Participants who guessed they received hydromorphone during the clinical trial, but learned they were on diacetylmorphine during the open-label period, saw a decrease in total daily dose of 78.3 mg less (95% CI -134.3,-22.4) during the open-label period. Conclusion If client preference is considered in the treatment of chronic opioid use disorder, clients may be able to better moderate their dose to suit their individual needs. Together with their healthcare providers, clients can participate in their treatment trajectories collaboratively to optimize client outcomes and promote person-centered treatment options.
Collapse
Affiliation(s)
- Sarin Blawatt
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | | | - Tianna Magel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver BCV6B 1G6, Canada
| | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- Corresponding author at: St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada.
| |
Collapse
|
7
|
Adams A, Blawatt S, MacDonald S, Finnick R, Lajeunesse J, Harrison S, Byres D, Schechter MT, Oviedo-Joekes E. Provider experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic: A qualitative systematic review. Int J Drug Policy 2023; 117:104058. [PMID: 37182352 PMCID: PMC10165059 DOI: 10.1016/j.drugpo.2023.104058] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/03/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Historical restrictions on take-home medications for opioid use disorder have generated considerable debate. The COVID-19 pandemic shifted the perceived risks and benefits of daily clinic attendance and led to widespread policy reform, creating an unprecedented opportunity to explore the impact of more flexible prescribing. We conducted a qualitative systematic review to synthesize the evidence on providers' experiences with relaxing restrictions on take-home doses of medications prescribed for opioid use disorder during the COVID-19 pandemic. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42022360589; https://www.crd.york.ac.uk/prospero/). From Sept.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, the Cochrane Register of Controlled Trials, and the grey literature from 2020 onward. Studies were eligible for inclusion if they used qualitative methods to investigate providers' experiences with relaxed restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic. We appraised study quality using the CASP qualitative checklist and used thematic synthesis and GRADE-CERQual to synthesize the results. RESULTS We retrieved 13 articles representing 11 studies. Six were conducted in the United States and most focused on changes to methadone treatment. Providers' experiences with increased flexibilities around take-homes were broadly positive, despite widespread initial concern over client safety and the potential for medication misuse. For a small number of providers, concerns about diversion were a specific manifestation of more general unease with loss of control over clients and the treatment process. Most providers appreciated increased flexibilities and described them as enabling more individualized, person-centered care. CONCLUSION Our findings support the continuation of flexibilities around take-homes and demonstrate that regulations and policies that reduce flexibility around take-homes conflict with person-centered approaches to care. Stronger guidance and support from professional regulatory agencies may help increase uptake of flexibilities around take-homes.
Collapse
Affiliation(s)
- Alison Adams
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Sarin Blawatt
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Rhys Finnick
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Julie Lajeunesse
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BCV6B 1G6, Canada
| | - David Byres
- Provincial Health Services Authority, 200-1333 W Broadway, Vancouver, BC V6H 4C1, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
| |
Collapse
|
8
|
Luo J, Zamar DS, Ogwang MD, Muyinda H, Malamba SS, Katamba A, Jongbloed K, Schechter MT, Sewankambo NK, Spittal PM. Cango Lyec (Healing the Elephant): Probable post-traumatic stress disorder (PTSD) and depression in Northern Uganda five years after a violent conflict. J Migr Health 2022; 6:100125. [PMID: 35832466 PMCID: PMC9272377 DOI: 10.1016/j.jmh.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/04/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background From 1986 to 2006, Northern Uganda experienced an atrocious civil war between the Lord's Resistance Army (LRA) and the Ugandan government. Acholi people living in the region continue to be impacted by trauma sequelae of the war and a wide range of daily stressors including poverty, hunger, and high rates of HIV infection. To date, there is a dearth of gender-differentiated mental health research in this post-conflict setting. The current study aimed to estimate the prevalence of probable post-traumatic stress disorder (PTSD) and depression in three districts most affected by the Northern Ugandan conflict and examine socio-structural, war-related, and sexual vulnerability factors associated with mental health. Methods Cango Lyec (Healing the Elephant) is an open cohort study involving participants from eight randomly selected communities in Amuru, Gulu, and Nwoya districts of Northern Uganda. Between November 2011 and July 2012, the baseline cohort (N = 2,458) completed the Harvard Trauma Questionnaire (HTQ) and Hopkins Symptom Checklist-25 (HSCL-25) for screening PTSD and depression, in addition to a detailed questionnaire assessing socio-demographic-behavioral characteristics. Baseline categorical variables were compared between males and females using Fisher's exact test. Multivariate logistic regression was used to model correlates of probable PTSD and depression. All analyses were stratified by gender. Results The overall prevalence of probable PTSD and depression was 11.7% and 15.2% respectively. Among former abductees, the prevalence was 23.2% for probable PTSD and 26.6% for probable depression. Women were significantly more likely to experience mental distress than men. Factors associated with mental distress included wartime trauma (adjusted odds ratios ranging from 2.80 to 7.19), experiences of abduction (adjusted odds ratios ranging from 1.97 to 3.03), and lack of housing stability and safety (adjusted odds ratios ranging from 1.95 to 4.59). Additional risk factors for women included HIV infection (AOR=1.90; 95% CI: 1.29–2.80), sexual abuse in the context of war (AOR=1.58; 95% CI: 1.02–2.45), and intimate partner violence (AOR=2.45; 95% CI: 1.07–5.63). Conclusion Cango Lyec participants displayed lower than previously reported yet significant levels of probable PTSD and depression. Based on findings from this study, providing trauma-informed care, ensuring food and housing security, eliminating gender-based violence, and reintegrating former abductees remain important tasks to facilitate post-conflict rehabilitation in Northern Uganda.
Collapse
|
9
|
Dobischok S, Metcalfe RK, Matzinger EA, Lock K, Harrison S, MacDonald S, Amara S, Schechter MT, Bansback N, Oviedo-Joekes E. Feasibility of Testing Client Preferences for Accessing Injectable Opioid Agonist Treatment (iOAT): A Pilot Study. Patient Prefer Adherence 2022; 16:3405-3413. [PMID: 36582266 PMCID: PMC9793789 DOI: 10.2147/ppa.s391532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Injectable opioid agonist treatment (iOAT) is an effective treatment for opioid use disorder (OUD). To our knowledge, no research has systematically studied client preferences for accessing iOAT. Incorporating preferences could help meet the heterogenous needs of clients and make addiction care more person-centred. This paper presents a pilot study of a best-worst scaling (BWS) preference elicitation survey that aimed to assess if the survey was feasible and accessible for our population and to test that the survey could gather sound data that would suit our planned analyses. PATIENTS AND METHODS Current and former iOAT clients (n = 18) completed a BWS survey supported by an interviewer using a think-aloud approach. The survey was administered on PowerPoint, and responses and contextual field notes were recorded manually. Think-aloud audio was recorded on Audacity. RESULTS Clients' feedback fell into five categories: framing of the task, accessibility, conceptualization of attributes and levels, formatting, and behaviour predicting questions. Survey repetitiveness was the most consistent feedback. The data simulation showed that 100 responses should provide an adequate sample size. CONCLUSION This pilot demonstrates the type of analysis that can be done with BWS in our population, suggests that such analysis is feasible, and highlights the importance of the interviewer and participant working side-by-side throughout the task.
Collapse
Affiliation(s)
- Sophia Dobischok
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
| | - Rebecca K Metcalfe
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
| | | | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, Vancouver, BC, Canada
| | - Sherif Amara
- SafePoint Supervised Consumption Site, Fraser Health Authority, Surrey, BC, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nick Bansback
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Correspondence: Eugenia Oviedo-Joekes, Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, 575-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada, Tel +1 604-682-2344 Ext. 62973, Fax +1-604-806-8210, Email
| |
Collapse
|
10
|
Palis H, Marchand K, Peachey GS, Westfall J, Lock K, MacDonald S, Jun J, Bojanczyk-Shibata A, Harrison S, Marsh DC, Schechter MT, Oviedo-Joekes E. Exploring the effectiveness of dextroamphetamine for the treatment of stimulant use disorder: a qualitative study with patients receiving injectable opioid agonist treatment. Subst Abuse Treat Prev Policy 2021; 16:68. [PMID: 34530878 PMCID: PMC8444161 DOI: 10.1186/s13011-021-00399-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/10/2022]
Abstract
Background A high proportion of people receiving both oral and injectable opioid agonist treatment report concurrent use of stimulants (i.e. cocaine and or amphetamines), which has been associated with higher rates of continued illicit opioid use and treatment dropout. A recent randomized controlled trial demonstrated the effectiveness of dextroamphetamine (a prescribed stimulant) at reducing craving for and use of cocaine among patients receiving injectable opioid agonist treatment. Following this evidence, dextroamphetamine has been prescribed to patients with stimulant use disorder at a clinic in Vancouver. This study investigates perceptions of the effectiveness of dextroamphetamine from the perspective of these patients. Methods Data were collected using small focus groups and one-on-one interviews with patients who were currently or formerly receiving dextroamphetamine (n = 20). Thematic analysis was conducted using an iterative approach, moving between data collection and analysis to search for patterns in the data across transcripts. This process led to the defining and naming of three central themes responding to the research question. Results Participants reported a range of stimulant use types, including cocaine (n = 8), methamphetamine (n = 8), or both (n = 4). Three central themes were identified as relating to participants’ perceptions of the effectiveness of the medication: 1) achieving a substitution effect (i.e. extent to which dextroamphetamine provided a substitution for the effect they received from use of illicit stimulants); 2) Reaching a preferred dose (i.e. speed of titration and effect of the dose received); and 3) Ease of medication access (i.e. preference for take home doses (i.e. carries) vs. medication integrated into care at the clinic). Conclusion In the context of continued investigation of pharmacological treatments for stimulant use disorder, the present study has highlighted how the study of clinical outcomes could be extended to account for factors that contribute to perceptions of effectiveness from the perspective of patients. In practice, elements of treatment delivery (e.g. dosing and dispensation protocols) can be adjusted to allow for various scenarios (e.g. on site vs. take home dosing) by which dextroamphetamine and other pharmacological stimulants could be implemented to provide “effective” treatment for people with a wide range of treatment goals and needs.
Collapse
Affiliation(s)
- Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | | | | | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Jennifer Jun
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Anna Bojanczyk-Shibata
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada.,Canadian Addiction Treatment Centres, 175 Commerce Valley West, Suite 300, Markham, Ontario, L3T 7P6, Canada.,ICES North, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada.,Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| |
Collapse
|
11
|
Pearce ME, Jongbloed K, Pooyak S, Christian WM, Teegee MGWWM, Caron NR, Thomas V, Henderson E, Zamar D, Yoshida EM, Schechter MT, Spittal PM. The Cedar Project: exploring the role of colonial harms and childhood maltreatment on HIV and hepatitis C infection in a cohort study involving young Indigenous people who use drugs in two Canadian cities. BMJ Open 2021; 11:e042545. [PMID: 34244246 PMCID: PMC8268907 DOI: 10.1136/bmjopen-2020-042545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study examined associations between childhood maltreatment, colonial harms and sex/drug-related risks for HIV and hepatitis C virus (HCV) infection among young Indigenous people who use drugs. DESIGN The Cedar Project is a cohort involving young Indigenous people who use drugs in British Columbia (BC), Canada. Indigenous collaborators, collectively known as the Cedar Project Partnership, govern the entire research process. SETTING Vancouver is a large city on the traditional territory of the Coast Salish peoples. Prince George is a mid-sized city, on the traditional territory of Lheidli T'enneh First Nation. PARTICIPANTS 420 participants completed the Childhood Trauma Questionnaire and returned for follow-up from 2003 to 2016. PRIMARY/SECONDARY OUTCOME MEASURES Primary outcomes were HIV and HCV infection over the study period. Secondary outcomes included sex and substance use-related risks. RESULTS Prevalence of childhood maltreatment was 92.6% experienced any maltreatment; 73.4% experienced emotional abuse; 62.6% experienced physical abuse; 60.3% experienced sexual abuse; 69.5% experienced emotional neglect and 79.1% experienced physical neglect. We observed significant associations between childhood maltreatment and apprehensions into residential schools and foster care. All maltreatment types were associated with higher odds of sex/substance use-related risks; sexual abuse was associated with higher odds of HCV infection (adjusted OR: 1.67; 95% CI 1.05 to 2.66; p=0.031). CONCLUSIONS Findings reflect high prevalence of childhood maltreatment and their associations with HIV/HCV risk and HCV infection. Public health prevention and treatment initiatives must be trauma informed and culturally safe to support healing, health, and well-being.
