119 research outputs found
An evaluation of the uptake of community drug checking services and its effect on risk reduction practices in British Columbia
No full textBackground: In response to a growing toxic drug crisis, drug checking services (DCS) have been implemented across British Columbia (BC). DCS have been offered in various settings (e.g., festivals, community) using different technologies (e.g., Fourier-transform infrared spectroscopy [FTIR]), though little is known about the uptake of DCS and its influence on behaviour. This thesis aims to examine characteristics shaping frequent utilization of DCS and the effect of DCS on behaviour change specific to reducing risk of harms.
Methods: Data were derived from a cross-sectional study administered across BC. Multivariable logistic regression models were utilized to investigate: 1) factors associated with frequency of DCS utilization and 2) the effect of attitude towards DCS results (i.e., not pleased vs. pleased) on engagement in risk reduction practices (i.e., disposed of drug, used less). Using descriptive statistics, we also examined whether specific risk reduction practices differed based on being pleased (or not) with DCS results.
Results: Amongst 321 participants, 152 (47.4%) utilized drug checking once. Factors positively associated with frequent drug checking utilization included having witnessed an overdose (Adjusted Odds Ratio [AOR] = 2.71; 95% Confidence Interval [CI}: 1.52 – 5.00) and having accessed healthcare services (AOR = 1.94; 95% CI: 1.06 – 3.61), whereas those who self-identified as Indigenous, Black, or Person of Colour (AOR = 0.45; 95% CI: 0.26 – 0.76) and those who had an outstanding warrant (AOR = 0.48; 95% CI: 0.24 – 0.94) were negatively associated with the outcome. Amongst 288 participants, 77 (26.7%) were not pleased with their results which was positively associated with engagement in a risk reduction practice (AOR = 4.00; 95% CI: 1.72 – 9.09). While most participants reported no behaviour change, the most reported risk reduction practices were disposing of the drug (18; 23.4%) and selling the drug (10; 4.7%) for participants not pleased and pleased with their results respectively.
Conclusions: Findings from this thesis suggest that various facilitators and barriers might influence frequent and continued DCS utilization. Additionally, we found that attitudes regarding DCS results can play an important role in determining behaviour change, further emphasizing the potential of DCS to reduce risk associated with substance use.Medicine, Faculty ofGraduat
Characterization of overdose survivors and their outcomes in opioid agonist treatment : findings from a pragmatic, pan-Canadian, randomized control trial
No full textBackground: Canada is currently facing an overdose epidemic primarily attributed to prescription and synthetic opioids. Previous work has revealed that individuals with a history of non-fatal overdose (NFO) are at a higher risk of mortality, but little is known about treatment outcomes among this population. The aim of this thesis was to characterize opioid agonist treatment (OAT) seeking individuals with prescription-type opioid use disorder (POUD) and a history of NFO, as well as their treatment outcomes.
Methods: Data were drawn from OPTIMA, a multi-site, 24-week, pragmatic, randomized control trial evaluating the relative effectiveness of buprenorphine/naloxone and methadone models of care for adults with POUD. Multivariable logistic regression was used to determine correlates of NFO and to explore treatment retention among participants with a history of NFO. Analysis of covariance (ANCOVA) was used to examine the mean difference in opioid use between treatment arms. Finally, descriptive statistics were produced to determine the prevalence of overdose during treatment and investigate patterns of opioid use before and after overdose.
Results: Among the 272 randomized participants, 159 (58%) had a lifetime history of NFO. Homelessness, receiving income assistance and positive urine drug screens (UDS) for fentanyl and methamphetamine were all independently associated with a history of NFO. Among participants with a history of NFO, retention was 17% for the buprenorphine/naloxone group and 18% for the methadone group and was not statistically different between the treatment arms (p = 0.54). Across the study period, there was an 11.9% adjusted mean difference in opioid-free UDS, favouring the buprenorphine/naloxone arm (95% CI= 3.5 to 20.3; p=0.0057). A total of 24 overdoses were reported during the study period (6 participants randomized to buprenorphine/naloxone; 12 randomized to methadone). All participants that initiated treatment continued to use opioids after overdose.
