Category: Drugs

Irish GPs support wider use of naloxone to treat opiate addiction

Two thirds of GPs in Ireland support planned initiatives to provide wider availability of naloxone in the community for treating opiate addiction and overdose, a survey by University College Ireland has found.1
More than 200 deaths due to opiate overdose occur each year in Ireland, one of the highest rates in Europe. Naloxone is an effective opiate antagonist that can revert opiate overdose. “Take home” naloxone schemes, in which patients considered at risk …

by Susan Mayor
BMJ 2017356 doi: https://doi.org/10.1136/bmj.j1103 (Published 03 March 2017)Cite this as: BMJ 2017;356:j1103 

Insite Inside Out

Insite, “is that the place where people shoot up heroin? Do you shoot heroin?” a border officer asked me when he saw the sign on my T-shirt. I was puzzled by his questions, but glad he knew about Insite.

Inside works; inside out! The research proved it. This blog pays tribute to the enormous efforts of researchers, administrators, staff and clients of the supervised injection facility (SIF), who keep Insite working. Setting up SIF is feasible and other sites should be encouraged to do so.
 

photocredit: huffingtonpost.ca

June 2009: 33studies in 15 journals
(Full summaries of quoted studies are available from http://uhri.cfenet.ubc.ca/images/Documents/insite_report-eng.pdf)
1)     SIFs (Insite) may have a unique ability to address several outstanding public health and public order concerns related to injection drug use
2)     The primary cohort used to evaluate Insite was based on a random sample of IDUs recruited from within Insite
3)     Insite was being successfully integrated into the community
4)     Insite attracts drug users who are at a particularly high risk of health problems and who were previously public drug users.
5)     Frequent users of Insite are most likely to be those individuals who are also at highest risk of HIV and overdose as a result of their high-intensity injection practices
6)     Insite is used by IDUs with a high burden of HCV infection, as well as a substantial number of uninfected individuals, and therefore has the potential to help reduce risk of disease transmission.
7)     Insite has attracted a large number of hard-to-reach IDUs and that the existence of the facility presents an excellent opportunity to enhance HIV prevention through education, the provision of clean injecting equipment, and the availability of a supervised and sterile environment to self-inject.
8)     Insite has succeeded in attracting young highrisk injection drug users.
9)     Insite’s benefits on reducing the high-risk behaviours of IDUs and on increasing public order have not been offset by negative effects on drug use patterns among Vancouver’s IDU population
10)   Insite has not promoted illicit drug injecting, but rather that it has attracted individuals with long histories of injection drug use.
11)   Insite is facilitating entry into detoxification services among its clients
12)   Insite encourages IDUs to enter detox
13)   Insite has not contributed to an increase in drug-related crime in surrounding neighbourhoods.
14)   Improvement in public order was a result of the presence of Insite
15)   Insite successfully plays a role in managing overdoses among IDUs
16)   people who use heroin at least daily are more likely to report overdose
17)   Insite plays an important role in reducing overdose risk and in safely managing those overdoses that do occur
18)   Prompt medical attention at Insite prevented as many as 12 overdose deaths per year over a recent four-year period
19)   Reductions in syringe sharing observed among Insite users only occurred after Insite opened, suggesting that Insite may have been responsible for this important behavioural change
20)   Insite appears to be helping to reduce syringe sharing, the key risk factor for HIV transmission
21)   Regular SIF (Insite) users have reduced their likelihood of sharing syringes by 69%
22)   Insite’s clients who are HIV-positive used condoms with their sex partners
23)   Individuals who require help injecting were among those most likely to receive safer injecting education within Insite
24)   Insite is helping to reduce some of the health risks associated with unsafe injecting