Collapse
Affiliation(s)
- Margo E Pearce
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Jongbloed
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sherri Pooyak
- Cree, Saskatoon, Saskatchewan, Canada
- Aboriginal HIV/AIDS Community Based Collaborative Centre, Saskatoon, Saskatchewan, Canada
| | | | - Maaxswxw Gibuu White Wolf Mary Teegee
- Gitk'san and Carrier, Luxgaboo Wolf Clan, Takla Lake First Nation, Prince George, British Columbia, Canada
- Carrier Sekani Family Services, Prince George, British Columbia, Canada
| | - Nadine R Caron
- Sagamok Anishnawbek First Nation (Ojibwa), Massey, Ontario, Canada
- Centre for Excellence in Indigenous Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria Thomas
- Wuikinuxv Nation, Prince George, British Columbia, Canada
- The Cedar Project, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Earl Henderson
- Cree, Métis, Prince George, British Columbia, Canada
- Department of Anthropology, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - David Zamar
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- The Cedar Project, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Eric M Yoshida
- Faculty of Medicine, Division of Gastroenterology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin T Schechter
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia M Spittal
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
12
|
Ritland L, Thomas V, Jongbloed K, Zamar DS, Teegee MP, Christian WK, Richardson CG, Guhn M, Schechter MT, Spittal PM. The Cedar Project: Relationship between child apprehension and attempted suicide among young Indigenous mothers impacted by substance use in two Canadian cities. PLoS One 2021; 16:e0252993. [PMID: 34111186 PMCID: PMC8191959 DOI: 10.1371/journal.pone.0252993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada's child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008-2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25-8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94-5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00-3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63-10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04-7.99), violence (HR: 2.54, 95%CI: 1.52-4.27) or overdose (HR: 4.97, 95%CI: 2.96-8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23-1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations.
Collapse
Affiliation(s)
- Lisa Ritland
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Victoria Thomas
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Wuikinuxv Nation
| | - Kate Jongbloed
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David S. Zamar
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Mary P. Teegee
- Takla Lake First Nation, Carrier Sekani Family Services, Prince George, BC, Canada
| | - Wenecwtsin-Kukpi Christian
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
- Splatsin te Secwepemc
| | - Chris G. Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Patricia M. Spittal
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
13
|
Marchand K, Palis H, Guh D, Lock K, MacDonald S, Brissette S, Marsh DC, Harrison S, Schechter MT, Oviedo-Joekes E. A multi-methods and longitudinal study of patients' perceptions in injectable opioid agonist treatment: Implications for advancing patient-centered methodologies in substance use research. J Subst Abuse Treat 2021; 132:108512. [PMID: 34098207 DOI: 10.1016/j.jsat.2021.108512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/13/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients' perceptions are vital to the delivery and evaluation of substance use treatment. They are most frequently collected at one time-point and measured using patient satisfaction questionnaires or qualitative methodologies. Interestingly, the findings of these studies often diverge, as satisfaction scores tend to be highly positive, while qualitative findings suggest dissatisfaction and areas for improvement. This divergence limits current understandings of patients' perceptions and their potential change over time in treatment. OBJECTIVE This study explores the relationship between open-ended positive and negative perceptions of treatment and patient satisfaction scores over time. METHODS The RUTH (Research on the Utilization of Therapeutic Hydromorphone) prospective cohort study included 131 participants receiving injectable diacetylmorphine or hydromorphone in Canada's first injectable opioid agonist treatment (iOAT) program. The study collected the Client Satisfaction Questionnaire (CSQ-8) at eight time-points over an 18-month period. Following a multi-methods approach, the study complemented the CSQ-8 with open-ended positive and negative comments of iOAT. The research team analyzed these comments thematically at each time-point to develop positive and negative perception themes. We then used growth curve modeling to explore the relationship between positive and negative perception themes and patient satisfaction over time. FINDINGS Over the eight time-points, six positive and eight negative perception themes emerged, broadly reflecting structural (e.g., expansion of iOAT), process (e.g., schedules), relational (e.g., interactions with providers), and outcome-related (e.g., met/unmet needs) perceptions of iOAT. On average, participants reported high satisfaction (grand mean = 29.2 out of 32), and scores did not significantly change over time. However, we did find significant unexplained variation within participants in their satisfaction trajectories and between participants in their initial satisfaction scores. In conditional growth curve models, the theme "unfavorable interactions with providers" had the strongest independent effect on overall satisfaction trajectories. CONCLUSIONS This study provides an example of how open-ended comments can be integrated with patient satisfaction questionnaire data to gather a comprehensive and patient-centered evaluation of substance use treatment. Considering the iOAT context specifically, relational dynamics and daily treatment access were significant predictors of patient satisfaction over time and may be attributes of iOAT that require further investigation.
Collapse
Affiliation(s)
- Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Daphne Guh
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Suzanne Brissette
- Centre Hospitalier de l'Université de Montréal (CHUM), 1000 Sanguinet, Montréal, QC H2X 0C1, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada; Canadian Addiction Treatment Centres, 300-175 Commerce Valley West, Markham, ON L3T 7P6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| |
Collapse
|
14
|
Malamba SS, Muyinda H, Ogwang DM, Katamba A, Zamar DS, Jongbloed K, Sewankambo NK, Schechter MT, Spittal PM. Cango Lyec (Healing the Elephant): Chronic Hepatitis B Virus among post-conflict affected populations living in mid-Northern Uganda. PLoS One 2021; 16:e0251573. [PMID: 34043637 PMCID: PMC8158885 DOI: 10.1371/journal.pone.0251573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background The legacy of war in Northern Uganda continues to impact people’s health and wellbeing in the Acholi region. Despite increasing attention to Hepatitis B Virus (HBV) in Uganda and globally, concerns remain that unique drivers of infection, and barriers to screening, and treatment, persist among those affected by conflict. Methods Cango Lyec (Healing the Elephant) cohort survey involved conflict-affected adults aged 13–49 in three mid-Northern Uganda districts (Gulu, Amuru and Nwoya). Baseline (2011–2012) samples were tested for HBV surface antigen (HBsAg), HBV e-antigen (HBeAg), antibodies to HBV surface antigen (HBsAb), antibodies to HBV e-antigen (HBeAb), and antibodies to HBV core antigen (HBcAb). All HBsAg positive samples were tested for IgM antibodies to HBV B core antigen (HBc-IgM) and where available, >6-month follow-up samples were tested for HBeAg and HBV DNA. Data were analyzed using STATA 15 software. Logistic regression accounted for variance due to complex two-stage sampling that included stratification, unequal selection probabilities and community clustering. Odds ratios measured effect potential risk factors associated with chronic HBV infection. Results Among 2,421 participants, 45.7% were still susceptible to HBV infection. HBsAg seropositivity was 11.9% (10.9–13.0), chronic HBV was 11.6% (10.4–12.8), acquired immunity resulting from vaccination was 10.9%, and prior natural infection was 31.5%. Older age (OR:0.570; 95%CI:0.368–0.883) and higher education (OR:0.598; 95%CI:0.412–0.868) were associated with reduced odds of chronic HBV infection. Being male (OR:1.639; 95%CI:1.007–2.669) and having been abducted (OR:1.461; 95%CI:1.055–2.023) were associated with increased odds of infection. Among women, having 1 or 2 pregnancies (compared to none or >2) was associated with increased odds of infection (OR:1.764; 95%CI:1.009–3.084). Conclusion Chronic HBV is endemic in Gulu, Amuru and Nwoya districts. Recommended strategies to reduce post-conflict prevalence include establishment of Northern Uganda Liver Wellness Centres, integration of screening and treatment into antenatal care, and roll out of birth-dose vaccination.
Collapse
Affiliation(s)
- Samuel S. Malamba
- HIV Reference Laboratory Program, Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | - Herbert Muyinda
- Child Health Development Center, Makerere University, Kampala, Uganda
| | - D. Martin Ogwang
- St Mary’s Hospital–Lacor, Gulu, Uganda
- Northern Uganda Program on Health Sciences, Gulu, Uganda
| | - Achilles Katamba
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - David S. Zamar
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Kate Jongbloed
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Patricia M. Spittal
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- * E-mail:
| |
Collapse
|
15
|
Palis H, Guh D, MacDonald S, Harrison S, Brissette S, Marsh DC, Schechter MT, Oviedo-Joekes E. Longitudinal patterns of cocaine use among patients receiving injectable hydromorphone or diacetylmorphine for the treatment of opioid use disorder: A growth curve modeling approach. Drug Alcohol Depend 2021; 218:108333. [PMID: 33268225 DOI: 10.1016/j.drugalcdep.2020.108333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Cocaine use is prevalent among people receiving injectable opioid agonist treatment. Investigations of cocaine use in this population have been descriptive and the potential heterogeneity existing in patterns of use have not been characterized. As such, among patients receiving injectable opioid agonist treatment, this study aimed to: 1) quantify intra- and inter-individual variation in cocaine use over 24-months and; 2) determine how predictors of interest explained this variation. METHODS Participants were patients receiving injectable opioid agonist treatment for opioid use disorder. Study visits were completed at baseline prior to receiving treatment, and 3,6,9,12,18, and 24 months after baseline. A multi-level regression approach to growth curve modeling was employed to estimate and explain intra- (within-person) and inter-individual (between-person) variation in cocaine use. RESULTS Significant intra and inter-individual variation in cocaine use was identified over 24-months. Treatment engagement was on average associated with reductions in the prior month number of days of cocaine use (range: 0-30)(Estimate (standard error): -0.05(0.02), p = 0.003). On average, men reported less cocaine use compared to women (Estimate (standard error): -5.91(1.57), p=<0.001), and participants reporting ever regularly using cocaine at baseline reported more cocaine use over 24-months compared to participants reporting never regularly using cocaine (Estimate (standard error): 4.72 (1.91), p = 0.013). CONCLUSIONS Significant reductions in cocaine use were observed and significant heterogeneity in patterns of cocaine use was identified. These heterogeneous cocaine use profiles suggest that an individualized approach to care will be critical in responding to patients' cocaine use in injectable opioid agonist treatment.
Collapse
Affiliation(s)
- Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Daphne Guh
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Suzanne Brissette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis, Montréal, QC, H2X 0A9, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada; Canadian Addiction Treatment Centres, 175 Commerce Valley West, Suite 300, Markham, Ontario, L3T 7P6, Canada; ICES North, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada; Health Sciences North Research Institute, 56 Walford Rd, Sudbury, ON, P3E 2H2, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| |
Collapse
|
16
|
Sharma R, Pooyak S, Jongbloed K, Zamar D, Pearce ME, Mazzuca A, Schechter MT, Spittal PM. The Cedar Project: Historical, structural and interpersonal determinants of involvement in survival sex work over time among Indigenous women who have used drugs in two Canadian cities. Int J Drug Policy 2020; 87:103012. [PMID: 33166826 DOI: 10.1016/j.drugpo.2020.103012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Indigenous women involved in survival sex work face multiple layers of discrimination, criminalization and alarming levels of intergenerational and lifetime trauma. This longitudinal study examined historical, structural and interpersonal factors associated with survival sex work involvement among Indigenous women who have used drugs in British Columbia (BC), Canada. METHODS The Cedar Project is an ongoing cohort study involving young Indigenous people who have used illicit drugs in Vancouver and Prince George, BC. Data was collected every 6 months from 2007 to 2016 . Generalized linear mixed-effects modeling was used to model survival sex work involvement, defined as exchanging sex for money, drugs, food or shelter in the previous six months. RESULTS Among 292 participants, 34% reported their family always/often lived by traditional culture and 37% reported their family always/often spoke their traditional language. In contrast, 48% had a parent in residential school and 72% were removed from their biological parents. In total, 55% of women were involved in survival sex work at baseline. In adjusted analyses, those who were single (ARR: 1.91; 95% CI: 1.50-2.35), identified as two-spirit (ARR: 2.16; 95% CI: 1.36-2.91), experienced sexual assault (ARR: 1.90; 95% CI: 1.22-2.58), were denied access to shelter (ARR: 1.71; 95% CI: 1.18-2.28), used crack daily (ARR: 2.85; 95% CI: 2.36-3.31), used injection drugs (ARR: 2.52; 95% CI: 1.98-3.07), and were unable to access substance use treatment (ARR: 1.58; 95% CI: 1.15-2.05) were more likely to be involved in sex work. CONCLUSION Indigenous-governed, wellness-based harm-reduction interventions, and structural reforms addressing housing insecurity and normalization of a culture of violence against Indigenous women, especially those involved in survival sex work, are urgently needed in Canada.
Collapse
Affiliation(s)
- Richa Sharma
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Sherri Pooyak
- AHA Centre/ Canadian Aboriginal AIDS Network, 6520 Salish Dr, Vancouver, BC, V6N 2C7
| | - Kate Jongbloed
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - David Zamar
- BC Children's Hospital Research Institute, 950 W28th Ave, Vancouver, BC, V5Z 4H4
| | - Margo E Pearce
- BC Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4
| | - April Mazzuca
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Martin T Schechter
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3
| | - Patricia M Spittal
- School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3.
| | | |
Collapse
|
17
|
Jongbloed K, Pearce ME, Thomas V, Sharma R, Pooyak S, Demerais L, Lester RT, Schechter MT, Spittal PM. The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study. JMIR Mhealth Uhealth 2020; 8:e16783. [PMID: 32716311 PMCID: PMC7427984 DOI: 10.2196/16783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/16/2020] [Accepted: 02/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results Less than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population.
