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Barbic S, Mallia E, Wuerth K, Ow N, Marchand K, Ben-David S, Ewert A, Turnbull H, Gao C, Ding X, Dhillon A, Hastings K, Langton J, Tee K, Mathias S. Implementing Foundry: A cohort study describing the regional and virtual expansion of a youth integrated service in British Columbia, Canada. Early Interv Psychiatry 2024. [PMID: 38736277 DOI: 10.1111/eip.13538] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/08/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
AIM Integrated youth services (IYS) have been identified as a national priority in response to the youth mental health and substance use (MHSU) crisis in Canada. In British Columbia (BC), an IYS initiative called Foundry expanded to 11 physical centres and launched a virtual service. The aim of the study was to describe the demographics of Foundry clients and patterns of service utilization during this expansion, along with the impact of the COVID-19 pandemic. METHODS Data were analysed for all youth (ages 12-24) accessing both in-person (April 27th, 2018-March 31st, 2021) and virtual (May 1st, 2020-March 31st, 2021) services. Cohorts containing all clients from before (April 27th, 2018-March 16th, 2020) and during (March 17th, 2020-March 31st, 2021) the COVID-19 pandemic were also examined. RESULTS A total of 23 749 unique youth accessed Foundry during the study period, with 110 145 services provided. Mean client age was 19.54 years (SD = 3.45) and 62% identified as female. Over 60% of youth scored 'high' or 'very high' for distress and 29% had a self-rated mental health of 'poor', with similar percentages seen for all services and virtual services. These ratings stayed consistent before and during the COVID-19 pandemic. CONCLUSIONS Foundry has continued to reach the target age group, with a 65% increase in number of clients during the study period compared with the pilot stage. This study highlights lessons learned and next steps to promote youth-centred data capture practices over time within an integrated youth services context.
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Affiliation(s)
- Skye Barbic
- Foundry, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Providence Research, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | | | | | - Nikki Ow
- Foundry, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kirsten Marchand
- Foundry, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Shelly Ben-David
- School of Social Work, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | | | | | - Chloe Gao
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- MD/PhD Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiaoxu Ding
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Avneet Dhillon
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Hastings
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Karen Tee
- Foundry, Vancouver, British Columbia, Canada
| | - Steve Mathias
- Foundry, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Turuba R, Katan C, Marchand K, Brasset C, Ewert A, Tallon C, Fairbank J, Mathias S, Barbic S. Weaving community-based participatory research and co-design to improve opioid use treatments and services for youth, caregivers, and service providers. PLoS One 2024; 19:e0297532. [PMID: 38635804 PMCID: PMC11025903 DOI: 10.1371/journal.pone.0297532] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/30/2023] [Indexed: 04/20/2024] Open
Abstract
Integrating the voices of service users and providers in the design and delivery of health services increases the acceptability, relevance, and effectiveness of services. Such efforts are particularly important for youth opioid use treatments and services, which have failed to consider the unique needs of youth and families. Applying community-based participatory research (CBPR) and co-design can facilitate this process by contextualizing service user experiences at individual and community levels and supporting the collaborative design of innovative solutions for improving care. However, few studies demonstrate how to effectively integrate these methods and engage underserved populations in co-design. As such, this manuscript describes how our team wove CBPR and co-design methods to develop solutions for improving youth opioid use treatments and services in Canada. As per CBPR methods, national, provincial, and community partnerships were established to inform and support the project's activities. These partnerships were integral for recruiting service users (i.e., youth and caregivers) and service providers to co-design prototypes and support local testing and implementation. Co-design methods enabled understanding of the needs and experiences of youth, caregivers, and service providers, resulting in meaningful community-specific innovations. We used several engagement methods during the co-design process, including regular working group meetings, small group discussions, individual interviews and consultations, and feedback grids. Challenges involved the time commitment and resources needed for co-design, which were exacerbated by the COVID-19 pandemic and limited our ability to engage a diverse sample of youth and caregivers in the process. Strengths of the study included youth and caregiver involvement in the co-design process, which centered around their lived experiences; the therapeutic aspect of the process for participants; and the development of innovations that were accepted by design partners.
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Affiliation(s)
- Roxanne Turuba
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Kirsten Marchand
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | | | - Alayna Ewert
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Corinne Tallon
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Steve Mathias
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
- Providence Research, Vancouver, British Columbia, Canada
| | - Skye Barbic
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Providence Research, Vancouver, British Columbia, Canada
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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.
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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
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Ow N, Marchand K, Liu G, Mallia E, Mathias S, Sutherland J, Barbic SP. Patterns of service utilization among youth with substance use service need: a cohort study. Subst Abuse Treat Prev Policy 2023; 18:62. [PMID: 37924116 PMCID: PMC10623844 DOI: 10.1186/s13011-023-00572-9] [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: 08/01/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Integrated youth services (IYS) are vital to addressing the needs of youth who use substances. Evidence on the characteristics of youths accessing these services and the types of services accessed have been limited. The objectives were to identify sociodemographic, self-reported health and mental health, patterns of service utilization (service type and frequency of visits) among youths with different levels of substance use service needs (low, moderate, and high), and to estimate the extent to which substance use service needs, self-reported health and mental health influenced the frequency of visits and types of service utilized. METHODS Data were collected from youth (12-24 years) accessing IYS centres in Canada. Information on socio-demographic factors, substance use in the last month, self-rated health measures, number of service visits, and type of services utilized were included. Poisson regression was used to estimate the relationship between substance use needs and number of service visits and the different type of services utilized. RESULTS Of 6181 youths, 48.0% were categorized as low substance use service needs, 30.6% had moderate needs and 21.4% had high needs, with higher proportion of men in the high needs group. Mental health and substance use (MHSU) services were utilized the most across all three groups, followed by counseling. The median number of visits was 4 for the low and moderate needs group and 5 in the high needs group. People with high service needs had 10% higher rate of service visits and utilized 10% more services than people with low service needs (service visits: RR = 1.1 (95%CI: 1.1-1.2); service type: RR = 1.1 (95%CI:1.0-1.1)). The rate of service visits increased by 30 to 50% and the number of services increased by 10-20% for people who rated their health good/fair/poor. Similarly, the rate of service visits increased by 40 to 60% and the number of services increased by 20% for people who rated their mental health good/fair/poor. CONCLUSIONS AND IMPACTS Our study highlighted that regardless of service needs, youth who use alcohol and drugs have complex intersecting needs that present once they access integrated youth services.