Conclusions: Findings from this research indicate that a considerable proportion of OAT-seeking individuals have a history of NFO. Low retention rates and high opioid use in treatment highlight the importance of an individualized, multidimensional approach to treatment for this population. Timely initiation of low-barrier treatment and interventions to address socio-structural barriers could potentially mitigate future overdose and improve treatment outcomes.Medicine, Faculty ofMedicine, Department ofGraduat
Leaving the Hospital Against Medical Advice Among People Who Use Illicit Drugs: A Systematic Review
No full textImproving hospital care for patients who use illicit drugs in Vancouver, Canada
No full textBackground: People who use illicit drugs (PWUD) experience a number of health-related harms that often lead to frequent hospitalizations. However, there exists little scientific evidence that has explored utilization and retention in hospital care, including leaving hospital against medical advice (AMA), among this population. The objective of this thesis is to provide evidence to improve hospital care for PWUD by first, identifying individual and contextual factors associated with leaving hospital AMA and other hospital-related experiences; and, second, to use these findings to develop and evaluate novel approaches to minimizing the risks and harms that PWUD experience in hospital settings. Methods: This dissertation draws on data collected from two open prospective cohort studies of HIV-positive and HIV-negative PWUD in Vancouver, Canada. These data were confidentially linked to a hospital discharge database as well as comprehensive records of HIV treatment and related clinical outcomes through a clinical monitoring laboratory. A variety of longitudinal and cross-sectional analytic techniques were used to examine the impact of intersecting individual and contextual factors on various hospital service outcomes. Results: This dissertation identified hospitals as a risk environment for PWUD, given the high prevalence of hospital discharge AMA and active illicit drug use in hospitals. The study findings highlighted various risk and protective factors for leaving hospital AMA, and discussed the negative consequences of being denied pain medication on illicit drug use in hospitals. The findings from this dissertation also point to novel strategies that may address these issues, including the implementation of an adult HIV/AIDS integrated health program operating in proximity to a hospital to minimize hospital discharge AMA among HIV-positive PWUD, as well as the potential for an in-hospital supervised injection facility (SIF) to reduce the harms associated with illicit drug use in hospital. Conclusion: Despite this setting of universal access to healthcare, there are individual- and contextual-level factors that play a pivotal role in shaping utilization and retention in hospital care among PWUD. The collective findings of this dissertation offer insights into how integrated harm reduction-based interventions may mitigate the risks associated with leaving hospital AMA and active illicit drug use in hospitals.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat
The impact of harm reduction on HIV and illicit drug use
No full textThere has been widespread support for harm reduction programs as an essential component for responding to the HIV and illicit drug use epidemics. However, despite the growing international acceptance of harm reduction, there continues to be strong opposition to this approach, with critics alleging that harm reduction programs enable drug use. Vancouver, Canada provides a compelling case study that demonstrates that many positive impacts of harm reduction can be attained while addiction treatment-related goals are simultaneously supported. While the evidence for harm reduction is clearly mounting, it is unfortunate that ideological and political barriers to implementing harm reduction programs in Canada remain. As evidenced by Vancouver and elsewhere, harm reduction programs do not exacerbate drug use and undermine treatment efforts and should thereby occupy a well-deserved space within the continuum of programs and services offered to people who inject drugs.Medicine, Department ofPopulation and Public Health (SPPH), School ofMedicine, Faculty ofReviewedFacult
Task shifting redefined: removing social and structural barriers to improve delivery of HIV services for people who inject drugs
No full textHIV infection among people who inject drugs (IDU) remains a major global public health challenge. However, among IDU, access to essential HIV-related services remains unacceptably low, especially in settings where stigma, discrimination, and criminalization exist. These ongoing problems account for a significant amount of preventable morbidity and mortality within this population, and indicate the need for novel approaches to HIV program delivery for IDU. Task shifting is a concept that has been applied successfully in African settings as a way to address health worker shortages. However, to date, this concept has not been applied as a means of addressing the social and structural barriers to HIV prevention and treatment experienced by IDU. Given the growing evidence demonstrating the effectiveness of IDU-run programs in increasing access to healthcare, the time has come to extend the notion of task shifting and apply it in settings where stigma, discrimination, and criminalization continue to pose significant barriers to HIV program access for IDU. By involving IDU more directly in the delivery of HIV programs, task shifting may serve to foster a new era in the response to HIV/AIDS among IDU.Medicine, Department ofMedicine, Faculty ofOther UBCNon UBCReviewedFacult
Integrated Models of Care for People Living with Hepatitis C Virus and a Substance Use Disorder: Protocol for a Systematic Review (Preprint)
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BACKGROUND
People living with a substance use disorder (SUD) are a key population within the hepatitis C virus (HCV) epidemic. While integrated and community-based models of care have shown positive outcomes among this population, the literature has been primarily focused on the HIV context. This paper outlines a systematic review protocol on the impact of various integrated models of care, which includes HCV and SUD services, on various treatment, and health-related outcomes among this population.
OBJECTIVE
The objective of this review is to determine the impact of integrated models of care on HCV and addiction treatment and health-related outcomes for adults living with HCV and an SUD.
METHODS
We will search 5 databases, article reference lists, and abstracts from relevant conferences that investigate the impact of integrated models of care on treatment and health-related outcomes among people living with HCV and an SUD. Database searches will be conducted and titles, abstracts, and the full-text of the relevant studies will be independently reviewed in separate stages. The methodological quality of included studies will be assessed using a validated tool. Data from included articles will be extracted using a standardized form and synthesized in a narrative account.
RESULTS
For this project, we have received funding from the Canadian Institute of Health Research. To date, we have completed the search strategy, reviewed the titles, abstracts, and full-texts. Grading the selected studies and qualitative synthesis of the results are currently under way, and we expect the final results to be submitted for publication in the fall of 2018.
CONCLUSIONS
The systematic review will describe different integrated models of care that could be effective in improving the health and well-being of people living with HCV and an SUD. Results of this review could also identify quality improvement strategies to minimize the health and cost burden imposed on patients, healthcare professionals, and the healthcare system.
CLINICALTRIAL
PROSPERO CRD42017078445; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=78445 (Archived by WebCite at http://www.webcitation.org/6z4YnkE9G)
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Integrated Models of Care for People Living with Hepatitis C Virus and a Substance Use Disorder: Protocol for a Systematic Review
No full textOpioid Prescribing In-Hospital: Time for Innovative Approaches to Help Combat the Opioid Crisis
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