Collapse
Affiliation(s)
- Kate Jongbloed
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margo E Pearce
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vicky Thomas
- The Cedar Project, Prince George, BC, Canada.,Wuikinuxv Nation, Prince George, BC, Canada
| | - Richa Sharma
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sherri Pooyak
- Aboriginal HIV/AIDS Community-Based Research Collaborative Centre, Victoria, BC, Canada.,Cree, Victoria, BC, Canada
| | - Lou Demerais
- Cree & Métis, Surrey, BC, Canada.,The Cedar Project, Vancouver, BC, Canada
| | - Richard T Lester
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin T Schechter
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Patricia M Spittal
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | -
- The Cedar Project, Prince George, BC, Canada.,The Cedar Project, Vancouver, BC, Canada
| |
Collapse
|
18
|
Palis H, Harrison S, MacDonald S, Marsh DC, Schechter MT, Oviedo‐Joekes E. Self‐managing illicit stimulant use: A qualitative study with patients receiving injectable opioid agonist treatment. Drug Alcohol Rev 2020; 39:914-923. [DOI: 10.1111/dar.13117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Heather Palis
- Centre for Health Evaluation and Outcome Sciences Providence Health Care, St. Paul's Hospital Vancouver Canada
- School of Population and Public Health University of British Columbia Vancouver Canada
| | - Scott Harrison
- Providence Crosstown Clinic Providence Health Care, Vancouver Canada
| | - Scott MacDonald
- Providence Crosstown Clinic Providence Health Care, Vancouver Canada
| | - David C. Marsh
- Northern Ontario School of Medicine Sudbury Canada
- Canadian Addiction Treatment Centres Markham Canada
| | - Martin T. Schechter
- Centre for Health Evaluation and Outcome Sciences Providence Health Care, St. Paul's Hospital Vancouver Canada
- School of Population and Public Health University of British Columbia Vancouver Canada
| | - Eugenia Oviedo‐Joekes
- Centre for Health Evaluation and Outcome Sciences Providence Health Care, St. Paul's Hospital Vancouver Canada
- School of Population and Public Health University of British Columbia Vancouver Canada
| |
Collapse
|
19
|
Katamba A, Ogwang MD, Zamar DS, Muyinda H, Oneka A, Atim S, Jongbloed K, Malamba SS, Odongping T, Friedman AJ, Spittal PM, Sewankambo NK, Schechter MT. Cango Lyec (Healing the Elephant): HIV incidence in post-conflict Northern Uganda. EClinicalMedicine 2020; 23:100408. [PMID: 32577610 PMCID: PMC7305337 DOI: 10.1016/j.eclinm.2020.100408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Civil war in Northern Uganda resulted in widespread atrocities, human rights violations, and death, and caused millions to flee to internally displaced persons camps. War-related traumas combined with difficulties accessing HIV prevention and health services has led to extreme HIV-related vulnerability among conflict-affected people who survived the war. Objectives were to (1) determine HIV incidence among conflict-affected people in Northern Uganda and (2) identify vulnerabilities associated with HIV infection. METHODS The Cango Lyec (Healing the Elephant) Project is a prospective cohort involving conflict-affected populations in three districts in Northern Uganda. In 2011, eight randomly selected communities were mapped, and a census was conducted. Consenting participants aged 13-49 years were followed over three rounds of follow-up. Longitudinal data collected included war-related experiences, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV-1 at baseline and each 12-month follow-up. Multivariable Cox proportional hazard models determined factors associated with HIV incidence. FINDINGS Overall, 1920 baseline HIV-negative participants with at least one follow-up contributed 3877 person-years (py) for analysis. Thirty-nine (23 female, 16 male) participants contracted HIV during follow-up. Age- and gender-standardised HIV incidence rate was 10•2 per 1000py (95%CI: 7•2-14•0). Stratified by sex, the age-adjusted HIV incidence was 11•0 per 1000py (95%CI: 6•9-16•6) among women and 9•4 per 1000py (95%CI: 5•3-15•3) among men. Adjusting for confounders, factors associated with risk of HIV included: having been abducted (HR: 3•70; 95%CI: 1•87-7•34), experiencing ≥12 war-related traumatic events (HR: 2•91 95%CI: 1•28-6•60), suicide ideation (HR: 2•83; 95%CI: 1•00-8•03), having ≥2 sexual partners (HR: 4•68; 95%CI: 1•36-16•05), inconsistent condom use (HR: 6•75; 95%CI: 2•49-18•29), and self-reported genital ulcers (HR: 4•39; 95%CI: 2•04-9•45). INTERPRETATION Conflict-affected participants who had experienced abduction and multiple traumas during the war were at greater risk of HIV infection. Trauma-informed HIV prevention and treatment services, and culturally-safe mental health initiatives, are urgent for Northern Uganda.
Collapse
Affiliation(s)
- Achilles Katamba
- Makerere University College of Health Sciences, School of Medicine, Uganda
| | - Martin D. Ogwang
- St Mary's Hospital - Lacor, Northern Uganda Program on Health Sciences
| | - David S. Zamar
- University of British Columbia, School of Population & Public Health, Canada
| | - Herbert Muyinda
- Makerere University, Child Health Development Center, Uganda
| | - Alex Oneka
- Cango Lyec Project, Makerere University, Child Health Development Center, Uganda
| | - Stella Atim
- Cango Lyec Project, Makerere University, Child Health Development Center, Uganda
| | - Kate Jongbloed
- University of British Columbia, School of Population & Public Health, Canada
| | - Samuel S. Malamba
- Uganda Virus Research Institute (UVRI) - HIV Reference Laboratory Program, Uganda
| | - Tonny Odongping
- Cango Lyec Project, Makerere University, Child Health Development Center, Uganda
| | - Anton J. Friedman
- University of British Columbia, School of Population & Public Health, Canada
| | - Patricia M. Spittal
- University of British Columbia, School of Population & Public Health, Canada
- BC Children's Hospital Research Institute, Canada
- Corresponding author: Patricia M. Spittal, BC Children's Hospital Research Institute, V3-323 Clinical Support Building, 950 W 28th Ave Vancouver, BC V5Z4H4, Canada, +1-604-875-2345, ext. 5944.
| | | | - Martin T. Schechter
- University of British Columbia, School of Population & Public Health, Canada
| |
Collapse
|
20
|
Marchand K, Foreman J, MacDonald S, Harrison S, Schechter MT, Oviedo-Joekes E. Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment. Subst Abuse Treat Prev Policy 2020; 15:7. [PMID: 31959189 PMCID: PMC6971856 DOI: 10.1186/s13011-020-0253-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 12/30/2022]
Abstract
Background Injectable opioid agonist treatment (iOAT) was designed as a pragmatic and compassionate approach for people who have not benefitted from medication assisted treatment with oral opioids (e.g., methadone). While, a substantial body of clinical trial evidence has demonstrated the safety and effectiveness of iOAT, considerably less is known about the patient-centered aspects of this treatment and their role in self-reported treatment goals and outcomes. The aim of this study was to explore participants’ experiences in iOAT as they broadly relate to the domains of patient-centered care. A secondary goal was to explore how these experiences affected participants’ self-reported treatment outcomes. Methods A qualitative methodology, and constructivist grounded theory approach, was used to guide sampling, data collection and analysis. A total of 30 in-depth interviews were conducted with people receiving iOAT in North America’s first clinic. Audio-recordings for each semi-structured interview were transcribed and read repeatedly. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved. Results “Building healthcare provider relationships for patient-centered care in iOAT” was the emergent core concept. Healthcare provider relationships were established through two interrelated processes: ‘Opening up’ was attributed to the positive environment, and to feeling understood and supported by healthcare providers. ‘Being a part of care’ emerged as participants felt safe to ask for what was needed and had opportunities to collaborate in treatment decisions. These processes established a foundation in which participants experienced care that was responsive to their individual dose, health and psychosocial needs. Conclusions The core concept suggested that therapeutic relationships were fundamental to experiences of patient-centered care in iOAT. When relationships were respectful and understanding, participants received individualized and holistic care in iOAT. These findings offer a valuable example of how therapeutic relationships can be strengthened in other substance use treatment settings, particularly when responding to the diverse treatment needs of clients.
Collapse
Affiliation(s)
- Kirsten Marchand
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. .,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Julie Foreman
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| |
Collapse
|
21
|
Marchand K, Beaumont S, Westfall J, MacDonald S, Harrison S, Marsh DC, Schechter MT, Oviedo-Joekes E. Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Subst Abuse Treat Prev Policy 2019; 14:37. [PMID: 31511016 PMCID: PMC6739978 DOI: 10.1186/s13011-019-0227-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/02/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite ongoing efforts aimed to improve treatment engagement for people with substance-related disorders, evidence shows modest rates of utilization as well as client-perceived barriers to care. Patient-centered care (PCC) is one widely recognized approach that has been recommended as an evidence-based practice to improve the quality of substance use disorder treatment. PCC includes four core principles: a holistic and individualized focus to care, shared decision-making and enhanced therapeutic alliance. AIMS This scoping review aimed to explore which PCC principles have been described and how they have defined and measured among people with substance-related disorders. METHODS Following the iterative stages of the Arksey and O'Malley scoping review methodology, empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references were eligible if they focused on people accessing treatment for substance-related disorders and described PCC. Two reviewers independently screened the title/abstract and full-texts of references. Descriptive analyses and a directed content analysis were performed on extracted data. FINDINGS One-hundred and forty-nine references met inclusion from the 2951 de-duplicated references screened. Therapeutic alliance was the most frequent principle of PCC described by references (72%); this was consistently defined by characteristics of empathy and non-judgment. Shared decision-making was identified in 36% of references and was primarily defined by client and provider strategies of negotiation in the treatment planning process. Individualized care was described by 30% of references and included individualized assessment and treatment delivery efforts. Holistic care was identified in 23% of references; it included an integrated delivery of substance use, health and psychosocial services via comprehensive care settings or coordination. Substance use and treatment engagement outcomes were most frequently described, regardless of PCC principle. CONCLUSIONS This review represents a necessary first step to explore how PCC has been defined and measured for people accessing substance use disorder treatment. The directed content analysis revealed population and context-specific evidence regarding the defining characteristics of PCC-principles that can be used to further support the implementation of PCC.
Collapse
Affiliation(s)
- Kirsten Marchand
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Scott Beaumont
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Jordan Westfall
- Canadian Association for Safe Supply, 46 East Hastings St, Vancouver, BC, V6A 1N1, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings St, Vancouver, BC, V6B 1G6, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| |
Collapse
|
22
|
Oviedo-Joekes E, Palis H, Guh D, Marchand K, Brissette S, Harrison S, MacDonald S, Lock K, Anis AH, Marsh DC, Schechter MT. Treatment with injectable hydromorphone: Comparing retention in double blind and open label treatment periods. J Subst Abuse Treat 2019; 101:50-54. [DOI: 10.1016/j.jsat.2019.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/08/2019] [Accepted: 03/29/2019] [Indexed: 11/27/2022]
|
23
|
Marchand K, Beaumont S, Westfall J, MacDonald S, Harrison S, Marsh DC, Schechter MT, Oviedo-Joekes E. Patient-centred care for addiction treatment: a scoping review protocol. BMJ Open 2018; 8:e024588. [PMID: 30593556 PMCID: PMC6318507 DOI: 10.1136/bmjopen-2018-024588] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Substance use disorders are chronic conditions that require a multidimensional treatment approach. Despite ongoing efforts to diversify such treatments, evidence continues to illuminate modest rates of treatment engagement and perceived barriers to treatment. Patient-centred care (PCC) is one approach that may strengthen the responsiveness of treatments for people with problematic substance use. The aim of this scoping review is to explore how the principles of PCC have been implemented and operationalised in healthcare settings for people with problematic substance use. METHODS AND ANALYSIS This scoping review follows the iterative stages of the Arksey and O'Malley framework. Both empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references will be considered if they focused on populations with problematic substance use and described or measured PCC or one of its principles in a health-oriented context. Two reviewers will independently screen references in two successive stages of title/abstract screening and then full-text screening for references meeting title/abstract criteria. A descriptive overview, tabular and/or graphical summaries, and a directed content analysis will be carried out on extracted data. This scoping review has been registered with Open Science Framework (https://osf.io/5swvd/). ETHICS AND DISSEMINATION This review will systematically examine the extent and nature of existing evidence of PCC in addiction research and clinical practice. Such evidence will contribute to the operationalisation of PCC for people with problematic substance use. A multidisciplinary team has been gathered to represent the needs of people with problematic substance use, healthcare providers and decision-makers. The team's knowledge users will be engaged throughout this review and will participate in dissemination activities (eg, workshops, presentations, publications, reports).
Collapse
Affiliation(s)
- Kirsten Marchand
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Scott Beaumont
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jordan Westfall
- Canadian Association for People Who Use Drugs, Vancouver, British Columbia, Canada
| | - Scott MacDonald
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - Scott Harrison
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
24
|
Blair AH, Pearce ME, Katamba A, Malamba SS, Muyinda H, Schechter MT, Spittal PM. The Alcohol Use Disorders Identification Test (AUDIT): Exploring the Factor Structure and Cutoff Thresholds in a Representative Post-Conflict Population in Northern Uganda. Alcohol Alcohol 2018; 52:318-327. [PMID: 28003244 DOI: 10.1093/alcalc/agw090] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/02/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Despite increased use of the Alcohol Use Disorders Identification Test (AUDIT) in sub-Saharan Africa, few studies have assessed its underlying conceptual framework, and none have done so in post-conflict settings. Further, significant inconsistencies exist between definitions used for problematic consumption. Such is the case in Uganda, facing one of the highest per-capita alcohol consumption levels regionally, which is thought to be hindering rebuilding in the North after two decades of civil war. This study explores the impact of varying designation cutoff thresholds in the AUDIT as well as its conceptual factor structure in a representative sample of the population. Methods In all, 1720 Cango Lyec Project participants completed socio-economic and mental health questionnaires, provided blood samples and took the AUDIT. Participant characteristics and consumption designations were compared at AUDIT summary score thresholds of ≥3, ≥5 and ≥8. Confirmatory factor analyses (CFA) explored one-, two- and three-factor level models overall and by sex with relative and absolute fit indicators. Results There were no significant differences in participant demographic characteristics between thresholds. At higher cutoffs, the test increased in specificity to identify those with hazardous drinking, disordered drinking and suffering from alcohol-related harms. All conceptual models indicated good fit, with three-factor models superior overall and within both sexes. Conclusion In Northern Uganda, a three-factor AUDIT model best explores alcohol use in the population and is appropriate for use in both sexes. Lower cutoff thresholds are recommended to identify those with potentially disordered drinking to best plan effective interventions and treatments. Short summary A CFA of the AUDIT showed good fit for one-, two, and three-factor models overall and by sex in a representative sample in post-conflict Northern Uganda. A three-plus total AUDIT cutoff score is suggested to screen for hazardous drinking in this or similar populations.