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Affiliation(s)
- Nikki Ow
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Providence Research, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Kirsten Marchand
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Providence Research, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Guiping Liu
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Emilie Mallia
- Foundry Central Office, 201-1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
| | - Steve Mathias
- Foundry Central Office, 201-1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Jason Sutherland
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Skye Pamela Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Centre for Advancing Health Outcomes, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Providence Research, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Foundry Central Office, 201-1190 Hornby Street, Vancouver, BC, V6Z 2K5, Canada
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McInerney K, Marchand K, Buckley J, Gao C, Kestler A, Mathias S, Argyle A, Barbic S. Informing youth-centred opioid agonist treatment: Findings from a retrospective chart review of youths' characteristics and patterns of opioid agonist treatment engagement in a novel integrated youth services program. Early Interv Psychiatry 2023; 17:1028-1037. [PMID: 37259685 DOI: 10.1111/eip.13446] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/05/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
AIM Youth ages 12-24 account for approximately 20% of overdoses and yet are poorly reached by opioid agonist treatment (OAT), the most widely recommended treatment for opioid use disorder (OUD). This study contributes to understanding this critical gap by describing youths' patterns of OAT engagement at a novel integrated youth-specific OAT program. METHODS A retrospective chart review was carried out on electronic medical records of n = 23 youth with OUD accessing a community-based integrated youth services (IYS) centre. Data abstraction focused on four domains: sociodemographic, social determinants of health, patterns of OAT engagement, and other services utilized. RESULTS Youths' mean age was 22.6 years (SD = 2.1), with a mean age of first opioid use of 17.4 (SD = 2.7). Youth reported extensive histories of adverse childhood experiences, concurrent mental and physical health complications, and poly-substance use. All youth were offered OAT and 83% initiated treatment with buprenorphine/naloxone, methadone, or slow-release oral morphine. Among those initiating OAT, 42.1% were considered stable on OAT. CONCLUSIONS To our knowledge, this is the first empirical study to describe youths' OAT engagement in an integrated youth-specific OAT program. Our findings demonstrated that a high proportion of youth with OUD initiated OAT in this novel program with varying degrees of OAT stability. These findings can be used to inform the development and implementation of youth-specific and integrated OAT. To account for the novelty of this area of study and small sample sizes, future collaborative efforts across IYS initiatives should be considered, including mixed method approaches to understand outcomes and experiences.
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Affiliation(s)
- Kelly McInerney
- Foundry North Shore, North Vancouver, British Columbia, Canada
| | - Kirsten Marchand
- Foundry Central Office, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation Outcome Sciences, Vancouver, British Columbia, Canada
| | | | - Chloe Gao
- Foundry Central Office, Vancouver, British Columbia, Canada
- Department of Medicine, Diamond Health Care Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Kestler
- Centre for Health Evaluation Outcome Sciences, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, Faculty of Medicine, Diamond Health Care Centre, Vancouver, British Columbia, Canada
- St. Paul's Hospital, Vancouver, British Columbia, Canada
- BC Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Steve Mathias
- Foundry Central Office, Vancouver, British Columbia, Canada
- Centre for Health Evaluation Outcome Sciences, Vancouver, British Columbia, Canada
- Providence Research, Vancouver, British Columbia, Canada
- Department of Psychiatry, The Unviersity of British Columbia, Vancouver, British Columbia, Canada
| | - Aubree Argyle
- School of Nursing and Human Physiology, Gonzaga University, Spokane, WA, USA
| | - Skye Barbic
- Foundry Central Office, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation Outcome Sciences, Vancouver, British Columbia, Canada
- St. Paul's Hospital, Vancouver, British Columbia, Canada
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Kreim S, Marchand K, Mallia E, Dubras R, McMaster WR, Tee K, Mathias S, Barbic S. Identifying early intervention opportunities for illicit stimulant use: A cross-sectional study of factors associated with illicit stimulant use among young people accessing integrated youth services in British Columbia, Canada. J Subst Use Addict Treat 2023:209076. [PMID: 37182544 DOI: 10.1016/j.josat.2023.209076] [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: 09/07/2022] [Revised: 12/12/2022] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Illicit stimulant (cocaine and/or amphetamine) use among young people aged 12-24 is a public health priority given that substance use initiation tends to peak in this developmental period and significant associated immediate and long-term harms are associated with its use. Young people using stimulants must be engaged in services as early as possible to reduce these harms. To inform early intervention opportunities, this study aimed to identify the risk/protective factors associated with illicit stimulant use among young people. METHODS We conducted a cross-sectional study on routinely collected self-reported data among young people accessing integrated youth services in British Columbia (Canada) between April 2018 and January 2022. Data were collected on young peoples' socio-demographic characteristics, and social, behavioral, and health profiles. Variable selection was guided by established risk/protective factors for substance use among young people. The study used multivariable logistic regression to identify risk/protective factors that were independently associated with past 30-day illicit stimulant use. RESULTS The analytic sample included n = 5620 young people aged 12-24 and a total of 163 (2.9 %) reported past 30-day illicit cocaine and/or amphetamine use. Demographic characteristics that were independently associated with illicit stimulant use included older age (aOR = 1.27, 95 % CI = 1.17-1.38) and gender identity as man vs woman (aOR = 1.71, 95 % CI = 1.10-2.70). Social and environmental risk factors included recently witnessing or experiencing violence (aOR = 2.32, 95 % CI = 1.47-3.68) and higher past-year crime/violent behaviors score (aOR = 1.39, 95 % CI = 1.13-1.69). Finally, regular alcohol (aOR = 6.90, 95 % CI = 2.36-25.42), regular (aOR = 3.74, 95 % CI = 1.95-7.54) or social (aOR = 3.06, 95 % CI = 1.44-6.60) tobacco use, and lifetime hallucinogen (aOR = 3.24, 95 % CI = 1.8-5.91) and ecstasy/MDMA (aOR = 2.53, 95 % CI = 1.48-4.39) use were also statistically significant risk factors. CONCLUSIONS These risk/protective factors support identification of young people who may benefit from further screening, assessment, and treatment for illicit stimulant use. This study also underscores the need to expand early intervention and harm reduction programs that can comprehensively respond to young peoples' stimulant use, health, and social needs.
