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Krausz RM, Westenberg JN, Tai AM, Fadakar H, Seethapathy V, Mathew N, Azar P, Phillips A, Schütz CG, Choi F, Vogel M, Cabanis M, Meyer M, Jang K, Ignaszewski M. A Call for an Evidence-Based Strategy Against the Overdose Crisis. Can J Psychiatry 2024; 69:5-9. [PMID: 37438926 PMCID: PMC10867411 DOI: 10.1177/07067437231188202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Affiliation(s)
- R. Michael Krausz
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jean N Westenberg
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Clinic for Addiction Medicine, University Psychiatric Clinics Basel, Basel, Switzerland
- School of Medicine, University College Cork, Cork, Ireland
| | - Andy M.Y. Tai
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hasti Fadakar
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Vijay Seethapathy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Services, Vancouver general Hospital, Vancouver, BC, Canada
- BC Mental Health and Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Nick Mathew
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Services, Vancouver general Hospital, Vancouver, BC, Canada
- BC Mental Health and Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Pouya Azar
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Services, Vancouver general Hospital, Vancouver, BC, Canada
| | - Anthony Phillips
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christian G Schütz
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Mental Health and Substance Use Services, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Fiona Choi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marc Vogel
- Clinic for Addiction Medicine, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Maurice Cabanis
- Centre for Mental Health, Klinikum Stuttgart, Stuttgart, Germany
| | - Maximilian Meyer
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Clinic for Addiction Medicine, University Psychiatric Clinics Basel, Basel, Switzerland
| | - Kerry Jang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martha Ignaszewski
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Services, Vancouver general Hospital, Vancouver, BC, Canada
- BC Children's hospital, Children's and Adolescent Psychiatry, Vancouver, BC, Canada
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Giang K, Charlesworth R, Thulien M, Mulholland A, Barker B, Brar R, Pauly B, Fast D. Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies. Int J Drug Policy 2023; 115:104023. [PMID: 37059025 PMCID: PMC10067449 DOI: 10.1016/j.drugpo.2023.104023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
Across North America, overlapping overdose and COVID-19 emergencies have had a substantial impact on young people who use drugs (YPWUD). New risk mitigation guidance (RMG) prescribing practices were introduced in British Columbia, Canada, in 2020 to allow people to decrease risk of overdose and withdrawal and better self-isolate. We examined how the prescribing of hydromorphone tablets specifically impacted YPWUD's substance use and care trajectories. Between April 2020 and July 2021, we conducted virtual interviews with 30 YPWUD who had accessed an RMG prescription of hydromorphone in the previous six months and 10 addiction medicine physicians working in Vancouver. A thematic analysis was conducted. YPWUD participants highlighted a disjuncture between risk mitigation prescriptions and the safe supply of unadulterated substances such as fentanyl, underscoring that having access to the latter is critical to reducing their reliance on street-based drug markets and overdose-related risks. They described re-appropriating these prescriptions to meet their needs, stockpiling hydromorphone so that it could be used as an “emergency backup” when they were unable to procure unregulated, illicit opioids. In the context of entrenched poverty, hydromorphone was also used to generate income for the purchase of drugs and various necessities. For some YPWUD, hydromorphone prescriptions could be used alongside opioid agonist therapy (OAT) to reduce withdrawal and cravings and improve adherence to OAT. However, some physicians were wary of prescribing hydromorphone due to the lack of evidence for this new approach. Our findings underscore the importance of providing YPWUD with a safe supply of the substances they are actively using alongside a continuum of substance use treatment and care, and the need for both medical and community-based safe and safer supply models.
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Affiliation(s)
- Karen Giang
- Department of Family Practice, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Reith Charlesworth
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Madison Thulien
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Alanna Mulholland
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Vancouver Coastal Health Authority, 520 West 6(th) Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Brittany Barker
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Canadian Institute of Substance Use Research, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada
| | - Rupinder Brar
- Department of Family Practice, University of British Columbia, 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada; Vancouver Coastal Health Authority, 520 West 6(th) Avenue, Vancouver, BC V5Z 1A1, Canada
| | - Bernie Pauly
- Canadian Institute of Substance Use Research, 2300 McKenzie Avenue, Victoria, BC V8N 5M8, Canada; School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria BC V8W 2Y2, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada; Department of Medicine (Division of Social Medicine), 317-2914 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada.
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Krausz RM, Wong JSH, Westenberg JN, Choi F, Schütz CG, Jang KL. Canada's Response to the Dual Public Health Crises: A Cautionary Tale. Can J Psychiatry 2021; 66:349-353. [PMID: 33567889 PMCID: PMC8044624 DOI: 10.1177/0706743721993634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Reinhard M Krausz
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - James S H Wong
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean N Westenberg
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Fiona Choi
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian G Schütz
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry L Jang
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
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