Collapse
Affiliation(s)
- Alden Hooper Blair
- School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, British Columbia, V6T 1Z9 Canada.,Global Health Sciences Program, University of California San Francisco, 550 16th Street, Third Floor, San Francisco, CA 94158, USA
| | - Margo Ellen Pearce
- School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, British Columbia, V6T 1Z9Canada
| | - Achilles Katamba
- Makerere University School of Public Health, New Mulago Hill Road, Kampala, Uganda
| | - Samuel S Malamba
- HIV Reference Laboratory Program, Uganda Virus Research Institute (UVRI), Plot 51-59 Nakiwongo Road, Entebbe, Uganda
| | - Herbert Muyinda
- Makerere University Child Health Development Center, Upper Mulago Hospital Complex, Kampala, Uganda
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, British Columbia, V6T 1Z9Canada
| | - Patricia M Spittal
- School of Population and Public Health, University of British Columbia, 2206 East Mall Drive, Vancouver, British Columbia, V6T 1Z9Canada
| |
Collapse
|
25
|
Bansback N, Guh D, Oviedo-Joekes E, Brissette S, Harrison S, Janmohamed A, Krausz M, MacDonald S, Marsh DC, Schechter MT, Anis AH. Cost-effectiveness of hydromorphone for severe opioid use disorder: findings from the SALOME randomized clinical trial. Addiction 2018; 113:1264-1273. [PMID: 29589873 DOI: 10.1111/add.14171] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/26/2017] [Accepted: 01/19/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Previous research has found diacetylmorphine, delivered under supervision, to be cost-effective in the treatment of severe opioid use disorder, but diacetylmorphine is not available in many settings. The Study to Assess Long-term Opioid Maintenance Effectiveness (SALOME) randomized controlled trial provided evidence that injectable hydromorphone is non-inferior to diacetylmorphine. The current study aimed to compare the cost-effectiveness of hydromorphone directly with diacetylmorphine and indirectly with methadone maintenance treatment. DESIGN A within-trial analysis was conducted using the patient level data from the 6-month, double-blind, non-inferiority SALOME trial. A life-time analysis extrapolated costs and outcomes using a decision analytical cohort model. The model incorporated data from a previous trial to include an indirect comparison to methadone maintenance. SETTING A supervised clinic in Vancouver, British Columbia, Canada. PARTICIPANTS A total of 202 long-term street opioid injectors who had at least two attempts at treatment, including one with methadone (or other substitution), were randomized to hydromorphone (n = 100) or diacetylmorphine (n = 102). MEASUREMENTS We measured the utilization of drugs, visits to health professionals, hospitalizations, criminal activity, mortality and quality of life. This enabled us to estimate incremental costs, quality-adjusted life years (QALYs) and cost-effectiveness ratios from a societal perspective. Sensitivity analyses considered different sources of evidence, assumptions and perspectives. FINDINGS The within-trial analysis found hydromorphone provided similar QALYs to diacetylmorphine [0.377, 95% confidence interval (CI) = 0.361-0.393 versus 0.375, 95% CI = 0.357-0.391], but accumulated marginally greater costs [$49 830 ($28 401-73 637) versus $34 320 ($21 780-55 998)]. The life-time analysis suggested that both diacetylmorphine and hydromorphone provide more benefits than methadone [8.4 (7.4-9.5) and 8.3 (7.2-9.5) versus 7.4 (6.5-8.3) QALYs] at lower cost [$1.01 million ($0.6-1.59 million) and $1.02 million ($0.72-1.51 million) versus $1.15 million ($0.71-1.84 million)]. CONCLUSIONS In patients with severe opioid use disorder enrolled into the SALOME trial, injectable hydromorphone provided similar outcomes to injectable diacetylmorphine. Modelling outcomes during a patient's life-time suggested that injectable hydromorphone might provide greater benefit than methadone alone and may be cost-saving, with drug costs being offset by costs saved from reduced involvement in criminal activity.
Collapse
Affiliation(s)
- Nick Bansback
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Daphne Guh
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Suzanne Brissette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Scott Harrison
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - Amin Janmohamed
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Michael Krausz
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Scott MacDonald
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Martin T Schechter
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Aslam H Anis
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
26
|
Palis H, Marchand K, Karamouzian M, MacDonald S, Harrison S, Guh D, Lock K, Brissette S, Anis AH, Krausz M, Marsh DC, Schechter MT, Oviedo-Joekes E. The association between nicotine dependence and physical health among people receiving injectable diacetylmorphine or hydromorphone for the treatment of chronic opioid use disorder. Addict Behav Rep 2018; 7:82-89. [PMID: 29892701 PMCID: PMC5993889 DOI: 10.1016/j.abrep.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 03/25/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION People with chronic opioid use disorder often present to treatment with individual and structural vulnerabilities and remain at risk of reporting adverse health outcomes. This risk is greatly compounded by tobacco smoking, which is highly prevalent among people with chronic opioid use disorder. Despite the known burden of tobacco smoking on health, the relationship between nicotine dependence and health has not been studied among those receiving injectable opioid agonist treatment. As such, the present study aims to explore the association between nicotine dependence and physical health among participants of the Study to Assess Longer-Term Opioid Medication Effectiveness (SALOME) at baseline and six-months. METHODS SALOME was a double-blind phase III clinical trial testing the non-inferiority of injectable hydromorphone to injectable diacetylmorphine for chronic opioid use disorder. Participants reporting tobacco smoking were included in a linear regression analysis of physical health at baseline (before receiving treatment) and at six-months. RESULTS At baseline, nicotine dependence score, lifetime history of emotional, physical, or sexual abuse and prior month safe injection site access were independently and significantly associated with physical health. At six-months nicotine dependence score was the only variable that maintained this significant and independent association with physical health. CONCLUSIONS Findings indicate that after six-months, the injectable treatment effectively brought equity to patients' physical health status, yet the association with nicotine dependence remained. Findings could inform whether the provision of treatment for nicotine dependence should be made a priority in settings where injectable opioid agonist treatment is delivered to achieve improvements in overall physical health in this population.
Collapse
Affiliation(s)
- Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Haft-Bagh Highway, Kerman, Iran
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6, Canada
| | - Daphne Guh
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Suzanne Brissette
- Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, CHUM Montréal, Montréal, QC H2X 3J4, Canada
| | - Aslam H. Anis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - David C. Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada
| | - Martin T. Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575-1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| |
Collapse
|
27
|
Abstract
Ethnic affiliation can define sociocultural boundaries and contribute to the HIV vulnerabilities faced by men who have sex with men (MSM). This study investigated the influence of ethnic affiliation on HIV vulnerabilities among MSM in North China. Our study analyzed a cross-sectional survey of MSM (n = 398) in two major North China cities. We examined associations between ethnic affiliation and (a) HIV status, (b) sexual behaviors and experiences, and (c) substance use. Compared to ethnic majority Han MSM: MSM belonging to ethnic minority groups of South China had significantly greater odds of HIV infection (AOR: 7.40; 95% CI: 2.33-23.47) and experience of forced sex (AOR: 3.27; 95% CI: 1.12-9.52). Compared to ethnic majority Han MSM, Ethnic Hui MSM had significantly lower odds of condomless anal sex (AOR: 0.41; 95% CI: 0.21-0.82) and significantly greater odds of circumcision (AOR: 2.62; 95% CI: 1.24-5.51). HIV prevalence and riskier sexual behaviors among MSM in China appear to vary significantly by ethnic affiliation. Current epidemiological practices of aggregating all ethnic minority groups in China into a single category may be masking important interethnic differences in HIV risk, and precluding opportunities for more culturally appropriate interventions.
Collapse
Affiliation(s)
- Stephen W Pan
- a Department of Public Health , Xi'an Jiaotong-Liverpool University , Suzhou , People's Republic of China
| | - Richard M Carpiano
- b School of Public Policy , University of California , Riverside , CA , USA.,c Department of Sociology , University of California , Riverside , CA , USA.,d Center for Healthy Communities , University of California , Riverside , CA , USA
| | - Dongliang Li
- e Chaoyang Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Zheng Zhang
- e Chaoyang Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Martin T Schechter
- f School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada
| | - Patricia M Spittal
- f School of Population and Public Health , University of British Columbia , Vancouver , BC , Canada
| | - Yuhua Ruan
- g Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Infectious Disease Prevention and Control, Chinese Centers for Disease Control and Prevention , Beijing , People's Republic of China
| |
Collapse
|
28
|
Jongbloed K, Pearce ME, Pooyak S, Zamar D, Thomas V, Demerais L, Christian WM, Henderson E, Sharma R, Blair AH, Yoshida EM, Schechter MT, Spittal PM. The Cedar Project: mortality among young Indigenous people who use drugs in British Columbia. CMAJ 2017; 189:E1352-E1359. [PMID: 29109208 DOI: 10.1503/cmaj.160778] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Young Indigenous people, particularly those involved in the child welfare system, those entrenched in substance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in British Columbia and explore predictors of mortality over time. METHODS We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression. RESULTS Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person-years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2-17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6-10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47-5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01-3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00-8.09). INTERPRETATION Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care.
Collapse
Affiliation(s)
- Kate Jongbloed
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Margo E Pearce
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Sherri Pooyak
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - David Zamar
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Vicky Thomas
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Lou Demerais
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Wayne M Christian
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Earl Henderson
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Richa Sharma
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Alden H Blair
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Eric M Yoshida
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Martin T Schechter
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | - Patricia M Spittal
- School of Population and Public Health (Jongbloed, Sharma, Blair, Schechter, Spittal), Department of Chemical and Biological Engineering (Zamar), and Faculty of Medicine, Division of Gastroenterology (Yoshida), The University of British Columbia; Canadian HIV Trials Network (Pearce); Canadian Aboriginal AIDS Network (Pooyak [Cree]); The Cedar Project, BC Children's Hospital Research Institute (Thomas [Wuikinuxv Nation]), BC Children's Hospital; Vancouver Native Health Society (Demerais [Cree, Métis]), Vancouver, BC; Splatsin te Secwepemc (Christian [Splatsin te Secwepemc]); Department of First Nations Studies (Henderson [Cree, Métis]), University of Northern British Columbia, Prince George, BC; Division of Gastroenterology (Yoshida), Vancouver General Hospital, Vancouver, BC
| | | |
Collapse
|
29
|
Oviedo-Joekes E, Brissette S, MacDonald S, Guh D, Marchand K, Jutha S, Harrison S, Janmohamed A, Zhang DZ, Anis AH, Krausz M, Marsh DC, Schechter MT. Safety profile of injectable hydromorphone and diacetylmorphine for long-term severe opioid use disorder. Drug Alcohol Depend 2017; 176:55-62. [PMID: 28521199 DOI: 10.1016/j.drugalcdep.2017.02.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 11/28/2022]
Abstract
AIMS To review the safety profile of injectable hydromorphone and diacetylmorphine and explore if adverse events (AEs) or serious adverse events (SAEs) were associated with dose and patterns of attendance. METHODS This was a non-inferiority randomized double-blind controlled trial (Vancouver, Canada) testing hydromorphone (n=100) and diacetylmorphine (n=102) for the treatment of severe opioid use disorder. Medications were delivered under the supervision of trained Registered Nurses up to three times daily. AEs were described using MedDRA codes. RESULTS Most common related AEs included immediate post-injection reaction or injection site pruritus reactions, somnolence and opioid overdoses. Adjusted analysis indicated that participants in the hydromorphone group were less likely to have any related AE or SAE compared to the diacetylmorphine group. Related somnolence and opioid overdose events were distributed throughout the six months treatment period. In the diacetylmorphine group, five of the eleven related SAE opioid overdoses (requiring naloxone) occurred in the first 30days since most recent treatment initiation. Analysis of somnolence and opioid overdose (AEs and SAEs) event rates by received dose suggested a non-linear relationship. However, in the diacetylmorphine group higher event rates per person days were recorded at lower doses. CONCLUSIONS When injectable hydromorphone and diacetylmorphine are individually dosed and monitored, their opioid-related side effects, including potential fatal overdoses, are safely mitigated and treated by health care providers. In the midst of an opioid overdose epidemic, injectable options are timely to reach a very important minority of people who inject street opioids and are not attracted to other treatments.