25)   Insite nurses are reaching the high-risk injectors, particularly female injection drug users
26)   Insite is providing a safe environment in which people who inject drugs are able to learn about and adopt practices that will help them to avoid serious injection-related harms
27)   Insite may help to address barriers which normally make it difficult for injection drug users to access medical services
28)   Insite clients’ lower rate of skin infections could be a result of the medical care and treatment provided
29)   Insite is providing an opportunity to coordinate policing and public health efforts
30)   Insite’s waiting time limits its use by IDUs who continue to inject in public
31)   Insite was associated with an array of community and public health benefits and, despite rigorous evaluation, no identified adverse impacts
32)   Insite might be improved by longer hours of operation, a washroom and reduced wait times
33)   Insite is providing a safe space, away from the dangers of the street-based drug scene, for women who inject drugs
List of Published Studies until June 2009
1.     Wood E, Kerr T, Montaner JS, Strathdee SA, Wodak A, Hankins C, Schechter MT, Tyndall MW. Rationale for evaluating North America’s first medically supervised safer-injecting facility. Lancet Infectious Diseases, 2004; 4(5): 301-306.
2.     Wood E, Kerr T, Lloyd-Smith E, Buchner C, March DC, Montaner JSG, Tyndall MW. Methodology for evaluating Insite: Canada’s first medically supervised safer injection facility for injection drug users. Harm Reduction Journal, 2004; 1(1): 9.
3.     Tyndall MW, Kerr T, Zhang R, King E, Montaner JG, Wood E. Attendance, drug use patterns, and referrals made from North America’s first supervised injection facility. Drug and Alcohol Dependence, 2006; 83(3): 193-198.
4.     Wood E, Tyndall MW, Li K, Lloyd-Smith E, Small W, Montaner JSG, Kerr T. Do supervised injecting facilities attract higher-risk injection drug users? American Journal of Preventive Medicine, 2005; 29(2): 126-130.
5.     Wood E, Tyndall MW, Qui Z, Zhang R, Montaner JSG, Kerr T. Service uptake and characteristics of injection drug users utilizing North America’s first medically supervised safer injecting facility. American Journal of Public Health, 2006; 96(5): 770-773.
6.     Wood E, Kerr T, Stoltz J, Qui Z, Zhang R, Montaner JSG, Tyndall MW. Prevalence and correlates of hepatitis C infection among users of North America’s first medically supervised safer injection facility. Public Health, 2005; 119(12): 1111-1115.
7.     Tyndall MW, Wood E, Zhang R, Lai C, Montaner JSG, Kerr T. HIV seroprevalence among participants at a supervised injection facility in Vancouver, Canada: Implications for prevention, care and treatment. Harm Reduction Journal, 2006; 3(1): 36.
8.     Stoltz JA, Wood E, Miller C, Small W, Li K, Tyndall MW, Montaner J, Kerr T. Characteristics of young illicit drug injectors who use North America’s first medically supervised safer injecting facility. Addiction Research & Theory, 2007; 15(1): 63-69.
9.     Kerr T, Stoltz JA, Tyndall M, Li K, Zhang R, Montaner J, Wood E. Impact of a medically supervised safer injection facility on community drug use patterns: A before and after study. British Medical Journal, 2006; 332(7535): 220-222.
10.   Kerr T, Tyndall M, Zhang R, Lai C, Montaner J, Wood E. Circumstances of first injection among illicit drug users accessing a medically supervised safer injection facility. American Journal of Public Health, 2007; 97(7): 1228-1230.
11.   Wood E, Tyndall MW, Zhang R, Stoltz J, Lai C, Montaner JSG, Kerr T. Attendance at supervised injecting facilities and use of detoxification services. New England Journal of Medicine, 2006; 354(23): 2512-2514.
12.   Wood E, Tyndall MW, Zhang R, Montaner JS, Kerr T. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction, 2007; 102(6): 916-919.
13.   Wood E, Tyndall MW, Lai C, Montaner JSG, Kerr T. Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Substance Abuse Treatment, Prevention, and Policy, 2006; 1(1): 13.
14.   Wood E, Kerr T, Small W, Li K, Marsh D, Montaner JS, Tyndall MW. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal, 2004; 171(7): 731-734.