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Affiliation(s)
- Sara Kreim
- Faculty of Science, University of British Columbia, 2207 Main Mall, Vancouver, BC V6T 1Z4, Canada
| | - Kirsten Marchand
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
| | - Emilie Mallia
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Richard Dubras
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - W Robert McMaster
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Medical Genetics, Faculty of Medicine, University of British Columbia, C201-4500 Oak Street, Vancouver, BC V6H3N1, Canada
| | - Karen Tee
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Steve Mathias
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Providence Research, 1190 Hornby Street, Vancouver, BC V6Z 1Y6, Canada; Department of Psychiatry, 2255 Wesbrook Mall, University of British Columbia, Vancouver, BC V6T 2A1, Canada
| | - Skye Barbic
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Providence Research, 1190 Hornby Street, Vancouver, BC V6Z 1Y6, Canada
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Dobischok S, Metcalfe R, Matzinger E, Palis H, Marchand K, Harrison S, MacDonald S, Byres D, Schechter M, Bansback N, Oviedo-Joekes E. Measuring the preferences of injectable opioid agonist treatment (iOAT) clients: Development of a person-centered scale (best-worst scaling). Int J Drug Policy 2023; 112:103948. [PMID: 36586152 DOI: 10.1016/j.drugpo.2022.103948] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) is effective for opioid use disorder (OUD), yet little is known about client preferences for accessing iOAT (e.g., with diacetylmorphine, hydromorphone, buprenorphine, fentanyl, etc.). Best-worst scaling (BWS) is a preference elicitation method from health economics that has never been applied to addiction care broadly, or iOAT specifically. We describe the stages of developing a BWS scale that assesses iOAT clients' treatment delivery preferences to inform program planning and maximize healthcare efficiency. METHODS We underwent several steps to reveal the relevant attributes/levels and design the scale structure. An initial list of potential attributes and levels was established from a literature review and prior qualitative data. Then, we conducted semi-structured interviews and focus groups with clients (n=21) on their iOAT preferences to confirm the attributes and prioritize/include new ones. Next, we conducted semi-structured interviews and focus groups with iOAT experts and stakeholders to receive their input on the draft list of attributes and levels. A BWS profile case design was piloted with iOAT clients (n=18) from different sites during a think aloud interview. After several rounds of revisions, the final version was tested by iOAT clients (n=2) before the scale was launched. RESULTS We developed a person-centered scale that assesses current and former iOAT clients' most and least wanted aspects of iOAT delivery. The final version yielded 7 unique attributes: choice of medication, choice of dose, convenience, location & space, scheduling & routines, staff & training, and types of services offered. CONCLUSION This scale can help expand iOAT programs in a way that is person-centered, rapid, and affordable. The methodology is a guide for other regions with similar populations who aim to develop strong quantitative methodologies that prioritize client collaboration.
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Affiliation(s)
- Sophia Dobischok
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Rebecca Metcalfe
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada
| | - Elizabeth Matzinger
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St. Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, 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
| | - Kirsten Marchand
- 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
| | - Scott MacDonald
- 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
| | - Martin 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
| | - Nick Bansback
- 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.
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Marchand K, Turuba R, Katan C, Fogarty O, Fairbank J, Tallon C, Mathias S, Barbic S. "The system always undermined what I was trying to do as an individual": identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada. Addict Sci Clin Pract 2023; 18:1. [PMID: 36593469 PMCID: PMC9806820 DOI: 10.1186/s13722-022-00359-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention. METHODS This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers' (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data. RESULTS Three overarching themes were identified, reflecting service providers' goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers' priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments. CONCLUSION These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths' needs (micro-level).
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Affiliation(s)
- Kirsten Marchand
- Foundry, 915-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada. .,Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Roxanne Turuba
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | - Oonagh Fogarty
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | | | - Steve Mathias
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
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9
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Marchand K, Liu G, Mallia E, Ow N, Glowacki K, Hastings KG, Mathias S, Sutherland JM, Barbic S. Impact of the COVID-19 pandemic on alcohol or drug use symptoms and service need among youth: a cross-sectional sample from British Columbia, Canada. Subst Abuse Treat Prev Policy 2022; 17:82. [PMID: 36550587 PMCID: PMC9774070 DOI: 10.1186/s13011-022-00508-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Concerns about youth alcohol and drug use have risen since the declaration of the global COVID-19 pandemic due to the pandemic's impact on known risk and protective factors for substance use. However, the pandemic's immediate and long-term impact on youths' substance use patterns has been less clear. Thus, this study sought to determine how the COVID-19 pandemic impacted alcohol or drug use and its risk and protective factors among youth accessing integrated youth services. METHODS We conducted a repeated cross-sectional study of patient-reported outcomes data collected between May 2018 and February 2022 among youth (n = 6022) ages 10-24 accessing a provincial network of integrated youth services in Canada. The main exposure of interest was the COVID-19 pandemic (March 2020 - February 2022) compared with a pre-pandemic period (May 2018 - February 2020). As measured by the Global Appraisal of Individual Needs - Short Screener, outcomes included the average number of past month alcohol or drug use symptoms and past month likelihood of service need for alcohol/drug use (moderate/high vs. low need). Interrupted time series (ITS) examined change in average monthly alcohol/drug use symptoms between the pre- and pandemic periods. Stratified multivariable logistic regression investigated how the pandemic modified the effects of established risk/protective factors on likelihood of alcohol/drug use service need. RESULTS Fifty-percent of youth met the criteria for moderate/high likelihood of alcohol/drug use service need, with the odds being 2.39 times (95% confidence interval = 2.04, 2.80) greater during the pandemic compared to the pre-pandemic period. Results from the ITS indicated significant immediate effects of the pandemic on monthly substance use symptoms (p = 0.01). Significant risk/protective factors for service need included exposure to violence, engagement in meaningful activities, and self-rated physical and mental health; and the direction of their effects remained consistent across pandemic and pre-pandemic periods. CONCLUSIONS This study demonstrated that the COVID-19 pandemic corresponded with increased alcohol or drug use among youth accessing integrated services. This signals an urgent need for increased clinical capacity in existing youth services and policies that can respond to risk/protective factors for substance use earlier.