Collapse
Affiliation(s)
- Eugenia Oviedo-Joekes
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Suzanne Brissette
- Centre de recheche du Centre Hospitalier de l'Université de Montréal, (CRCHUM), 900 St-Denis, Montréal, QC, H2X 0A9, Canada
| | - Scott MacDonald
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6 B 1G6, Canada
| | - Daphne Guh
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Salima Jutha
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Scott Harrison
- Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6 B 1G6, Canada
| | - Amin Janmohamed
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Derek Z Zhang
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Aslam H Anis
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Michael Krausz
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; Department of Psychiatry, Faculty of Medicine, Detwiller Pavilion 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada
| | - Martin T Schechter
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| |
Collapse
|
30
|
Marchand K, Palis H, Fikowski J, Harrison S, Spittal P, Schechter MT, Oviedo-Joekes E. The Role of Gender in Suicidal Ideation among Long-term Opioid Users. Can J Psychiatry 2017; 62:465-472. [PMID: 28521111 PMCID: PMC5528992 DOI: 10.1177/0706743717711173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aims to examine factors associated with suicidal ideation among people with opioid dependence and to explore whether these factors are gender-specific. METHODS Cross-sectional data were collected among long-term opioid-dependent individuals ( n = 176; 46.0% women). Lifetime histories of suicidal ideation were measured using the Composite International Diagnostic Interview, and additional data were collected regarding sociodemographic characteristics, drug use, health, and adverse life events. Multivariable logistic regression was used to determine the relationships between these variables and suicidal ideation for the full study sample and separately for women and men to explore the potential role of gender. RESULTS A total of 43.8% ( n = 77) of participants reported a lifetime history of suicidal ideation. Among those with suicidal ideation, 49.3% were women and the overall average age of first ideation was 19.82 years (SD, 11.66 years). Results from multivariable analyses showed that a history of depression, anxiety, and childhood emotional neglect and the number of lifetime traumatic events were significantly associated with higher odds of suicidal ideation. The gender-based analysis suggested that histories of depression and anxiety remained independently associated with lifetime suicidal ideation among women, whereas for men, childhood emotional neglect and the number of lifetime potentially traumatic events were independently associated with lifetime suicidal ideation. CONCLUSIONS This study offers a critical first step to understanding factors associated with suicidal ideation among long-term opioid-dependent men and women and the potential importance of gender-sensitive approaches for suicidal behavior interventions. These data inform further research and clinical opportunities aiming to better respond to the psychological health needs of this population.
Collapse
Affiliation(s)
- Kirsten Marchand
- 1 Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia.,2 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Heather Palis
- 1 Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia.,2 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Jill Fikowski
- 1 Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia.,2 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Scott Harrison
- 3 Urban Health & HIV/AIDS, Providence Health Care, Vancouver, British Columbia
| | - Patricia Spittal
- 1 Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia.,2 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Martin T Schechter
- 1 Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia.,2 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| | - Eugenia Oviedo-Joekes
- 1 Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia.,2 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
31
|
Oviedo-Joekes E, Palis H, Guh D, Marchand K, Brissette S, Lock K, MacDonald S, Harrison S, Anis AH, Krausz M, Marsh DC, Schechter MT. Characteristics and response to treatment among Indigenous people receiving injectable diacetylmorphine or hydromorphone in a randomised controlled trial for the treatment of long-term opioid dependence. Drug Alcohol Rev 2017; 37:137-146. [DOI: 10.1111/dar.12573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/23/2017] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Eugenia Oviedo-Joekes
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
- School of Population and Public Health; University of British Columbia; Vancouver Canada
| | - Heather Palis
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
- School of Population and Public Health; University of British Columbia; Vancouver Canada
| | - Daphne Guh
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
| | - Kirsten Marchand
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
- School of Population and Public Health; University of British Columbia; Vancouver Canada
| | - Suzanne Brissette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM); Montréal Canada
| | - Kurt Lock
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
| | | | - Scott Harrison
- Crosstown Clinic; Providence Health Care; Vancouver Canada
| | - Aslam H. Anis
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
| | - Michael Krausz
- Department of Psychiatry; University of British Columbia; Vancouver Canada
| | | | - Martin T. Schechter
- Centre for Health Evaluation and Outcome Sciences; Providence Health Care, St. Paul's Hospital; Vancouver Canada
- School of Population and Public Health; University of British Columbia; Vancouver Canada
- Centre for Excellence in Indigenous Health, Faculty of Medicine; University of British Columbia; Vancouver Canada
| |
Collapse
|
32
|
Palis H, Marchand K, Guh D, Brissette S, Lock K, MacDonald S, Harrison S, Anis AH, Krausz M, Marsh DC, Schechter MT, Oviedo-Joekes E. Men's and women's response to treatment and perceptions of outcomes in a randomized controlled trial of injectable opioid assisted treatment for severe opioid use disorder. Subst Abuse Treat Prev Policy 2017; 12:25. [PMID: 28526048 PMCID: PMC5437624 DOI: 10.1186/s13011-017-0110-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/12/2017] [Indexed: 12/04/2022]
Abstract
Background To test whether there are gender differences in treatment outcomes among patients receiving injectable opioids for the treatment of long-term opioid-dependence. The study additionally explores whether men and women have different perceptions of treatment effectiveness. Methods This study is a secondary analysis from SALOME, a double-blind, phase III, randomized controlled trial testing the non-inferiorirty of injectable hydromorphone to injectable diacetylmorphine among 202 long-term street opioid injectors in Vancouver (Canada). Given this was a secondary analysis, no a priori power calaculation was conducted. Differences in baseline characteristics and six-month treatment outcomes (illicit heroin use, opioid use, crack cocaine use, non-legal activities, physical and psychological health scores, urine positive for street heroin markers, and retention) were analysed by gender using fitted models. Responses to an open ended question on reasons for treatment effectiveness were explored with a thematic analysis. Results Men and women differed significantly on a number of characteristics at baseline. For example, women were significantly younger, presented to treatment with significantly higher rates of prior month sex work (31.5% vs. 0%), and used significantly more crack cocaine (14.71 vs. 8.38 days). After six-months of treatment there were no significant differences in treatment outcomes by gender, after adjusting for baseline values. For both men and women, improved health and quality of life were the most common reasons provided for treatment effectiveness, however women were more specific in the types of health improvements. Conclusions Despite presenting to treatment with vulnerabilities not faced to the same extent by men, at six-months women did not differ significantly from men in tested trial efficacy outcomes. While the primary outcome in the trial was the reduction of illicit opioid use, in the open-ended responses both men and women focused their comments on improvement in health and quality of life as reasons for treatment effectiveness. The supervised model of care with injectable medications provides a particularly suitable framework for providing care to opioid-dependent men and women not attracted or retained by other treatments. The absence of statistical differences reported in this secondary analysis may be due to lack of adequate statistical power to detect meaningful effects. Trial registration This trial is registered with ClinicalTrials.gov (NCT01447212) Registered: October 4, 2011 at the following link: https://clinicaltrials.gov/ct2/show/NCT01447212.
Collapse
Affiliation(s)
- Heather Palis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Daphne Guh
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Suzanne Brissette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Hôpital Saint-Luc, Montréal, QC, H2X 3J4, Canada
| | - Kurt Lock
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Scott MacDonald
- Providence Crosstown Clinic, Providence Health Care, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Scott Harrison
- Providence Crosstown Clinic, Providence Health Care, 84 West Hastings Street, Vancouver, BC, V6B 1G6, Canada
| | - Aslam H Anis
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
| | - Michael Krausz
- Department of Psychiatry, Faculty of Medicine, Detwiller Pavilion 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | - Martin T Schechter
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| |
Collapse
|
33
|
Spittal PM, Craib KJ, Teegee M, Baylis C, Christian WM, Moniruzzaman A, Schechter MT. The Cedar project: prevalence and correlates of HIV infection among young Aboriginal people who use drugs in two Canadian cities. Int J Circumpolar Health 2016. [DOI: 10.3402/ijch.v66i3.18259] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
34
|
Malamba SS, Muyinda H, Spittal PM, Ekwaru JP, Kiwanuka N, Ogwang MD, Odong P, Kitandwe PK, Katamba A, Jongbloed K, Sewankambo NK, Kinyanda E, Blair A, Schechter MT. "The Cango Lyec Project - Healing the Elephant": HIV related vulnerabilities of post-conflict affected populations aged 13-49 years living in three Mid-Northern Uganda districts. BMC Infect Dis 2016; 16:690. [PMID: 27871229 PMCID: PMC5117608 DOI: 10.1186/s12879-016-2030-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The protracted war between the Government of Uganda and the Lord's Resistance Army in Northern Uganda (1996-2006) resulted in widespread atrocities, destruction of health infrastructure and services, weakening the social and economic fabric of the affected populations, internal displacement and death. Despite grave concerns that increased spread of HIV/AIDS may be devastating to post conflict Northern Uganda, empirical epidemiological data describing the legacy of the war on HIV infection are scarce. METHODS The 'Cango Lyec' Project is an open cohort study involving conflict-affected populations living in three districts of Gulu, Nwoya and Amuru in mid-northern Uganda. Between November 2011 and July 2012, 8 study communities randomly selected out of 32, were mapped and house-to-house census conducted to enumerate the entire community population. Consenting participants aged 13-49 years were enrolled and interviewer-administered data were collected on trauma, depression and socio-demographic-behavioural characteristics, in the local Luo language. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression was used to determine factors associated with HIV prevalence at baseline. RESULTS A total of 2954 participants were eligible, of whom 2449 were enrolled. Among 2388 participants with known HIV status, HIV prevalence was 12.2% (95%CI: 10.8-13.8), higher in females (14.6%) than males (8.5%, p < 0.001), higher in Gulu (15.2%) than Nwoya (11.6%, p < 0.001) and Amuru (7.5%, p = 0.006) districts. In this post-conflict period, HIV infection was significantly associated with war trauma experiences (Adj. OR = 2.50; 95%CI: 1.31-4.79), the psychiatric problems of PTSD (Adj. OR = 1.44; 95%CI: 1.06-1.96), Major Depressive Disorder (Adj. OR = 1.89; 95%CI: 1.28-2.80) and suicidal ideation (Adj. OR = 1.87; 95%CI: 1.34-2.61). Other HIV related vulnerabilities included older age, being married, separated, divorced or widowed, residing in an urban district, ulcerative sexually transmitted infections, and staying in a female headed household. There was no evidence in this study to suggest that people with a history of abduction were more likely to be HIV positive. CONCLUSIONS HIV prevalence in this post conflict-affected population is high and is significantly associated with age, trauma, depression, history of ulcerative STIs, and residing in more urban districts. Evidence-based HIV/STI prevention programs and culturally safe, gender and trauma-informed are urgently needed.
Collapse
Affiliation(s)
- Samuel S Malamba
- Uganda Virus Research Institute (UVRI) - HIV Reference Laboratory Program, Entebbe, Uganda. .,Northern Uganda Program on Health Sciences, c/o Uganda Virus Research Institute, HIV Reference Laboratory, P.O. Box 49, Entebbe, Kampala, Uganda.
| | - Herbert Muyinda
- Makerere University, Child Health Development Center, Kampala, Uganda
| | - Patricia M Spittal
- University of British Columbia, School of Population & Public Health, Vancouver, Canada
| | - John P Ekwaru
- School of Public Health, University of Alberta, Alberta, Canada
| | - Noah Kiwanuka
- Uganda Virus Research Institute - International HIV/AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Program, Entebbe, Uganda.,Makerere University College of Health Sciences, Kampala, Uganda
| | - Martin D Ogwang
- St. Mary's Hospital-Lacor, Gulu, Uganda.,Northern Uganda Program on Health Sciences, Kampala, Uganda
| | - Patrick Odong
- Northern Uganda Program on Health Sciences, Kampala, Uganda
| | - Paul K Kitandwe
- Uganda Virus Research Institute - International HIV/AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Program, Entebbe, Uganda
| | | | - Kate Jongbloed
- University of British Columbia, School of Population & Public Health, Vancouver, Canada
| | | | - Eugene Kinyanda
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.,Butabika National Psychiatric Referral Hospital, Nakawa, Uganda
| | - Alden Blair
- University of British Columbia, School of Population & Public Health, Vancouver, Canada
| | - Martin T Schechter
- University of British Columbia, School of Population & Public Health, Vancouver, Canada
| |
Collapse
|
35
|
Kerr T, Wood E, Palepu A, Wilson D, Schechter MT, Tyndall MW. Responding to an Explosive HIV Epidemic Driven by Frequent Cocaine Injection: Is There a Role for Safe Injecting Facilities? Journal of Drug Issues 2016. [DOI: 10.1177/002204260303300303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although there have been repeated calls for the establishment of safe injection facilities (SIFs) in Vancouver since the early 1990s, questions remain concerning the feasibility of SIFs due to the high prevalence of injection cocaine and the concomitant problems cocaine use presents. Therefore, we determined the prevalence of willingness to attend SIFs among cocaine injectors in Vancouver and explored the factors associated with this willingness, using data from the Vancouver Injection Drug Users Study. After considering the results derived from this analysis, additional qualitative methods were employed to explore further willingness to use SIFs, barriers and facilitators of SIF utilization, and methods of maximizing use among selected subpopulations of cocaine injectors. The results suggest that a high proportion of cocaine injectors, including some of those most at risk, would attend an SIF if one were available. However, in order to better accommodate cocaine injectors, several modifications could be made to conventional SIF service design and delivery. The vast majority of these modifications relate to ensuring effective responses to cocaine toxicity. Given the acceptability of SIFs among cocaine injectors, it appears that an SIF pilot could result in significant and immediate benefits in terms of public health and community safety.
