Canadian Society of Addiction Medicine, CSAM conference

Posted October 26, 2018 by janklimas

Celebrating 30 years of CSAM-SMCA in Vancouver, BC, the conference focused on: Crisis, Controversy & Change. What is the role of education in tackling the overdose crisis?
Three speakers at the education session on Friday offered several potential solutions.

Friday, October 26th: Medical Education in Addictions (CSAM-SMCA Education Committee)

(1:30) Who Learns the Most about Addictions in Hospitals? A Mixed Methods Study.
Jan Klimas (representing a co-author team: Gorfinkel, L., Ahamad, K., Mead, A., McLean, M., Fairgrieve, C., Nolan, S., Small, W., Cullen, W., Wood, E., and Nadia Fairbairn), summarised the results of a 2-year evaluation of the addiction medicine consult team in the St Paul’s hospital, Vancouver, British Columbia. Learners, such as medical students, completed web surveys before and after their clinical placements with the team. A purposeful sample participated in post-elective interviews. Results of this research study will soon appear in a paper accepted for publication in the Substance Abuse journal.

(1:45) Addiction Medicine Mentorship: Capacity Building Through Relationship Building.
Kate Hardy (Manager) and Sarah Clarke (Sarah Clarke) from the Metaphi mentoring project spoke about the role of primary care providers in the treatment of substance use disorders. The length of the treatment is more important than the intensity. Patients prefer to be treated in primary care. Integrating mental health with physical health services creates better outcomes. Primary care has greater capacity for treatment. But many providers are not willing to take over the care of persons with SUD. Medical mentoring of primary care providers by specialists. There’s no wrong door to access the addictions treatment. Mentorship, such the one provided via Hardy’s and Clarke’s project – metaphi – must be easy and convenient, sufficiently incentivized. Check out the project website www.metaphi.ca.

(2:00) The ABC’s of Addiction Fellowship Programs in Canada.
Melanie Willows (introducing her co-author team: Anees Bahji, Annabel Mead, Nikki Bozinoff, Ron Lim, Lydia Vezina, Ronald Fraser & Kim Corace) and a group of fellowship directors facilitated a session, which was sponsored by the CSAM education committee, about the Canadian fellowships in addiction medicine and offered recommendations for the future of the training programmes in Canada. In addition to the fellowship directors, the talk started with a lived experience of someone who has been accepted to the fellowship but who has not started the fellowship. A recent fellowship alumna concluded the group presentation.

If you enjoyed reading about this year’s CSAM 2018 conference, you can read about the CSAM 2015 here

Diagnosing opioid addiction in people with chronic pain

Posted September 22, 2018 by janklimas

Diagnosing opioid addiction in people with chronic pain requires a fully validated alternative to DSM-5.

Over the past two decades, a steep rise in the number of opioids dispensed for pain treatment has been accompanied by a dramatic rise in overdose deaths in the United States. In 2016, up to 32 000 deaths reportedly involved prescription opioids. Besides that, the economic burden of prescription opioid overdose exceeds $78bn (£59bn; €67bn) annually.

Despite all the evidence of harm, it remains unclear exactly how to determine if a patient with chronic pain has opioid addiction. What criteria should serve as a gold standard in making a diagnosis of opioid use disorder (OUD) in this context? This is an important gap in the literature. It hinders both evidence based care and research on the links between prescription opioids and OUD. Therefore, we discuss the limitations of diagnosing OUD in people with chronic pain, and make several recommendations for further research.

Diagnosing opioid addiction in people with chronic pain

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) provides a widely used set of diagnostic criteria for OUD. But these criteria do not always apply to patients who are prescribed opioids for chronic pain. According to DSM-5, if a patient presents with 2 out of 9 specific symptoms, it may indicate …

Source:

Gorfinkel Lauren, Voon Pauline, Wood Evan, Klimas Jan. Diagnosing opioid addiction in people with chronic pain BMJ 2018; 362 :k3949

If you like this post, check out my other articles about screening here

Will this patient go into severe alcohol withdrawal?

