Category: mental health

20 per cent heroin eligible, study finds

medical heroin

This study looked at how many, and what types of people who inject drugs (PWID), in the AIDS Care Cohort to evaluate Exposure to Survival Services Study (ACCESS), would be eligible for medical heroin in Vancouver, Canada.

Medical heroin could possibly help people who have treatment resistant opioid use disorder and who live with HIV/AIDS.

How was the study done?

We looked at how many, and what types of PWID in the ACCESS Study would be eligible for medical heroin. Participants had to meet eligibility criteria from clinical trials of medical heroin.

The ACCESS study involves people living with HIV who use illicit drugs, mostly living in Vancouver’s Downtown Eastside neighbourhood. Researchers work with participants to look at how social, economic, physical, policy, and individual factors impact the health and well-being of HIV-positive illicit drug users. ACCESS participants do an interviewer-administered survey, and a clinic visit with a study nurse, every 6 months. (text taken from: http://www.bccsu.ca/access/)

What did the study find?

478 participants said they injected opioids. 20% met the eligibility criteria for treatment with medical heroin. Those who were homeless, or were involved in the local illicit drug trade, were more likely to be eligible for medical heroin.

20% met the eligibility criteria for treatment with medical heroin and also said they were homeless and dealt drugs.

Why is the medical heroin useful?

Untreated opioid use disorder among people who live with HIV/AIDS can lead to illnesses, overdose, or death. Medical heroin can play an important role in helping people who have treatment resistant opioid use disorders and who live with HIV/AIDS.

Reference: Klimas, J., Dong, H., Fairbairn, N., Socías, E., Barrios, R., Wood, E., Kerr, T., Montaner, J., Milloy, M. (2018) Eligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting. Addiction Science& Clinical Practice. In Press (https://ascpjournal.biomedcentral.com/track/pdf/10.1186/s13722-017-0104-y?site=ascpjournal.biomedcentral.com)

What are the core skills of an addiction expert?

expert button

Should all medical doctors receive the same training in addiction medicine? Here’s what international experts think about core skills of and addiction specialist.

core skills

In a new article published by the Substance Abuse journal, we report on interviews with members of the International Society of Addiction Medicine who identified progression for the core skills and addiction medicine competencies at three educational levels: (i) undergraduate (ii), postgraduate and (iii) continued medical education (CME). The experts described broad ideas, such as knowledge/skills/attitudes towards addiction, for the undergraduate level. At the graduate level, they recommended knowledge of addiction treatment. Next, the experts also described specific recommendations, including the need to tailor the curriculum to national settings and different specialties. We still don’t know whether a global curriculum is needed. But a consensus on a core set of principles for progression of knowledge, attitude, and skills in addiction medicine to be developed at each educational level among medical graduates would likely have substantial value.

Why are the core skills important?

Our findings provide a consensus opinion on core skills for progression of knowledge, attitude, and competencies in addiction medicine. A panel of international scholars recommended that medical students and physicians should learn these skills throughout medical education. This is particularly important for the development of new addiction medicine curricula and enhancement of available courses. If applied, our findings would have profound effects on the quality of medical education. Better education can improve subsequent clinical care provided to people with substance use disorders worldwide.

Study title:

Two birds with one stone: physicians training in research

Combined training in addiction medicine and research is feasible and acceptable for physicians – a new study shows; however, there are important barriers to overcome and improved understanding of the experience of addiction physicians in the clinician-scientist track is required.

Addiction care is usually provided by unskilled lay-persons in most countries. The resulting care is inadequate, effective treatments are overlooked and millions of people suffer despite recent discovery of new treatments for substance use disorders. In rare instances when addiction care is provided by medical professionals, they are not adequately trained in caring for people with substance use disorders and, therefore, feel unprepared to provide such care.  Physician scientists are the bridge between science and practice. Despite large evidence-base upon which to base clinical practice, most health systems have not combined training of healthcare providers in addiction medicine and research. 
In recent years, new programmes have emerged to train the comprehensive addiction medicine professionals internationally.

We undertook a qualitative study to assess the experiences of 26 physicians who completed such a training programme in Vancouver, Canada. They included psychiatrists, internal medicine and family medicine physicians, faculty, mentors, medical students and residents. All received both addiction medicine and research training. Drawing on Kirkpatrick’s model of evaluating training programmes, we analysed the interviews thematically using qualitative data analysis software. We identified five themes relating to learning experience that were influential: (i) attitude, (ii) knowledge, (iii) skill, (iv) behaviour and (v) patient outcome. The presence of a supportive learning environment, flexibility in time lines, highly structured rotations, and clear guidance regarding development of research products facilitated clinician-scientist training.  Competing priorities, to include clinical and family responsibilities, hindered training.

Read more here: http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0862-y
Klimas, J., McNeil, R., Ahamad, K., Mead, A., Rieb, L., Cullen, W., Wood, E., Small, W. (2017) Two birds with one stone: Experiences of Combining Clinical and Research Training in Addiction Medicine. BMC Medical Education, 17:22

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

New article out now: Time to confront the iatrogenic opioid addiction

The Medical Post
May 2, 2016
CanadianHealthcareNetwork.ca
OPINION: JAN KLIMAS
 Time to confront iatrogenic opioid addiction
Canada has been grappling for decades in a largely ineffective attempt to keep heroin out of our borders. Now the unsafe prescribing of opioids has organized crime groups turning their attention to ‘customers’ whose addiction started in the doctor’s office. Physicians are going to have to face the tough conversations that involve two of the hardest words in a doctor’s vocabulary: ‘enough’ and ‘no.
The full article is now online, and has appeared in the Doctor Daily e-newsletter on Monday May 2m 2016

Published by the Canadian Healthcare Network, The Medical Post is  “the independent newspaper and online information source for Canada’s doctors, with a 45-plus-year tradition of providing a one-of-a-kind mix of clinical updates, medico-political news and lifestyle features to assist doctors and enhance their professional and personal live.” Text taken from http://www.canadianhealthcarenetwork.ca/physicians/magazines/the-medical-post/