• Comparing Canadian and United States opioid agonist therapy policies.

      Priest, Kelsey C; Gorfinkel, Lauren; Klimas, Jan; Jones, Andrea A; Fairbairn, Nadia; McCarty, Dennis (2019-02-11)
      Canada and the United States (U.S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT)-buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited OAT access. Through a non-systematic literature scan and a review of publicly available policy documents, we examined and compared OAT policies and practice at the federal (Canada vs. U.S.) and local levels (British Columbia [B.C.] vs. Oregon). Differences and similarities were noted between federal and local OAT policies, and subsequently OAT access. In Canada, OAT policy control has shifted from federal to provincial authorities. Conversely, in the U.S., federal authorities maintain primary control of OAT regulations. Local OAT health insurance coverage policies were substantively different between B.C. and Oregon. In B.C., five OAT options were available, while in Oregon, only two OAT options were available with administrative limitations. The differences in local OAT access and coverage policies between B.C. and Oregon, may be explained, in part, to the differences in Canadian and U.S. federal OAT policies, specifically, the relaxation of special federal OAT regulatory controls in Canada. The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U.S. policymakers and health officials could consider adopting Canada's regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.
    • Development and Evaluation of the Online Addiction Medicine Certificate: Free Novel Program in a Canadian Setting.

      Gorfinkel, Lauren Renee; Giesler, Amanda; Dong, Huiru; Wood, Evan; Fairbairn, Nadia; Klimas, Jan (2019-05-24)
    • In-hospital training in addiction medicine: A mixed-methods study of health care provider benefits and differences.

      Gorfinkel, Lauren; Klimas, Jan; Reel, Breanne; Dong, Huiru; Ahamad, Keith; Fairgrieve, Christopher; McLean, Mark; Mead, Annabel; Nolan, Seonaid; Small, Will; et al. (2019-01-28)
      Hospital-based clinical addiction medicine training can improve knowledge of clinical care for substance-using populations. However, application of structured, self-assessment tools to evaluate differences in knowledge gained by learners who participate in such training has not yet been addressed. Participants (n = 142) of an elective with the hospital-based Addiction Medicine Consult Team (AMCT) in Vancouver, Canada, responded to an online self-evaluation survey before and immediately after the structured elective. Areas covered included substance use screening, history taking, signs and symptoms examination, withdrawal treatment, relapse prevention, nicotine use disorders, opioid use disorders, safe prescribing, and the biology of substance use disorders. A purposefully selected sample of 18 trainees were invited to participate in qualitative interviews that elicited feedback on the rotation. Of 168 invited trainees, 142 (84.5%) completed both pre- and post-rotation self-assessments between May 2015 and May 2017. Follow-up participants included medical students, residents, addiction medicine fellows, and family physicians in practice. Self-assessed knowledge of addiction medicine increased significantly post-rotation (mean difference in scores = 11.87 out of the maximum possible 63 points, standard deviation = 17.00; P < .0001). Medical students were found to have the most significant improvement in addiction knowledge (estimated mean difference = 4.43, 95% confidence interval = 0.76, 8.09; P = .018). Illustrative quotes describe the dynamics involved in the learning process among trainees. Completion of a hospital-based clinical elective was associated with improved knowledge of addiction medicine. Medical students appear to benefit more from the addiction elective with a hospital-based AMCT than other types of learners.
    • Medication-assisted treatment for youth with opioid use disorder: Current dilemmas and remaining questions

      Chang, Derek C.; Klimas, Jan; Wood, Evan; Fairbairn, Nadia; British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada; British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada; British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada; British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada (2017-11-30)
    • Slow release oral morphine versus methadone for the treatment of opioid use disorder.

      Klimas, Jan; Gorfinkel, Lauren; Giacomuzzi, Salvatore M; Ruckes, Christian; Socías, M Eugenia; Fairbairn, Nadia; Wood, Evan (2019-04-02)
      Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the random-effects model and expressed as risk ratios (RRs) or mean differences with 95% CIs. Heterogeneity was assessed (χ2 statistic) and quantified (I2 statistic) and a sensitivity analysis was undertaken to assess the impact of particular high-risk trials.
    • Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain: A Systematic Review.

      Klimas, Jan; Gorfinkel, Lauren; Fairbairn, Nadia; Amato, Laura; Ahamad, Keith; Nolan, Seonaid; Simel, David L; Wood, Evan (2019-05-03)