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Affiliation(s)
- Kirsten Marchand
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Guiping Liu
- grid.17091.3e0000 0001 2288 9830Centre for Health Services and Policy Research, 201- 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Emilie Mallia
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Nikki Ow
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Krista Glowacki
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Katherine G. Hastings
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Steve Mathias
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada ,grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1 Canada
| | - Jason M. Sutherland
- grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada ,grid.17091.3e0000 0001 2288 9830Centre for Health Services and Policy Research, 201- 2206 East Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation & Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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Turuba R, Amarasekera A, Howard AM, Brockmann V, Tallon C, Irving S, Mathias S, Henderson J, Marchand K, Barbic S. A qualitative study exploring how young people perceive and experience substance use services in British Columbia, Canada. Subst Abuse Treat Prev Policy 2022; 17:43. [PMID: 35643591 PMCID: PMC9148204 DOI: 10.1186/s13011-022-00456-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Substance use among youth (ages 12–24) is troublesome given the increasing risk of harms associated. Even more so, substance use services are largely underutilized among youth, most only accessing support when in crisis. Few studies have explored young people’s help-seeking behaviours to address substance use concerns. To address this gap, this study explored how youth perceive and experience substance use services in British Columbia (BC), Canada. Methods Participatory action research methods were used by partnering with BC youth (under the age of 30) from across the province who have lived and/or living experience of substance use to co-design the research protocol and materials. An initial focus group and interviews were held with 30 youth (ages 12–24) with lived and/or living experience of substance use, including alcohol, cannabis, and illicit substances. The discussions were audio-recorded, transcribed verbatim, and analyzed thematically using a data-driven approach. Results Three main themes were identified and separated by phase of service interaction, starting with: Prevention/Early intervention, where youth described feeling unworthy of support; Service accessibility, where youth encountered many barriers finding relevant substance use services and information; and Service delivery, where youth highlighted the importance of meeting them where they are at, including supporting those who have milder treatment needs and/or do not meet the diagnosis criteria of a substance use disorder. Conclusions Our results suggest a clear need to prioritize substance use prevention and early interventions specifically targeting youth and young adults. Youth and peers with lived and/or living experience should be involved in co-designing and co-delivering such programs to ensure their relevance and credibility among youth. The current disease model of care leaves many of the needs of this population unmet, calling for a more integrated youth-centred approach to address the multifarious concerns linked to young people’s substance use and service outcomes and experiences.
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11
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Marchand K, Turuba R, Katan C, Brasset C, Fogarty O, Tallon C, Fairbank J, Mathias S, Barbic S. Becoming our young people’s case managers: caregivers’ experiences, needs, and ideas for improving opioid use treatments for young people using opioids. Subst Abuse Treat Prev Policy 2022; 17:34. [PMID: 35525987 PMCID: PMC9077957 DOI: 10.1186/s13011-022-00466-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Evidence continues to show that young people, ages 15-24, remain at significant risk of harms from non-medical opioid use and opioid use disorder (OUD), with experts calling for widespread implementation of developmentally-appropriate interventions. These recommendations include the involvement of caregivers in the prevention, early intervention, and treatment of young people using opioids. However, little research has investigated caregivers’ experiences supporting young people, leaving critical gaps in understanding this role. The aim of this study is to explore caregivers’ experiences accessing opioid use treatments with young people and their needs and ideas for improving such treatments. Methods This study reports qualitative findings from Phase 1 of the Improving Treatment Together project, a multi-phase, multi-site community-based participatory study broadly aimed at co-designing opioid use treatments to improve the experiences and outcomes of young people using non-medical opioids. During Phase 1, a total of 27 caregivers (parents, guardians) participated in full-day workshops that were conducted in three communities in British Columbia, Canada. Following human-centred co-design methods, caregivers engaged in small and large group discussions of their experiences, needs, and ideas for improving opioid use treatments for young people. Discussions were audio-recorded, transcribed verbatim, and thematically analysed. Results Across communities, caregivers’ main experiences were defined as ‘becoming our young people’s case managers’ and ‘enduring a never-ending rollercoaster’. To improve these experiences, two needs themes were identified – expanding organizational and system-level capacity and wider-spread understanding of opioid use as a health issue. Caregivers brainstormed a total of 378 individual ideas to meet these needs, several of which spanned multiple needs themes. Conclusions Caregivers’ experiences, needs, and ideas reveal critical opportunities for improving the quality of interventions for opioid use among young people. This study represents a substantial contribution to the design and implementation of developmentally-appropriate and family-centred interventions for young people using opioids.