15.   Kerr T, Tyndall MW, Lai C, Montaner JSG, Wood E. Drug-related overdoses within a medically supervised safer injection facility. International Journal of Drug Policy, 2006; 17(5): 436-441.
16.   Milloy M-JS, Kerr T, Mathias R, Zhang R, Montaner JS, Tyndall Mark, Wood E. Non-fatal overdose among a cohort of active injection drug users recruited from a supervised injection facility. American Journal of Drug and Alcohol Abuse, 2008; 34(4): 499-509.
17.   Kerr T, Small W, Moore D, Wood E. A micro-environmental intervention to reduce the harms associated with drug-related overdose: Evidence from the evaluation of Vancouver’s safer injection facility. International Journal of Drug Policy, 2007; 18(1): 37-45.
18.   Milloy M-J, Kerr T, Tyndall M, Montaner J, Wood E. Estimated drug overdose deaths averted by North America’s first medically-supervised safer injection facility. PLoS ONE, 2008; 3(10): e3351.
19.   Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet, 2005; 366(9482): 316-318.
20.   Wood E, Tyndall MW, Stoltz JA, Small W, Lloyd-Smith E, Zhang R, Montaner JSG, Kerr T. Factors associated with syringe sharing among users of a medically supervised safer injecting facility. American Journal of Infectious Diseases, 2005; 1(1): 50-54.
21.   Milloy M-J, Wood E. Emerging role of supervised injecting facilities in human immunodeficiency virus prevention. Addiction, 2009; 104(4): 620-621.
22.   Marshall B, Wood E, Zhang R, Tyndall M, Montaner JS, Kerr T. Condom use among injection drug users accessing a supervised injecting facility. Sexually Transmitted Infections, 2009; 85(2): 121-126.
23.   Wood E, Tyndall MW, Stoltz J, Small W, Zhang R, O’Connell J, Montaner JSG, Kerr T. Safer injecting education for HIV prevention within a medical supervised safer injecting facility. International Journal of Drug Policy, 2005; 16(4): 281-284.
24.   Stoltz JA, Wood E, Small W, Li K, Tyndall MW, Montaner JSG, Kerr T. Changes in injecting practices associated with the use of a medically supervised safer injection facility. Journal of Public Health, 2007; 29(1): 35-39.
25.   Wood RA, Wood E, Lai C, Tyndall, MW, Montaner JSG, Kerr T. Nurse-delivered safer injection education among a cohort of injection drug users: Evidence from the evaluation of Vancouver’s supervised injection facility. International Journal of Drug Policy, 2008; 19(3): 183-188.
26.   Fast D, Small W, Wood E, Kerr T. The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility. Harm Reduction Journal, 2008; 5(1): 32.
27.   Small W, Wood E, Lloyd-Smith E, Tyndall M, Kerr T. Accessing care for injection-related infections through a medically supervised injecting facility: A qualitative study. Drug and Alcohol Dependence, 2008; 98(1-2): 159-162.
28.   Lloyd-Smith E, Wood E, Zhang R, Tyndall MW, Montaner JSG, Kerr T. Risk factors for developing a cutaneous injection-related infection among injection drug users: A cohort study. BMC Public Health, 2008; 8(1): 405.
29.   DeBeck K, Wood E, Zhang R, Tyndall M, Montaner J, Kerr T. Police and public health partnerships: Evidence from the evaluation of Vancouver’s supervised injection facility. Substance Abuse Treatment, Prevention, and Policy, 2008; 3(1): 11.
30.   McKnight I, Maas B, Wood E, Tyndall MW, Small W, Lai C, Montaner JS, Kerr T. Factors associated with public injecting among users of Vancouver’s supervised injection facility. American Journal of Drug and Alcohol Abuse, 2007; 33(2): 319-325.
31.   Wood E, Tyndall MW, Montaner JS, Kerr T. Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. Canadian Medical Association Journal, 2006; 175(11): 1399-1404.
32.   Petrar S, Kerr T, Tyndall MW, Zhang R, Montaner JS, Wood E. Injection drug users’ perceptions regarding use of a medically supervised safer injecting facility. Addictive Behaviors, 2006; 32(5): 1088-1093.
33.   Fairbairn N, Small W, Shannon K, Wood E, Kerr T. Seeking refuge from violence in street-based drug scenes: Women’s experiences in North America’s first supervised injection facility. Social Science & Medicine, 2008; 67(5): 817-823.
I wrote this post using conclusion quotes from summaries of research summed up in the document
Findings from the Evaluation of Vancouver’s Pilot Medically Supervised Safer Injection Facility – Insite. Vancouver: British Columbia Centre for Excellence in HIV/AIDS (June 2009). 