Posted August 28, 2018 by janklimas

New research from the BC Centre on Substance Use (BCCSU) suggests applying easy and effective tool to identify patients at high risk of going into withdrawal, in efforts to modernize alcohol detox. In a study published in the August issue of the peer-reviewed Journal of American Medical Association, BCCSU researchers used data from approximately 71,295 persons taking part in 14 scientific studies to predict which patient will develop serious complications, including seizures and delirium.

Which patient will go into severe alcohol withdrawal?

From the press release by British Columbia Centre on Substance Use (Aug 28, 2018):

Research sheds light on how to improve diagnosis and treatment of severe alcohol withdrawal syndrome

The treatment of alcohol withdrawal urgently needs to be modernized in order to improve patient outcomes and safety and reduce health care cost, according to new research from the BC Centre on Substance Use (BCCSU).

The study, published today in the Journal of the American Medical Association, involved a multi-year systematic review involving more than 71,000 patients and sought to determine how best to identify the risks of developing severe, complicated alcohol withdrawal – a potentially life-threatening emergency. Those who consume alcohol in quantities above low-risk recommendations may develop this syndrome when they abruptly stop or substantially reduce their alcohol consumption.

Researchers found that patients are commonly over-admitted into inpatient alcohol withdrawal management care, resulting in a poor patient experience and unnecessary health care resource consumption. The review identified highly valid and easily administered screening tools to properly assess symptoms and risks before recommending acute treatment such as withdrawal management, and to look at outpatient care to improve patient outcomes and reduce the burden on the health system.

“Alcohol addiction is not only the most common substance use disorder, it’s among the most devastating in terms of both health impacts and the costs to our health system,” said Dr. Evan Wood, executive director of the BCCSU and lead author of the study. “This study demonstrates that there are more sophisticated tools that the health system should be employing to provide more appropriate care for patients, which will result not only in better outcomes but also free-up resources for high-priority needs.”

According to a study released by the University of Victoria’s Canadian Institute for Substance Use Research (CISUR) and the Canadian Centre on Substance Use and Addiction (CCSA), alcohol use costs Canadians $14.6 billion per year in health care, lost production, criminal justice, and other direct costs – higher than all other substances combined.

B.C. has the highest rate in the country of hospitalizations entirely caused by alcohol, and consumption is rising faster in the province than elsewhere in Canada. Research from the Canadian Institute for Health Information published last year found that British Columbians who use alcohol consume, on average, 9.4 litres of pure alcohol each year — the equivalent of roughly 14 bottles of beer or two-and-half bottles of wine each week.

“Hospital wards are often filled with individuals suffering the consequences alcohol addiction,” said Dr. Keith Ahamad, a co-author on the study and Medical Director at Vancouver Coastal Health’s Regional Addiction Program. “This study helps identify those who truly need admission and demonstrates that many patients can be better treated as outpatients, even in primary care.”

The BCCSU is funded by the provincial government and is currently developing provincial guidelines for treating alcohol use disorder, expected to be released later this. They will be the first evidence-based guidelines of their kind for the province.

(Text taken from http://www.bccsu.ca/news-releases/)

From: Will This Hospitalized Patient develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review. JAMA (In Press) JAMA Network: jama.jamanetwork.com

If you’re interested in alcohol, read more about my alcohol research here.

For more information about the study or to schedule an interview, please contact:
Kevin Hollett, BC Centre on Substance Use
778-918-1537
khollett[at]cfenet.ubc.ca

Addiction social work fellowship launched

Posted July 30, 2018 by janklimas

Addiction social work fellowship launched!

Substance use disorders disproportionately contribute to the global social and economic burden of disease.

Sadly, their treatment has been inadequate in large part due to an enduring research to practice gap. Here, the competencies for treating and preventing substance use disorders are often lacking from social work education curricula.

Addiction social work fellowship launched in Canada

Recently, the British Columbia Centre on Substance Use started a new interdisciplinary fellowship in addiction social work, nursing and medicine in Vancouver, Canada. We describe the new fellowship program and outline initial impact of the training on knowledge and skills in addiction social work from our qualitative evaluation of the fellowship.