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12
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Marchand K, Pellatt KM, Barbic S. Centering Young People's Perspectives, Needs, and Preferences in Researching Barriers to Medications for Opioid Use Disorder. JAMA Pediatr 2022; 176:616. [PMID: 35404398 DOI: 10.1001/jamapediatrics.2022.0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Skye Barbic
- Foundry, Vancouver, British Columbia, Canada
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13
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Glowacki K, Whyte M, Weinstein J, Marchand K, Barbic D, Scheuermeyer F, Mathias S, Barbic S. Exploring how to enhance care and pathways between the emergency department and integrated youth services for young people with mental health and substance use concerns. BMC Health Serv Res 2022; 22:615. [PMID: 35525965 PMCID: PMC9077976 DOI: 10.1186/s12913-022-07990-8] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Integrated youth services (IYS) provide multidisciplinary care (including mental, physical, and social) prioritizing the needs of young people and their families. Despite a significant rise in emergency department (ED) visits by young Canadians with mental health and substance use (MHSU) concerns over the last decade, there remains a profound disconnect between EDs and MHSU integrated youth services. The first objective of this study was to better understand the assessment, treatment, and referral of young people (ages 12–24 years) presenting to the ED with MHSU concerns. The second objective was to explore how to improve the transition from the ED to IYS for young people with MHSU concerns. Methods We conducted semi-structured one-on-one video and phone interviews with stakeholders in British Columbia, Canada in the summer of 2020. Snowball sampling was utilized, and participants (n = 26) were reached, including ED physicians (n = 6), social workers (n = 4), nurses (n = 2), an occupational therapist (n = 1); a counselor (n = 1); staff/leadership in IYS organizations (n = 4); mental health/family workers (n = 3); peer support workers (n = 2), and parents (n = 3). A thematic analysis (TA) was conducted using a deductive and inductive approach conceptually guided by the Social Ecological Model. Results We identified three overarching themes, and factors to consider at all levels of the Social Ecological Model. At the interpersonal level inadequate communication between ED staff and young people affected overall care and contributed to negative experiences. At the organizational level, we identified considerations for assessments and the ED and the hospital (wait times, staffing issues, and the physical space). At the community level, the environment of IYS and other community services were important including wait times and hours of operation. Policy level factors identified include inadequate communication between services (e.g., different charting systems and documentation). Conclusions This study provides insight into important long-term systemic issues and more immediate factors that need to be addressed to improve the delivery of care for young people with MHSU challenges. This research supports intervention development and implementation in the ED for young people with MHSU concerns.
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Affiliation(s)
- Krista Glowacki
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada. .,Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada. .,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Madelyn Whyte
- Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada
| | - Jade Weinstein
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Kirsten Marchand
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.,Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada.,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - David Barbic
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Y 1Z6, Canada
| | - Frank Scheuermeyer
- Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, 1081 Burrard St, Vancouver, BC, V6Y 1Z6, Canada
| | - Steve Mathias
- Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada.,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Faculty of Medicine, T325 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.,Foundry Central Office, Providence Health Care, 1881 Burrard, Vancouver, BC, V5G 7H9, Canada.,Centre for Health Evaluation & Outcome Sciences, Providence Health Care, #588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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14
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Marchand K, Fogarty O, Pellatt KM, Vig K, Melnychuk J, Katan C, Khan F, Turuba R, Kongnetiman L, Tallon C, Fairbank J, Mathias S, Barbic S. “We need to build a better bridge”: findings from a multi-site qualitative analysis of opportunities for improving opioid treatment services for youth. Harm Reduct J 2022; 19:37. [PMID: 35430803 PMCID: PMC9013476 DOI: 10.1186/s12954-022-00623-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Adolescence and young adulthood is an important period for substance use initiation and related harms. In the context of the ongoing opioid crisis, the risks for youth (ages 16–29) who use opioids are particularly heightened. Despite recommendations to adopt a developmentally appropriate and comprehensive approach to reduce opioid-related harms among youth, data continue to show that youth are not adequately engaged in opioid treatments and encounter many barriers. The aim of this study is to identify youth-centered opportunities for improving opioid treatment services.
Methods This paper reports multi-site qualitative findings from youth participating in the ‘Improving Treatment Together’ project, a community-based participatory project being conducted in British Columbia and Alberta, two western Canadian provinces that have been dramatically impacted by the opioid crisis. Qualitative data were collected during three workshops with youth who used opioids and accessed opioid treatment services in the prior 12 months. These workshops were conducted in three communities following the core elements of human-centered co-design. A multi-site qualitative analysis was conducted to identify within- and between-site themes surrounding youths’ needs for improving opioid treatment service experiences and outcomes. Results Three overarching needs themes were identified from across the communities. The first reflected youths’ difficulties finding and staying connected to opioid treatment services, with the overarching need theme suggesting opportunities to reduce organizational and systems-related barriers to care, such as waiting times and wider information about service availability. The second area of need was rooted in youths’ feelings of judgment when accessing services. Consequently, opportunities to increase respectful and empathic interactions were the overarching need. The final theme was more nuanced across communities and reflected opportunities for an individualized approach to opioid treatment services that consider youths’ unique basic safety, social, and health needs. Conclusions This study identifies fundamental directions for the operationalization and implementation of youth-centered opioid treatment services. These directions are contextualized in youths’ lived experiences accessing services in their local communities, with overarching themes from across sites strengthening their transferability to other settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12954-022-00623-7.