The evaluation of Insite keeps going. Check out the newest research at http://uhri.cfenet.ubc.ca.

How can we do better job in studying Topiramate?

Topiramate prevents seizures in people with epilepsy. Previously, we looked at all studies to see whether Topiramate can help treat cocaine addiction, reduce cocaine use and prolong treatment retention.
Photocredit: desdaughter.com
No current evidence supported the clinical use of Topiramate for the treatment of cocaine dependence.
Some of these studies were not blinded. This means that the participants knew whether they got the actual Topiramate or a flat placebo. Too many people dropped out of these studies. They did not measure things in the same way. For instance, not a single study measured craving in the same way. If things from several studies aren’t measured in the same way, we cannot put them together to answer the question whether Topiramate works. Finally, the studies excluded people who also had other drug use disorders. Most people have multiple disorders.
One study was different than all others. It was Dutch. Not only did the participants use less cocaine but they also received less Topiramate and their dose was set over a shorter time than in the American studies.
All of these cues make Topiramate very interesting to study even more, especially if it’s paired with a structured support, such as contingency management. Contingency management helps people curb cocaine addiction by rewarding healthy habits.
There is no drug for cocaine use disorder.  In the past, researchers have studied whether drugs for depression, epilepsy or seizures could treat cocaine addiction.
Until we do better job as researchers, we won’t know whether Topiramate works for cocaine use disorder.
Reference: Klimas, J., Wood, E., Werb, D. How Can We Investigate the Role of Topiramate in the Treatment of Cocaine Use Disorder More Thoroughly? Addiction, 2016, In Press: onlinelibrary.wiley.com/doi/10.1111/add.13618/abstract 

Changing the ways of CPDD – College on Problems of Drug Dependence – June 12-16, #CPDD2016

Change is the ultimate law of life. Those that do not change and adapt, do not survive. In the life of scientific meetings, this means constantly improving the organisation of the events and tailoring them to the changing needs of the conference delegates. This year, the annual meeting of the College on Problems of Drug Dependence (CPDD) introduced several improvements and more are on the way in next years.

cpdd logo

photocredit: cpdd.org

 

Bye Bye Tote Bags

Many of us were used to the traditional design of the CPDD tote bags. Each year had a different colour. For years when conference visited a warm region, such as Phoenix, AR, the tote bag included a special layer for keeping the contents cool. The non-bag policy brought the desired recognition of sustainability and (un-)expected diversity among the conference bags – everyone was different.

Bye Bye Printed Programs

For years, the conference book was a comprehensive bible for the conference week. Everybody read it and most followed it. Although the College printed a limited number of copies, this year, the e-programs drained participants smartphones’ batteries. What more, they offered note-taking and photograph uploading that many appreciated. Welcome to the digital age.

Hello Mentors

Since the early days, the senior delegates offered mentorship to junior delegates. Mostly informal. Following the new trends adopted at other conferences, such as AHSR or NAPCRG, the CPDD sent out emails to all Members in Training (MIT), offering to match them with a potential mentor (mentor bios included). If both parties agreed, the match-maker introduced them via email. I have learned a lot from my mentor. Especially that the decision makers may not read addiction journals, also that the team identity strengthens sense of ownership among team members and that the road to the research success can be long and winding. Let’s hope that the beneficial mentoring program continues in future.

Hello Shorter Conference

With the increasing demands on scientists’ workloads, there is a chance that the upcoming conferences will be shorter.

See also my previous blog posts about CPDD from the previous years:

2015Getting the most out of the Conference of the College on Problems of Drugs Dependence #CPDD2015

2014: 76th Annual Conference of College on Problems of Drug Dependence: Decide to be fearless& fabulous 

2013: My itinerary for the Conference – College on Problems of Drug Dependence, San Diego, June 15-20 

Need more skilled addiction specialists? New paper out now

photocredit: Wolters Kluwer

Training in addiction medicine gives clinicians early intervention tools, prevents the escalation of addiction and prevents costly and lengthy treatment. The problem is that very little information exists on the treatment workforce. It seems that most health systems do not have enough providers trained in addiction medicine to reduce the public health consequences of this increasing societal problem. In 2014, the Boston-based Advocates for Human Potential, Inc., developed a so-called Provider Availability Index. It measures the gap between the need for and availability of trained healthcare providers, but similar efforts have not been done in Canadian setting. This paper briefly describes mathematical estimates of the number of skilled addiction care providers in British Columbia, Canada, and offers recommendations for steps that can be taken immediately to increase provider availability. The article was published ahead of print in the Journal of Addiction Medicine on May 13, 2016 and the suggested citation is: 
McEachern, J., Ahamad, K., Nolan, S., Mead, A., Wood, E., & Klimas, J. (9000). A needs assessment of the number of comprehensive addiction care physicians required in a canadian setting. J Addict Med, Publish Ahead of Print. doi:10.1097/adm.0000000000000230