“The Addiction Social Work Fellowship program accepts two positions in Social Work annually. The program strives for excellence in clinical training, scholarship, research, and advocacy and includes specialty training in inpatient and outpatient addiction services, as well as related concurrent disorders training. The program prepares Fellows to work clinically in the field of addictions and take leadership roles in academic and/or research settings.” (www.bccsu.ca)

To read the whole story, please visit the journal website https://www.tandfonline.com/loi/wswp20 or lookup the paper using the following citation:

Callon, C., Reel, B., Bosma, H., Durante, E., Johnson, C., Wood, E., Klimas, J. (In Press) Addiction Social Work Fellowship in Addiction Medicine: A Novel Programme in a Canadian setting. (Early Online July 30th) Journal of Social Work Practice in the Addictions

If you enjoyed reading this post, you may also enjoy reading about the fellowship here.

Systematic reviews enhance drugs conference

Posted July 4, 2018 by janklimas

Systematic reviews are the cream of the research crop. Those who understand their value thrive at an opportunity to meet the review authors at scientific conferences. This year, the annual meeting of the College on Problems of Drug Dependence (CPDD) in San Diego featured several important reviews. Here’s a listing of all the posters presenting reviews from the session on Wednesday, June 13^th, 2018.

Overdose

Non-fatal overdose prevalence among people who inject drugs Samantha Colledge (June 11, 2018);

Prescription drug monitoring programs on nonfatal and fatal drug overdoses David Fink;

Gender

Limited inclusion of women in functional neuroimaging studies of opioid-use disorder Hestia Moningka;

Women’s prescription drug misuse Bridgette Peteet;

Gender differences in HIV, anti-HCV and HBsAg prevalence among people who inject Janni Leung;

Services

Case for hospital teams in treatment of opioid use disorders Kelsey Priest;

Addiction-related characteristics of substances users in harm reduction settings Charlotte Kervran;

STDs and injecting

Extremely low HIV incidence among PWID: Terminology, high/middle income settings, methodology, and addressing new outbreaks Don Des Jarlais;

Use of opioids and stimulants by people who inject drugs Amy Peacock;

Factors associated with uptake or willingness to use pre-exposure prophylaxis (PrEP) among people who inject drugs Yohansa Fernández;

Pre-exposure prophylaxis (PrEP) for people who inject drugs? Angela Bazzi;

Cannabis

Cannabis and cannabinoids for the treatment of people with chronic non-cancer pain conditions Emily Stockings;

Medical marijuana laws and adolescent marijuana use in the US Aaron Sarvet;

Does liberalization of cannabis policy influence adolescents’ levels of use? Maria Melchior;

Other topics

Clinical and toxicological profile of NBOMESs Nino Marchi;

Sensation-seeking personality trait and its association to drug seeking behavior in adolescents Thiago Fidalgo.

Systematic reviews cream of the crop from Brazil through Egypt

NIDA International poster session on Monday, June 11, 2018

Three Australians, two North Americans; an Egyptian, African and Brazilian had one poster on systematic review each. Five were meta-analyses.

The Australian reviews dealt with overdose, STDs and injecting:

Nonfatal overdose prevalence among people who inject drugs S. Colledge, (UK, Australia);

Gender differences in HIV, anti-hepatitis C virus, and hepatitis B virus surface antigen prevalence among people who inject drugs J. Leung, (Australia, UK, Portugal);

Use of opioids and stimulants by people who inject drugs: A. Peacock, (Australia);

The North-Americans reviewed drug monitoring programmes:

Global review of drug-checking services 2017 L.J. Maier, (California);

Urinalysis frequency and health outcomes for persons on opioid agonist therapy: J. McEachern, (Canada);

Anger, brain stimulation and antipsychotics were reviewed too:

Anger in users of psychoactive substances H.V. Laitano, (Brazil);

Noninvasive brain stimulation in addiction medicine A. Elaghoury.(Egypt);

Atypical versus typical antipsychotics for the treatment of addiction: S. Hanu. (Ghana).

With the increasing demands on scientists’ workloads, systematic reviews are an effective way of staying up to date with the most recent developments in the field. See also my previous blog posts about CPDD from the previous years:

2017: Dr Wood tells the forum recipe for research-centre success

2016: Changing the ways of CPDD – College on Problems of Drug Dependence – June 12-16, #CPDD2016

2015: Getting 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