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Ow N, Marchand K, Glowacki K, Alqutub D, Mathias S, Barbic SP. YESS: A feasibility study of a supported employment program for youths with mental health disorders. Front Psychiatry 2022; 13:856905. [PMID: 36213923 PMCID: PMC9543261 DOI: 10.3389/fpsyt.2022.856905] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE In Canada, employment/education support is rarely embedded as a component of mental health service delivery. This study describes a supported education/employment program (SEP) that integrates both clinical and community mental health services. The main objectives were to estimate the feasibility of a 5-week SEP among youths aged 17-24 with mental illness and to estimate the extent to which participation in this program improved employment and mental health outcomes. METHODS This was a single cohort study. Feasibility outcomes assessed were demand, acceptability, practicality, integration, adaptation, and effectiveness. These were assessed through recruitment and retention rates, recording patterns of missing data, and examining differences between completers and non-completers. Appropriateness of the outcome measures was assessed through the strength of the association between the outcome measures at baseline. Effectiveness of the program was assessed through employment and as measured using MyLifetracker (MLT), Satisfaction with Life Scale (SWLS), and the Canadian Personal Recovery Outcome Measure (CPROM). RESULTS A total of 110 youths with a mean age of 20.6 (SD: 2.2) were recruited. At 5 weeks, 82 (74.5%) of participants remained in the program. Of the people who completed the program, 56.1% were women, 76.6% were in stable housing and 64.1% had depression. Approximately 60% of non-completers used two or more services and were in at-risk housing. More than 25% of participants improved on the patient-reported outcomes. Scores on these measures were moderately to highly correlated with each other. Employment rates varied and corresponded to the waves of the COVID-19 pandemic in Canada. CONCLUSION Results showed that this program was feasible and there was high demand for SEP during the COVID-19 pandemic but gaining employment remained difficult. Educational or employment outcomes, measured over a short period, may not be adequate. Instead, individualized and patient-reported outcome measures may be more appropriate for SEP programs.
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Affiliation(s)
- Nikki Ow
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Kirsten Marchand
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Foundry Central Office, Vancouver, BC, Canada
| | - Krista Glowacki
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Foundry Central Office, Vancouver, BC, Canada
| | | | - Steve Mathias
- Foundry Central Office, Vancouver, BC, Canada.,Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Skye P Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Foundry Central Office, Vancouver, BC, Canada
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16
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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.
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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
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Marchand K, Tallon C, Katan C, Fairbank J, Fogarty O, Pellatt KM, Turuba R, Mathias S, Barbic S. Improving Treatment Together: a protocol for a multi-phase, community-based participatory, and co-design project to improve youth opioid treatment service experiences in British Columbia. Addict Sci Clin Pract 2021; 16:53. [PMID: 34391483 PMCID: PMC8364413 DOI: 10.1186/s13722-021-00261-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/26/2021] [Accepted: 08/06/2021] [Indexed: 01/13/2023] Open
Abstract
Background Opioid use is one of the most critical public health issues as highly potent opioids contribute to rising rates of accidental opioid-related toxicity deaths. This crisis has affected people from all age groups, including youth (ages 15–24) who are in a critical developmental period where the stakes of opioid use are especially high. Efforts to reduce the significant harms of opioid use have focused on the expansion of evidence-based treatments, including medications for opioid use disorder (e.g. buprenorphine). While these treatments are unequivocally life saving, recent evidence suggests that they may not align with youths’ needs. Accordingly, the ‘Improving Treatment Together’ (ITT) project has been designed with the aim to improve youths’ opioid treatment service experiences and outcomes by co-developing, implementing, and measuring youth-centred opioid use treatment service innovations. This manuscript describes the protocol for this multi-phase project. Methods The ITT project follows community-based participatory research (CBPR) and strategically integrates co-design processes throughout its four phases. Upon establishing a project partnership between national, provincial and community-based organizations, Phase 1 follows four core elements of human-centred co-design (empathy, needs identification, ideation, prototyping) in nine separate workshops. These workshops will be held in four diverse communities with youth, caregivers and service providers who have accessed or delivered opioid treatment services. Phase 1 will culminate in the co-production of opioid treatment service innovations to be considered by the project’s partners for further co-development, pilot testing, and wider implementation during the remaining phases of the project. Throughout each phase, the project will collect and analyse both qualitative and quantitative research and evaluation data to determine the project’s impact. Discussion This protocol provides a detailed description of the ITT project, with an emphasis on the project’s application of co-design and CBPR processes, the planned research and implementation procedures, and the establishment of a unique partnership. To our knowledge, this is one of the first projects to integrate these participatory processes to the design, implementation and measurement of youth-centred opioid treatment services. Embedding these processes throughout each phase of the project will strengthen the relevance and feasibility of the project’s service delivery innovations. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-021-00261-7.
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Affiliation(s)
- Kirsten Marchand
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada. .,Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada. .,Providence Health Care, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
| | - Corinne Tallon
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, 75 Albert St #500, Ottawa, ON, K1P 5E7, Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, 75 Albert St #500, Ottawa, ON, K1P 5E7, Canada
| | - Oonagh Fogarty
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | | | - Roxanne Turuba
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Steve Mathias
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute, Vancouver, BC, V6Z 1Y6, Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.,Providence Health Care Research Institute, Vancouver, BC, V6Z 1Y6, Canada
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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.
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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
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Marchand K, Aguirre V, Worthington M, Chew D, Fitton V, Cullen H. M34 Enhanced Recovery After Surgery (ERAS) Pathway for Cardiac Surgery: The First Australian Experience. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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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.
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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
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21
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Affiliation(s)
- Kirsten Marchand
- Ms. Marchand is a doctoral candidate with the School of Population and Public Health, University of British Columbia, and Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia
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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.