Collapse
Affiliation(s)
- Thomas Kerr
- Canadian HIV/AIDS Legal Network and Research Associate at the BC Centre for Excellence in HIV/AIDS
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS and coprincipal investigator of the Vancouver Injection Drug Users Study (VIDUS)
| | - Anita Palepu
- Internal medicine specialist and an assistant professor on the Faculty of Medicine at the University of British Columbia
| | - Dean Wilson
- Healthcare advocate and past president of the Vancouver Area Network of Drug Users (VANDU)
| | - Martin T. Schechter
- Department of Healthcare and Epidemiology at the University of British Columbia
| | - Mark W. Tyndall
- Faculty of Medicine at the University of British Columbia, and a research associate at the BC Centre for Excellence in HIV/AIDS
| |
Collapse
|
36
|
Palis H, Marchand K, Peng D, Fikowski J, Harrison S, Spittal P, Schechter MT, Oviedo-Joekes E. Factors Associated with Perceived Abuse in the Health Care System Among Long-Term Opioid Users: A Cross-Sectional Study. Subst Use Misuse 2016; 51:763-76. [PMID: 27096889 DOI: 10.3109/10826084.2016.1155605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Opioid-dependence is a chronic relapsing disorder. Histories of physical, sexual, and emotional abuse are prevalent among long-term opioid users. While perceived abuse in health care has been linked to histories of abuse in other populations it has not been investigated among long-term opioid users. OBJECTIVE To determine factors associated with perceived abuse in health care among a sample of long-term opioid users. METHODS Gender Matters in the Health of Long-Term Opioid Users (GeMa) was a descriptive cross-sectional study. Participants (n = 175) answered questions on health, drug use, treatment history, and victimization. A multivariable model of perceived abuse in health care was built using logistic regression. RESULTS Half of participants (n = 88) reported perceived abuse in health care in lifetime with no gender differences. Histories of abuse, physical, and psychological health problems, and health care access were more prevalent among those reporting perceived abuse in health care compared to those not reporting such experiences. Multivariable analysis showed that more methadone maintenance treatment attempts in life, prescribed psychiatric medication in life, and having higher childhood emotional abuse scores were independently associated with perceived abuse in health care. Among all childhood neglect and abuse types measured, emotional abuse was the only significant predictor. CONCLUSIONS A high prevalence of lifetime perceived abuse in health care (50%) was reported, along with extremely high childhood abuse and neglect scores. Consideration of these variables by health care and service providers is extremely important to improving patient perceptions of care, and ultimately health and treatment outcomes among opioid-dependent people.
Collapse
Affiliation(s)
- Heather Palis
- a Centre for Health Evaluation & Outcome Sciences , Providence Health Care , St. Paul's Hospital, Vancouver , Canada.,b School of Population and Public Health , University of British Columbia , Vancouver , Canada
| | - Kirsten Marchand
- a Centre for Health Evaluation & Outcome Sciences , Providence Health Care , St. Paul's Hospital, Vancouver , Canada.,b School of Population and Public Health , University of British Columbia , Vancouver , Canada
| | - Defen Peng
- a Centre for Health Evaluation & Outcome Sciences , Providence Health Care , St. Paul's Hospital, Vancouver , Canada
| | - Jill Fikowski
- a Centre for Health Evaluation & Outcome Sciences , Providence Health Care , St. Paul's Hospital, Vancouver , Canada.,b School of Population and Public Health , University of British Columbia , Vancouver , Canada
| | - Scott Harrison
- c Providence Health Care, St. Paul's Hospital , Vancouver , Canada
| | - Patricia Spittal
- a Centre for Health Evaluation & Outcome Sciences , Providence Health Care , St. Paul's Hospital, Vancouver , Canada.,b School of Population and Public Health , University of British Columbia , Vancouver , Canada
| | - Martin T Schechter
- a Centre for Health Evaluation & Outcome Sciences , Providence Health Care , St. Paul's Hospital, Vancouver , Canada.,b School of Population and Public Health , University of British Columbia , Vancouver , Canada
| | - Eugenia Oviedo-Joekes
- a Centre for Health Evaluation & Outcome Sciences , Providence Health Care , St. Paul's Hospital, Vancouver , Canada.,b School of Population and Public Health , University of British Columbia , Vancouver , Canada
| |
Collapse
|
37
|
Oviedo-Joekes E, Guh D, Brissette S, Marchand K, MacDonald S, Lock K, Harrison S, Janmohamed A, Anis AH, Krausz M, Marsh DC, Schechter MT. Hydromorphone Compared With Diacetylmorphine for Long-term Opioid Dependence: A Randomized Clinical Trial. JAMA Psychiatry 2016; 73:447-55. [PMID: 27049826 DOI: 10.1001/jamapsychiatry.2016.0109] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Diacetylmorphine hydrochloride (the active ingredient in heroin), delivered under supervision, is effective for the treatment of severe opioid use disorder. However, owing to political and regulatory barriers, it is not available in many settings around the world, which limits the options for many long-term street opioid injectors not attracted into or retained in available treatments. OBJECTIVE To test if injectable hydromorphone hydrochloride is noninferior to injectable diacetylmorphine in reducing illicit heroin use for chronic injection opioid users after 6 months of intervention. DESIGN, SETTING, AND PARTICIPANTS The Study to Assess Longer-term Opioid Medication Effectiveness (SALOME) was a phase 3, double-blind, noninferiority trial. The study randomized 202 long-term street opioid injectors in Vancouver, British Columbia, Canada. Eligible participants were recruited between December 19, 2011, and December 18, 2013. Both intent-to-treat (ITT) and per-protocol (PP) analyses were conducted. INTERVENTIONS Participants were randomly assigned to receive injectable diacetylmorphine or hydromorphone (up to 3 times daily) for 6 months under supervision. MAIN OUTCOMES AND MEASURES Primary and coprimary efficacy outcomes were self-reported days of street heroin use (primary), days of any street-acquired opioids in the prior 30 days (noninferiority margin, 4 days), and the proportion of urinalyses positive for street heroin markers (margin, 10% of the observed rate in the diacetylmorphine group). The mean differences between diacetylmorphine and hydromorphone for the ITT and PP analyses were reported. RESULTS The study included 202 participants; 100 randomized to receive hydromorphone and 102 to diacetylmorphine. Their mean (SD) age was 44.33 (9.63) years, and 30.7% (62 of 202) were women. Noninferiority of hydromorphone was confirmed in the PP analysis (-1.44; 90% CI, -3.22 to 0.27) for street heroin use, although the margin of 4 days was not excluded in the ITT analysis (-2.34; 90% CI, -4.14 to -0.52). Noninferiority was confirmed for any street opioids in the ITT analysis (-0.85; 90% CI, -2.97 to 1.25) and the PP analysis (-0.15; 90% CI, -2.09 to 1.76), as well as for the urinalyses (0.09; 90% CI, -0.02 to 0.19 for the ITT analysis and 0.13; 90% CI, 0.02-0.24 for the PP analysis). There were 29 SAEs considered to have some relationship with the injection medication, 5 in the hydromorphone group and 24 in the diacetylmorphine group (rate ratio, 0.21; 95% CI, 0.06-0.69). Seizures and overdoses accounted for 25 of the 29 related SAEs. CONCLUSIONS AND RELEVANCE This study provides evidence to suggest noninferiority of injectable hydromorphone relative to diacetylmorphine for long-term opioid dependence. In jurisdictions where diacetylmorphine is currently not available or for patients in whom it is contraindicated or unsuccessful, hydromorphone could be offered as an alternative. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01447212.
Collapse
Affiliation(s)
- Eugenia Oviedo-Joekes
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada2School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Daphne Guh
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Suzanne Brissette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada2School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Scott MacDonald
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - Kurt Lock
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Scott Harrison
- Providence Crosstown Clinic, Providence Health Care, Vancouver, British Columbia, Canada
| | - Amin Janmohamed
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Aslam H Anis
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada2School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Krausz
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada5Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - David C Marsh
- Northern Ontario School of Medicine, Sudbury, Canada
| | - Martin T Schechter
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, British Columbia, Canada2School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
38
|
Jongbloed K, Friedman AJ, Pearce ME, Van Der Kop ML, Thomas V, Demerais L, Pooyak S, Schechter MT, Lester RT, Spittal PM. The Cedar Project WelTel mHealth intervention for HIV prevention in young Indigenous people who use illicit drugs: study protocol for a randomized controlled trial. Trials 2016; 17:128. [PMID: 26957103 PMCID: PMC4784291 DOI: 10.1186/s13063-016-1250-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/23/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Despite successes in preventing and treating HIV, Indigenous people in Canada continue to face disproportionately high rates of HIV infection. Programs that support healing from lifetime trauma, support connection to culture, and reduce drug-related harms are critical to preventing HIV among young Indigenous people who use drugs. The Cedar Project WelTel mHealth intervention proposed here is a structured mobile-phone initiative to connect young Indigenous people who use drugs with Cedar Case Managers in a community-based setting. The intervention consists of a package of supports, including a mobile phone and cellular plan, weekly two-way text messaging, and support from Cedar Case Managers. METHODS The Cedar Project WelTel mHealth study is a multi-site Zelen pre-randomized trial to measure the effect of a two-way supportive text-message intervention to reduce HIV vulnerability among young Indigenous people who use illicit drugs in two Canadian cities. The trial is nested within the Cedar Project, an ongoing cohort study addressing HIV and hepatitis C vulnerability among young Indigenous people who use drugs in Vancouver and Prince George, British Columbia. The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, governs all aspects of the study. Two hundred participants will be followed over a 16-month period, with HIV propensity score at 6 months as the primary outcome. Secondary outcomes include HIV propensity at 1 year, HIV risk, resilience, psychological distress, access to drug-related services, and connection to culture measured at 6 months and 1 year. Primary analysis is by intention to treat. DISCUSSION Culturally safe interventions that address barriers to HIV prevention while supporting the strength of young Indigenous people who use drugs are urgently needed. Despite presenting a tremendous opportunity to connect young, highly transient Indigenous people who use drugs to prevention services, supportive two-way mHealth programs have yet to be tested for HIV prevention in a community-based setting with this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02437123 https://clinicaltrials.gov/show/NCT02437123 (registered 4 May 2015). Protocol version: 24 July 2015.
Collapse
Affiliation(s)
- Kate Jongbloed
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Anton J Friedman
- The Cedar Project, Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Margo E Pearce
- The Cedar Project, Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Mia L Van Der Kop
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18a, Campus Solna, Stockholm, 171 77, Sweden. .,Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, 566-828 West 10th Avenue, Vancouver, BC, V5Z 1L8, Canada.
| | - Vicky Thomas
- The Cedar Project, Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Lou Demerais
- Vancouver Native Health Society, 455 Hastings Street E, Vancouver, BC, V6A 1P5, Canada.
| | - Sherri Pooyak
- Canadian Aboriginal AIDS Network, 6520 Salish Drive, Vancouver, BC, V6N 2C7, Canada.
| | - Martin T Schechter
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Richard T Lester
- Neglected Global Diseases Initiative, Faculty of Medicine, University of British Columbia, 564-828 West 10th Avenue, Vancouver, BC, V5Z 1L8, Canada.
| | - Patricia M Spittal
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | | |
Collapse
|
39
|
Pearce ME, Jongbloed KA, Richardson CG, Henderson EW, Pooyak SD, Oviedo-Joekes E, Christian WM, Schechter MT, Spittal PM. The Cedar Project: resilience in the face of HIV vulnerability within a cohort study involving young Indigenous people who use drugs in three Canadian cities. BMC Public Health 2015; 15:1095. [PMID: 26510467 PMCID: PMC4625636 DOI: 10.1186/s12889-015-2417-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/12/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Indigenous scholars have long argued that it is critical for researchers to identify factors related to cultural connectedness that may protect against HIV and hepatitis C infection and buffer the effects of historical and lifetime trauma among young Indigenous peoples. To our knowledge, no previous epidemiological studies have explored the effect of historical and lifetime traumas, cultural connectedness, and risk factors on resilience among young, urban Indigenous people who use drugs. METHODS This study explored risk and protective factors associated with resilience among participants of the Cedar Project, a cohort study involving young Indigenous peoples who use illicit drugs in three cities in British Columbia, Canada. We utilized the Connor-Davidson Resilience Scale to measure resilience, the Childhood Trauma Questionnaire to measure childhood maltreatment, and the Symptom-Checklist 90-Revised to measure psychological distress among study participants. Multivariate linear mixed effects models (LME) estimated the effect of study variables on mean change in resilience scores between 2011-2012. RESULTS Among 191 participants, 92 % had experienced any form of childhood maltreatment, 48 % had a parent who attended residential school, and 71 % had been in foster care. The overall mean resilience score was 62.04, with no differences between the young men and women (p = 0.871). Adjusted factors associated with higher mean resilience scores included having grown up in a family that often/always lived by traditional culture (B = 7.70, p = 0.004) and had often/always spoken their traditional language at home (B = 10.52, p < 0.001). Currently knowing how to speak a traditional language (B = 13.06, p = 0.001), currently often or always living by traditional culture (B = 6.50, p = 0.025), and having recently sought drug/alcohol treatment (B = 4.84, p = 0.036) were also significantly associated with higher mean resilience scores. Adjusted factors associated with diminished mean resilience scores included severe childhood emotional neglect (B = -13.34, p = 0.001), smoking crack daily (B = -5.42, p = 0.044), having been sexual assaulted (B = 14.42, p = 0.041), and blackout drinking (B = -6.19, p = 0.027). CONCLUSIONS Young people in this study have faced multiple complex challenges to their strength. However, cultural foundations continue to function as buffers that protect young Indigenous people from severe health outcomes, including vulnerability to HIV and HCV infection.
Collapse
Affiliation(s)
- Margo E Pearce
- School of Population and Public Health, University of British Columbia, Columbia, Canada.
- Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard St., V6Z1Y6, Vancouver, BC, Canada.
| | - Kate A Jongbloed
- School of Population and Public Health, University of British Columbia, Columbia, Canada.
- Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard St., V6Z1Y6, Vancouver, BC, Canada.
| | - Chris G Richardson
- School of Population and Public Health, University of British Columbia, Columbia, Canada.
- Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard St., V6Z1Y6, Vancouver, BC, Canada.
| | - Earl W Henderson
- Cree, Métis; University of Northern British Columbia, Columbia, Canada.
| | - Sherri D Pooyak
- Cree; University of Victoria; Canadian Aboriginal AIDS Network, Victoria, Canada.
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Columbia, Canada.
- Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard St., V6Z1Y6, Vancouver, BC, Canada.
| | | | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, Columbia, Canada.
- Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard St., V6Z1Y6, Vancouver, BC, Canada.
| | - Patricia M Spittal
- School of Population and Public Health, University of British Columbia, Columbia, Canada.
- Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard St., V6Z1Y6, Vancouver, BC, Canada.
| |
Collapse
|
40
|
Marchand K, Palis H, Peng D, Fikowski J, Harrison S, Spittal P, Schechter MT, Oviedo-Joekes E. The Role of Gender in Factors Associated With Addiction Treatment Satisfaction Among Long-Term Opioid Users. J Addict Med 2015; 9:391-8. [PMID: 26335006 PMCID: PMC4605272 DOI: 10.1097/adm.0000000000000145] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/20/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To identify factors associated with Opioid Agonist Treatment (OAT) satisfaction and to determine whether these relationships are gender specific. METHODS This study was based on data collected in a cross-sectional study among long-term opioid-dependent individuals (n = 160; 46.3% women). Participants completed the Client Satisfaction Questionnaire in reference to OAT episodes. Sociodemographic, illicit substance use, health, and addiction treatment history data were collected. Multivariable linear regression was used to determine the relationship between these variables and treatment satisfaction. To explore the potential role of gender in these identified relationships stratified multivariable models were tested. Additional open-ended questions regarding positive and negative perceptions of treatment were collected, and a thematic analysis was conducted. RESULTS In the multivariable linear regression model, participants who were older, of Aboriginal ancestry, and currently receiving OAT had higher OAT satisfaction scores, whereas participants who had methadone dose preferences of 30 mg or less had lower OAT satisfaction. In stratified analyses among women, the relationship between preferred methadone dose and current OAT remained significantly associated with satisfaction. Open-ended positive and negative perceptions complemented and provided further valuable data to interpret these identified relationships. CONCLUSIONS To our knowledge, this is the first study to explore the potential role of gender in factors associated with OAT satisfaction. These findings provide valuable information to health care providers working in OAT settings regarding how to address women and men's OAT needs and improve treatment satisfaction.
Collapse
Affiliation(s)
- Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences (KM, HP, DP, JF, PS, MTS, EOJ), Providence Health Care, St Paul's Hospital, Vancouver, BC, Canada; and School of Population and Public Health (KM, HP, JF, PS, MTS, EOJ) and School of Nursing (SH), University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Strang J, Groshkova T, Uchtenhagen A, van den Brink W, Haasen C, Schechter MT, Lintzeris N, Bell J, Pirona A, Oviedo-Joekes E, Simon R, Metrebian N. Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction†. Br J Psychiatry 2015; 207:5-14. [PMID: 26135571 DOI: 10.1192/bjp.bp.114.149195] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Supervised injectable heroin (SIH) treatment has emerged over the past 15 years as an intensive treatment for entrenched heroin users who have not responded to standard treatments such as oral methadone maintenance treatment (MMT) or residential rehabilitation. AIMS To synthesise published findings for treatment with SIH for refractory heroin-dependence through systematic review and meta-analysis, and to examine the political and scientific response to these findings. METHOD Randomised controlled trials (RCTs) of SIH treatment were identified through database searching, and random effects pooled efficacy was estimated for SIH treatment. Methodological quality was assessed according to criteria set out by the Cochrane Collaboration. RESULTS Six RCTs met the inclusion criteria for analysis. Across the trials, SIH treatment improved treatment outcome, i.e. greater reduction in the use of illicit 'street' heroin in patients receiving SIH treatment compared with control groups (most often receiving MMT). CONCLUSIONS SIH is found to be an effective way of treating heroin dependence refractory to standard treatment. SIH may be less safe than MMT and therefore requires more clinical attention to manage greater safety issues. This intensive intervention is for a patient population previously considered unresponsive to treatment. Inclusion of this low-volume, high-intensity treatment can now improve the impact of comprehensive healthcare provision.
Collapse
Affiliation(s)
- John Strang
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Teodora Groshkova
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Ambros Uchtenhagen
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Wim van den Brink
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Christian Haasen
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Martin T Schechter
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Nick Lintzeris
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - James Bell
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Alessandro Pirona
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Eugenia Oviedo-Joekes
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Roland Simon
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| | - Nicola Metrebian
- John Strang, MD, MBBS, FRCPsych, FRCP, Professor of the Addictions, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and South London and Maudsley NHS Foundation Trust, London, UK; Teodora Groshkova, PhD, Researcher, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK, and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Ambros Uchtenhagen, MD, PhD, Emeritus Professor of Social Psychiatry, The University of Zürich, Switzerland; Wim van den Brink, MD, PhD, Professor of Psychiatry and Addiction, Amsterdam Institute for Addiction Research, The Netherlands; Christian Haasen, MD, PhD, Director, Centre for Interdisciplinary Addition Research, Department of Psychiatry, Hamburg, Germany; Martin T. Schechter, OBC, MD, PhD, FRSC, FCAHS, Professor and Director, School of Population and Public Health, The University of British Columbia, Canada; Nick Lintzeris, MBBS, PhD, FAChAM, Associate Professor, Faculty of Medicine, The University of Sydney, and Director, Drug and Alcohol Services, SESLHD, New South Wales, Australia; James Bell, MD, FRACP, FAChAM, South London and Maudsley NHS Foundation Trust, London, UK; Alessandro Pirona, MSc, PhD, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Eugenia Oviedo-Joekes, PhD, Associate Professor, School of Population and Public Health, University of British Columbia, Canada; Roland Simon, Head of Unit, Interventions, Best Practice and Scientific Partners, European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal; Nicola Metrebian, PhD, Senior Research Fellow, National Addictions Centre, King's College London, Institute of Psychiatry, London, UK
| |
Collapse
|
42
|
Clarkson AF, Christian WM, Pearce ME, Jongbloed KA, Caron NR, Teegee MP, Moniruzzaman A, Schechter MT, Spittal PM. The Cedar Project: Negative health outcomes associated with involvement in the child welfare system among young Indigenous people who use injection and non-injection drugs in two Canadian cities. Can J Public Health 2015; 106:e265-70. [PMID: 26451986 DOI: 10.17269/cjph.106.5026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/25/2015] [Accepted: 05/06/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Indigenous leaders and child and family advocates are deeply concerned about the health impacts of the child welfare system, including HIV vulnerability. The objectives of this study were to describe the prevalence of having been apprehended into the child welfare system and associated HIV vulnerabilities among young Indigenous people who use drugs. METHODS The Cedar Project is a cohort of young Indigenous people ages 14-30 years who use illicit drugs in Vancouver and Prince George, British Columbia. Multivariable logistic regression modeling determined associations between a history of involvement in the child welfare system and vulnerability to HIV infection. RESULTS Of 605 participants, 65% had been taken from their biological parents. Median age of first apprehension was 4 years old. Having been sexually abused, having a parent who attended residential school and being HIV-positive were all independently associated with having been involved in the child welfare system. Participants who had been involved in the child welfare system were also more likely to have been homeless, paid for sex, diagnosed and hospitalized with mental illness, self-harmed, thought about suicide, and attempted suicide. Among participants who used injection drugs, those who had been involved in child welfare were more likely to have shared needles and overdosed. CONCLUSION This study has found compelling evidence that young Indigenous people who use drugs in two cities in BC are experiencing several distressing health outcomes associated with child welfare involvement, including HIV infection. Jurisdictional reforms and trauma-informed programs that use culture as intervention are urgently needed.
Collapse
|
43
|
|
44
|
Jongbloed K, Thomas V, Pearce ME, Christian KW, Zhang H, Oviedo-Joekes E, Schechter MT, Spittal PM. The Cedar Project: Residential transience and HIV vulnerability among young Aboriginal people who use drugs. Health Place 2015; 33:125-31. [PMID: 25840350 DOI: 10.1016/j.healthplace.2015.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/18/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022]
Abstract
Aboriginal homelessness is considered to be a result of historic dispossession of traditional territories and forced displacement from community structures. Using data collected from 2005-2010 from the Cedar Project, a cohort of young Aboriginal people who use drugs in two Canadian cities, we examined how residential transience shapes HIV vulnerability. At baseline, 48 of 260 participants (18.5%) reported sleeping in six or more places ('highly transient') in the past six months. Generalized linear mixed models identified associations between high transience and sex and drug related HIV vulnerabilities. Transience was independently associated with sex work (AOR:3.52, 95%CI:2.06, 6.05); sexual assault (AOR:2.48, 95%CI:1.26, 4.86); injection drug use (AOR:4.54, 95%CI:2.71, 7.61); daily cocaine injection (AOR:2.16, 95%CI:1.26, 3.72); and public injection (AOR:2.87, 95%CI:1.65, 5.00). After stratification, transience and sexual vulnerability remained significantly associated among women but not men. Ensuring that young Aboriginal people have access to safe spaces to live, work, and inject must include policies addressing residential transience as well as the absence of a roof and walls.
Collapse
Affiliation(s)
- Kate Jongbloed
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Vicky Thomas
- The Cedar Project, Centre for Evaluation and Outcome Sciences, St. Paul׳s Hospital, Vancouver, Canada; Wuikinuxv Nation, The Cedar Project, Prince George, Canada
| | - Margo E Pearce
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Hongbin Zhang
- The Cedar Project, Centre for Evaluation and Outcome Sciences, St. Paul׳s Hospital, Vancouver, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Martin T Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Patricia M Spittal
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | | |
Collapse
|
45
|
Pearce ME, Blair AH, Teegee M, Pan SW, Thomas V, Zhang H, Schechter MT, Spittal PM. The Cedar Project * : historical trauma and vulnerability to sexual assault among young aboriginal women who use illicit drugs in two Canadian cities. Violence Against Women 2015; 21:313-29. [PMID: 25648945 DOI: 10.1177/1077801214568356] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explored trends of sexual assault and associated risk factors within a cohort of young Aboriginal women who used drugs in Vancouver and Prince George, Canada, between 2003 and 2010. Results demonstrated no change in the trend of sexual assault over time; however, odds of sexual assault were significantly higher for women who had at least one parent who attended residential school, had experienced childhood sexual abuse, were involved in sex work, had been offered money to not use condoms, had used injection drugs, had injected cocaine and opiates daily, had binged with injection drugs, and had difficulty accessing clean syringes. Findings highlight the urgency of interventions addressing the complexity of risk and opportunities for healing.
Collapse
Affiliation(s)
| | | | - Mary Teegee
- Takla Lake First Nation, Carrier Sekani Family Services, Prince George, British Columbia, Canada
| | | | - Vicky Thomas
- University of British Columbia, Vancouver, Canada Wuikinuxv Nation, Prince George, British Columbia, Canada
| | | | | | | |
Collapse
|
46
|
Oviedo-Joekes E, Marchand K, Lock K, MacDonald S, Guh D, Schechter MT. The SALOME study: recruitment experiences in a clinical trial offering injectable diacetylmorphine and hydromorphone for opioid dependency. Subst Abuse Treat Prev Policy 2015; 10:3. [PMID: 25619263 PMCID: PMC4355145 DOI: 10.1186/1747-597x-10-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 01/17/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Study to Assess Long-term Opioid Medication Effectiveness (SALOME) is a two-stage phase III, single site (Vancouver, Canada), randomized, double blind controlled trial designed to test if hydromorphone is as effective as diacetylmorphine for the treatment of long-term illicit opioid injection. Recruiting participants for clinical trials continues to be a challenge in medical and addiction research, with many studies not being able to reach the planned sample size in a timely manner. The aim of this study is to describe the recruitment strategies in SALOME, which offered appealing treatments but had limited clinic capacity and no guaranteed post-trial continuation of the treatments. METHODS SALOME included chronic opioid-dependent, current illicit injection opioid users who had at least one previous episode of opioid maintenance treatment. Regulatory approvals were received in June 2011 and recruitment strategies were implemented over the next 5 months. Recruitment strategies included ongoing open communication with the community, a consistent and accessible team and participant-centered screening. All applicants completed a pre-screening checklist to assess prerequisites. Applicants meeting these prerequisites were later contacted to commence the screening process. RESULTS A total of 598 applications were received over the two-year recruitment period; 130 were received on the first day of recruitment. Of these applicants, 485 met prerequisites; however, many could not be found or were not reached before recruitment ended. For the 253 candidates who initiated the screening process, the average time lapse between application and screening date was 8.3 months (standard deviation [SD] = 4.44) and for the 202 randomized to the study, the average processing time from initial screen to randomization was 25.9 days (SD = 37.48; Median = 15.0). CONCLUSIONS As in prior trials offering injectable diacetylmorphine within a supervised model, recruiting participants for this study took longer than planned. The recruitment challenges overcome in SALOME were due to the high number of applicants compared with the limited number that could be randomized and treated. Our study emphasizes the value of integrating these strategies into clinical addiction research to overcome study-specific barriers. TRIAL REGISTRATION ClinicalTrials.gov: NCT01447212.