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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
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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]
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McKanna T, Ryan A, Krinshpun S, Kareht S, Marchand K, Grabarits C, Ali M, McElheny A, Gardiner K, LeChien K, Hsu M, Saltzman D, Stosic M, Martin K, Benn P. Fetal fraction-based risk algorithm for non-invasive prenatal testing: screening for trisomies 13 and 18 and triploidy in women with low cell-free fetal DNA. Ultrasound Obstet Gynecol 2019; 53:73-79. [PMID: 30014528 PMCID: PMC6587793 DOI: 10.1002/uog.19176] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/13/2018] [Accepted: 07/10/2018] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To identify pregnancies at increased risk for trisomy 13, trisomy 18 or triploidy attributable to low fetal fraction (FF). METHODS A FF-based risk (FFBR) model was built using data from more than 165 000 singleton pregnancies referred for single-nucleotide polymorphism (SNP)-based non-invasive prenatal testing (NIPT). Based on maternal weight and gestational age (GA), FF distributions for normal, trisomy 13, trisomy 18 and triploid pregnancies were constructed and used to adjust prior risks for these abnormalities. A risk cut-off of ≥ 1% was chosen to define pregnancies at high risk for trisomy 13, trisomy 18 or triploidy (high FFBR score). The model was evaluated on an independent blinded set of pregnancies for which SNP-based NIPT did not return a result, and for which pregnancy outcome information was gathered retrospectively. RESULTS The evaluation cohort comprised 1148 cases, of which approximately half received a high FFBR score. Compared with rates expected based on maternal age (MA) and GA, cases with a high FFBR score had a significantly increased rate of trisomy 13, trisomy 18 or triploidy combined (5.7% vs 0.7%; P < 0.001) and also of unexplained pregnancy loss (14.7% vs 10.4%; P < 0.001). For cases that did not receive a high FFBR score, the incidence of a chromosomal abnormality or pregnancy loss was not significantly different from that expected based on MA and GA. In this study cohort, the sensitivity of the FFBR model for detection of trisomy 13, trisomy 18 or triploidy was 91.4% (95% CI, 76.9-98.2%) with a positive predictive value of 5.7% (32/564; 95% CI, 3.9-7.9%). CONCLUSIONS For pregnancies with a FF too low to receive a result on standard NIPT, the FFBR algorithm identified a subset of cases at increased risk for trisomy 13, trisomy 18 or triploidy. For the remainder of cases, the risk of a fetal chromosomal abnormality was unchanged from that expected based on MA and GA. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
| | | | | | | | - K. Marchand
- Beth Israel Deaconess Medical CenterBostonMAUSA
| | - C. Grabarits
- Vanderbilt University Medical CenterNashvilleTNUSA
| | - M. Ali
- Weill Cornell MedicineNew YorkNYUSA
| | - A. McElheny
- St Louis University School of MedicineSt LouisMOUSA
| | | | | | - M. Hsu
- Northshore University Health SystemChicagoILUSA
| | - D. Saltzman
- Icahn School of Medicine at Mount SinaiNew YorkNYUSA
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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).
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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
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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.
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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
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Palis H, Marchand K, Oviedo-Joekes E. The relationship between sense of community belonging and self-rated mental health among Canadians with mental or substance use disorders. J Ment Health 2018; 29:168-175. [DOI: 10.1080/09638237.2018.1437602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Heather Palis
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, and
- Providence Health Care, Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Kirsten Marchand
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, and
- Providence Health Care, Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, and
- Providence Health Care, Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
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Steel D, Marchand K, Oviedo-Joekes E. Our Life Depends on This Drug: Competence, Inequity, and Voluntary Consent in Clinical Trials on Supervised Injectable Opioid Assisted Treatment. Am J Bioeth 2017; 17:32-40. [PMID: 29148954 DOI: 10.1080/15265161.2017.1388449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Supervised injectable opioid assisted treament (siOAT) prescribes injectable opioids to individuals for whom other forms of addiction treatment have been ineffective. In this article, we examine arguments that opioid-dependent people should be assumed incompetent to voluntarily consent to clinical research on siOAT unless proven otherwise. We agree that concerns about competence and voluntary consent deserve careful attention in this context. But we oppose framing the issue solely as a matter of the competence of opioid-dependent people and emphasize that it should be considered in the context of inequities in access to siOAT as a medical treatment. Consequently, we suggest that bioethics literature on nonexploitation, which focuses on clinical research in low-income countries, is helpful due to locating ethical issues within systemic social conditions. Finally, we consider the implications of our argument for the ethics of clinical research on siOAT.
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Marchand K, Steel D, Oviedo-Joekes E. Collaborative Efforts With Opioid Users to Promote Competence and Voluntariness in Clinical Trials With Injectable Opioid Assisted Treatment. Am J Bioeth 2017; 17:W1-W3. [PMID: 29148948 DOI: 10.1080/15265161.2017.1398281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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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.
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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
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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.
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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
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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
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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.
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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.
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Marchand K, Oviedo-Joekes E. Prioritizing the patient in patient-centered addictions treatment. Addiction 2017; 112:466-467. [PMID: 28168794 DOI: 10.1111/add.13680] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Kirsten Marchand
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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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.
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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
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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.
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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
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Marchand K, Palis H, Oviedo-Joekes E. Patient Perceptions of Prejudice and Discrimination by Health Care Providers and its Relationship with Mental Disorders: Results from the 2012 Canadian Community Health-Mental Health Survey Data. Community Ment Health J 2016; 52:294-301. [PMID: 26410218 DOI: 10.1007/s10597-015-9949-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 01/13/2015] [Accepted: 09/22/2015] [Indexed: 01/16/2023]
Abstract
Using data from a nationally representative survey, the Canadian Community Health Survey-Mental Health, this secondary analysis aimed to determine the prevalence of perceived prejudice by health care providers (HCPs) and its relationship with mental disorders. Respondents accessing HCPs in the prior year were asked if they experienced HCP prejudice. A hypothesis driven multivariable logistic regression analysis was conducted to determine the relationship between type of mental disorders and HCP prejudice. Among the 3006 respondents, 10.9 % perceived HCP prejudice, 62.4 % of whom reported a mental disorder. The adjusted odds of prejudice was highest for respondents with anxiety (OR 3.12; 95 % CI 1.60, 6.07), concurrent mood or anxiety and substance disorders (OR 3.08; 95 % CI 1.59, 5.95) and co-occurring mood and anxiety disorders (OR 2.89; 95 % CI 1.68, 4.97) compared to respondents without any mental disorders. These findings are timely for informing discussions regarding policies to address HCP prejudice towards people with mental disorders.
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Affiliation(s)
- Kirsten Marchand
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 588B-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 and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 588B-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 and Outcome Sciences, Providence Health Care, St. Paul's Hospital, 588B-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
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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.