Collapse
Affiliation(s)
- Eugenia Oviedo-Joekes
- />Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, 575- 1081 Burrard St., Vancouver, BC V6Z 1Y6 Canada
- />School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Kirsten Marchand
- />Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, 575- 1081 Burrard St., Vancouver, BC V6Z 1Y6 Canada
- />School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Kurt Lock
- />Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, 575- 1081 Burrard St., Vancouver, BC V6Z 1Y6 Canada
| | - Scott MacDonald
- />Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, Vancouver, BC V6B 1G6 Canada
| | - Daphne Guh
- />Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, 575- 1081 Burrard St., Vancouver, BC V6Z 1Y6 Canada
| | - Martin T Schechter
- />Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul’s Hospital, 575- 1081 Burrard St., Vancouver, BC V6Z 1Y6 Canada
- />School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| |
Collapse
|
47
|
Oviedo-Joekes E, Marchand K, Lock K, Chettiar J, Marsh DC, Brissette S, Anis AH, Schechter MT. A chance to stop and breathe: participants' experiences in the North American Opiate Medication Initiative clinical trial. Addict Sci Clin Pract 2014; 9:21. [PMID: 25262567 PMCID: PMC4181618 DOI: 10.1186/1940-0640-9-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/23/2014] [Indexed: 01/09/2023] Open
Abstract
Background The North American Opiate Medication Initiative (NAOMI) clinical trial compared the effectiveness of injectable diacetylmorphine (DAM) or hydromorphone (HDM) to oral methadone maintenance treatment (MMT). This study aimed to determine participants’ perceptions of treatment delivered in NAOMI. Methods A qualitative sub-study was conducted with 29 participants (12 female): 18 (62.1%) received injectable DAM or HDM and 11 (37.9%) received MMT. A phenomenological theoretical framework was used. Semi-structured interviews were audio-recorded and transcribed verbatim. A thematic analysis was used over successive phases and was driven by the semantic meanings of the data. Results Participants receiving injectable medications suggested that the supervised delivery model was stringent but provided valuable stability to their lives. Females discussed the adjustment required for the clinical setting, while males focused on the challenging clinic schedule and its impact on employment abilities. Participants receiving MMT described disappointment with being randomized to this treatment; however, positive aspects, including the quick titration time and availability of auxiliary services, were also discussed. Conclusion Treatment with injectable DAM (or HDM) is preferred by participants and considered effective in reducing the burden of opioid dependency. Engaging patients in research regarding their perceptions of treatment provides a comprehensive assessment of treatment needs and barriers. Clinical trial registration NCT00175357
Collapse
Affiliation(s)
- Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St, Paul's Hospital, 575- 1081 Burrard St,, Vancouver, BC V6Z 1Y6, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Oviedo-Joekes E, Guh D, Marchand K, Marsh DC, Lock K, Brissette S, Anis AH, Schechter MT. Differential long-term outcomes for voluntary and involuntary transition from injection to oral opioid maintenance treatment. Subst Abuse Treat Prev Policy 2014; 9:23. [PMID: 24908387 PMCID: PMC4064505 DOI: 10.1186/1747-597x-9-23] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/03/2014] [Indexed: 11/29/2022]
Abstract
Background The most widely used maintenance treatment for opioid dependency is substitution with long-acting oral opioids. Treatment with injectable diacetylmorphine provides an opportunity for patients to stabilize and possibly transition to oral treatment, if clinically indicated. The aim of this study was to explore outcomes of individuals that received injectable diacetylmorphine and voluntarily transitioned to oral methadone. Design and methods The North American Opiate Medication Initiative was a randomized controlled trial that compared the effectiveness of injectable diacetylmorphine (or hydromorphone) to oral methadone for long-term opioid-dependency. Treatment was provided for 12-months with an additional 3 months for transition and weaning. Participants were followed until 24-months from randomization. Among the participants randomized to injectable treatments, a sub-group voluntarily chose to transition to oral methadone (n = 16) during the treatment period. Illicit heroin use and treatment retention were assessed at 24-months for those voluntarily and involuntarily transitioning (n = 95) to oral methadone. Results At 24-months, the group that voluntarily transitioned to oral methadone had higher odds of treatment retention (adjusted odds ratio = 5.55; 95% confidence interval [CI] = 1.11, 27.81; Chi-square = 4.33, df = 1, p-value = 0.037) than the involuntary transition group. At 24-months, the adjusted mean difference in prior 30 days of illicit heroin use for the voluntary, compared to the involuntary group was -5.58 (95% CI = -11.62, 0.47; t-value = -1.83, df = 97.4, p-value = 0.070). Conclusions Although the results of this study were based on small groups of self-selected (i.e., non-randomized) participants, our data underlines the critical importance of voluntary and patient-centered decision making. If we had continued offering treatment with diacetylmorphine, those retained to injectable medication may have sustained the achieved improvements in the first 12 months. Diversified opioid treatment should be available so patients and physicians can flexibly choose the best treatment at the time. Trial registration Clinical Trial Registration: NCT00175357
Collapse
Affiliation(s)
- Eugenia Oviedo-Joekes
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St, Paul's Hospital, 575- 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Cotton LA, Kuang XT, Le AQ, Carlson JM, Chan B, Chopera DR, Brumme CJ, Markle TJ, Martin E, Shahid A, Anmole G, Mwimanzi P, Nassab P, Penney KA, Rahman MA, Milloy MJ, Schechter MT, Markowitz M, Carrington M, Walker BD, Wagner T, Buchbinder S, Fuchs J, Koblin B, Mayer KH, Harrigan PR, Brockman MA, Poon AFY, Brumme ZL. Genotypic and functional impact of HIV-1 adaptation to its host population during the North American epidemic. PLoS Genet 2014; 10:e1004295. [PMID: 24762668 PMCID: PMC3998893 DOI: 10.1371/journal.pgen.1004295] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/21/2014] [Indexed: 11/20/2022] Open
Abstract
HLA-restricted immune escape mutations that persist following HIV transmission could gradually spread through the viral population, thereby compromising host antiviral immunity as the epidemic progresses. To assess the extent and phenotypic impact of this phenomenon in an immunogenetically diverse population, we genotypically and functionally compared linked HLA and HIV (Gag/Nef) sequences from 358 historic (1979–1989) and 382 modern (2000–2011) specimens from four key cities in the North American epidemic (New York, Boston, San Francisco, Vancouver). Inferred HIV phylogenies were star-like, with approximately two-fold greater mean pairwise distances in modern versus historic sequences. The reconstructed epidemic ancestral (founder) HIV sequence was essentially identical to the North American subtype B consensus. Consistent with gradual diversification of a “consensus-like” founder virus, the median “background” frequencies of individual HLA-associated polymorphisms in HIV (in individuals lacking the restricting HLA[s]) were ∼2-fold higher in modern versus historic HIV sequences, though these remained notably low overall (e.g. in Gag, medians were 3.7% in the 2000s versus 2.0% in the 1980s). HIV polymorphisms exhibiting the greatest relative spread were those restricted by protective HLAs. Despite these increases, when HIV sequences were analyzed as a whole, their total average burden of polymorphisms that were “pre-adapted” to the average host HLA profile was only ∼2% greater in modern versus historic eras. Furthermore, HLA-associated polymorphisms identified in historic HIV sequences were consistent with those detectable today, with none identified that could explain the few HIV codons where the inferred epidemic ancestor differed from the modern consensus. Results are therefore consistent with slow HIV adaptation to HLA, but at a rate unlikely to yield imminent negative implications for cellular immunity, at least in North America. Intriguingly, temporal changes in protein activity of patient-derived Nef (though not Gag) sequences were observed, suggesting functional implications of population-level HIV evolution on certain viral proteins. Upon HIV transmission, many – though not all – immune escape mutations selected in the previous host will revert to the consensus residue. The persistence of certain escape mutations following transmission has led to concerns that these could gradually accumulate in circulating HIV sequences over time, thereby undermining host antiviral immune potential as the epidemic progresses. As certain immune-driven mutations reduce viral fitness, their spread through the population could also have consequences for the average replication capacity and/or protein function of circulating HIV sequences. Here, we characterized HIV sequences, linked to host immunogenetic information, from patients enrolled in historic (1979–1989) and modern (2000–2011) HIV cohorts from four key cities in the North American epidemic. We reconstructed the epidemic's ancestral (founder) HIV sequence and assessed the subsequent extent to which known HIV immune escape mutations have spread in the population. Our data support the gradual spread of many - though not all - immune escape mutations in HIV sequences over time, but to an extent that is unlikely to have major immediate immunologic consequences for the North American epidemic. Notably, in vitro assessments of ancestral and patient-derived HIV sequences suggested functional implications of ongoing HIV evolution for certain viral proteins.
Collapse
Affiliation(s)
- Laura A. Cotton
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Xiaomei T. Kuang
- Department of Molecular Biology and Biochemistry, Faculty of Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Anh Q. Le
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Benjamin Chan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Denis R. Chopera
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- KwaZulu-Natal Research Institute for Tuberculosis and HIV, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Chanson J. Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Tristan J. Markle
- Department of Molecular Biology and Biochemistry, Faculty of Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Eric Martin
- Department of Molecular Biology and Biochemistry, Faculty of Science, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Aniqa Shahid
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Gursev Anmole
- Department of Molecular Biology and Biochemistry, Faculty of Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Philip Mwimanzi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Pauline Nassab
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kali A. Penney
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Manal A. Rahman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - M.-J. Milloy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin T. Schechter
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Markowitz
- Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York, United States of America
| | - Mary Carrington
- Cancer and Inflammation Program, Laboratory of Experimental Immunology, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
- Ragon Institute of MGH, MIT and Harvard University, Cambridge, Massachusetts, United States of America
| | - Bruce D. Walker
- Ragon Institute of MGH, MIT and Harvard University, Cambridge, Massachusetts, United States of America
| | - Theresa Wagner
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Susan Buchbinder
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Jonathan Fuchs
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Beryl Koblin
- New York Blood Center, New York, New York, United States of America
| | - Kenneth H. Mayer
- Fenway Community Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - P. Richard Harrigan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark A. Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Molecular Biology and Biochemistry, Faculty of Science, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Art F. Y. Poon
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zabrina L. Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- * E-mail:
| |
Collapse
|
50
|
Patel S, Schechter MT, Sewankambo NK, Atim S, Kiwanuka N, Spittal PM. Lost in transition: HIV prevalence and correlates of infection among young people living in post-emergency phase transit camps in Gulu District, Northern Uganda. PLoS One 2014; 9:e89786. [PMID: 24587034 PMCID: PMC3938506 DOI: 10.1371/journal.pone.0089786] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 01/26/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Little is known about HIV infection and the related vulnerabilities of young people living in resource-scarce, post-emergency transit camps that are now home to thousands of Internally Displaced Persons (IDPs) following two decades of war in northern Uganda. The objective of this analysis was to assess the prevalence and correlates of HIV infection among young people living in post-conflict transition in Gulu District, northern Uganda. METHODS In 2010, a cross-sectional demographic and behavioural survey was conducted in two of Gulu District's sub-counties with 384 purposively selected transit camp residents aged 15 to 29 years. Biological specimens were collected for rapid HIV testing in the field and confirmatory laboratory testing. Multivariable logistic regression identified independent determinants of HIV infection. RESULTS HIV prevalence was alarmingly high at 12.8% (95% CI: 9.6%, 16.5%). The strongest determinant of HIV infection among young people was a non-consensual sexual debut (adjusted odds ratio [AOR], 9.88; 95% CI: 1.70-18.06). Residing in Awach sub-county (AOR, 2.93; 95% CI: 1.28-6.68), experiencing STI symptoms in the previous 12 months (AOR, 2.36; 95% CI: 1.43-6.17), and practicing dry sex (AOR, 2.31; 95% CI: 1.04-5.13) were other key determinants of HIV infection. CONCLUSIONS Study findings contribute to filling an important gap in epidemiological evidence and are useful for planning public health interventions in northern Uganda that effectively target young people in post-conflict transition and support them in the resettlement process. Findings serve to recommend reaching beyond traditional prevention programming in a way more effectively beneficial to young people in post-conflict settings by developing population-specific responses sensitive to local contexts and sufficient to address the underlying causes of the complex risk factors influencing the spread of HIV.
Collapse
Affiliation(s)
- Sheetal Patel
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- * E-mail:
| | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | | | - Stella Atim
- Community-based Researcher, Gulu Town, Uganda
| | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patricia M. Spittal
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| |
Collapse
|