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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
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Fikowski J, Marchand K, Palis H, Oviedo-Joekes E. Feasibility of applying the life history calendar in a population of chronic opioid users to identify patterns of drug use and addiction treatment. Subst Abuse 2014; 8:73-8. [PMID: 25535454 PMCID: PMC4267511 DOI: 10.4137/sart.s19419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 08/17/2014] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 11/29/2022]
Abstract
Uncovering patterns of drug use and treatment access is essential to improving treatment for opioid dependence. The life history calendar (LHC) could be a valuable instrument for capturing time-sensitive data on lifetime patterns of drug use and addiction treatment. This study describes the methodology applied when collecting data using the LHC in a sample of individuals with long-term opioid dependence and aims to identify specific factors that impact the feasibility of administering the LHC interview. In this study, the LHC allowed important events such as births, intimate relationships, housing, or incarcerations to become reference points for recalling details surrounding drug use and treatment access. The paper concludes that the administration of the LHC was a resource-intensive process and required special attention to interviewer training and experience with the study population. These factors should be considered and integrated into study plans by researchers using the LHC in addiction research.
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Affiliation(s)
- Jill Fikowski
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, Vancouver, BC, Canada. ; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Marchand
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, Vancouver, BC, Canada. ; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Heather Palis
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, Vancouver, BC, Canada. ; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eugenia Oviedo-Joekes
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. Paul's Hospital, Vancouver, BC, Canada. ; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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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
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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.
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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
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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.
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Brissette S, Marchand K, Oveido-Joekes E, Schechter M, Krausz M. SALOME: STUDY TO ASSESS LONGER-TERM OPIOID MEDICATION EFFECTIVENESS: A PROGRESS REPORT. The Canadian Journal of Addiction 2014. [DOI: 10.1097/02024458-201406000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Costa V, Guichard B, Digne M, Legens C, Lecour P, Marchand K, Raybaud P, Krebs E, Geantet C. A rational interpretation of improved catalytic performances of additive-impregnated dried CoMo hydrotreating catalysts: a combined theoretical and experimental study. Catal Sci Technol 2013. [DOI: 10.1039/c2cy20553j] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Marchand K, Oviedo-Joekes E, Guh D, Marsh DC, Brissette S, Schechter MT. Sex work involvement among women with long-term opioid injection drug dependence who enter opioid agonist treatment. Harm Reduct J 2012; 9:8. [PMID: 22276954 PMCID: PMC3281790 DOI: 10.1186/1477-7517-9-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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: 05/30/2011] [Accepted: 01/25/2012] [Indexed: 11/10/2022] Open
Abstract
Background Substitution with opioid-agonists (e.g., methadone) has shown to be an effective treatment for chronic long-term opioid dependency. Survival sex work, very common among injection drug users, has been associated with poor Opioid Agonist Treatment (OAT) engagement, retention and response. Therefore, this study was undertaken to determine factors associated with engaging in sex work among long-term opioid dependent women receiving OAT. Methods Data from a randomized controlled trial, the North American Opiate Medication Initiative (NAOMI), conducted in Vancouver and Montreal (Canada) between 2005-2008, was analyzed. The NAOMI study compared the effectiveness of oral methadone to injectable diacetylmorphine or injectable hydromorphone, the last two on a double blind basis, over 12 months. A research team, independent of the clinic services, obtained outcome evaluations at baseline and follow-up (3, 6, 9, 12, 18 and 24 months). Results A total 53.6% of women reported engaging in sex work in at least one of the research visits. At treatment initiation, women who were younger and had fewer years of education were more likely to be engaged in sex work. The multivariate logistic generalized estimating equation regression analysis determined that psychological symptoms, and high illicit heroin and cocaine use correlated with women's involvement in sex work during the study period. Conclusions After entering OAT, women using injection drugs and engaging in sex work represent a particularly vulnerable group showing poorer psychological health and a higher use of heroin and cocaine compared to women not engaging in sex work. These factors must be taken into consideration in the planning and provision of OAT in order to improve treatment outcomes. Trial Registration NCT00175357.
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Affiliation(s)
- Kirsten Marchand
- Centre for Health Evaluation & Outcome Sciences, Providence Health Care, St, Paul's Hospital 620B-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Oviedo-Joekes E, Guh D, Brissette S, Marchand K, Marsh D, Chettiar J, Nosyk B, Krausz M, Anis A, Schechter MT. Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women. Drug Alcohol Depend 2010; 111:50-7. [PMID: 20510551 DOI: 10.1016/j.drugalcdep.2010.03.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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] [Received: 10/22/2009] [Revised: 03/16/2010] [Accepted: 03/16/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is consistent evidence showing women access treatment with more severe substance-related profiles relative to men; however, treatment outcome evaluation shows inconclusive results regarding gender differences. Furthermore, few studies evaluate response by gender. METHODS The present analyses were performed using data from the NAOMI study, an open-label, phase III randomized controlled trial, carried out between 2005 and 2008 in Vancouver and Montreal, Canada. A total of 226 long-term treatment-refractory opioid dependent individuals were randomized to receive injectable diacetylmorphine or oral methadone for 12 months. Patients in both treatment groups were offered psychosocial and primary care services. Main outcomes were retention in addiction treatment at 12 months. Drug use, health, psychosocial adjustment and health-related quality of life were examined at baseline and during treatment, using the European Addiction Severity Index, Maudsley Addiction Profile, SF-6D and EuroQol EQ-5D. RESULTS A total of 88 (38.9%) females and 138 (61.1%) males were included in the present analysis. Retention rates among female participants in the diacetylmorphine group were significantly higher than oral methadone (83.3% vs. 47.8%). Males receiving diacetylmorphine improved significantly more than females in physical health, health-related quality of life, and family relations but female participants in the diacetylmorphine group had significantly greater improvements in illicit drug use scores and psychological health compared to females allocated to oral methadone. CONCLUSIONS Among long-term opioid dependent women who have not benefited sufficiently from available treatments, medically prescribed diacetylmorphine is more effective than oral methadone. Men receiving diacetylmorphine showed more improvements than women.
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Affiliation(s)
- Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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