Abstract
Background
The COVID-19 pandemic is affecting mental health and substance use (MHSU) issues worldwide. The purpose of this study was to characterize the literature on changes in cannabis use ...during the pandemic and the factors associated with such changes.
Methods
We conducted a scoping review by searching peer-reviewed databases and grey literature from January 2020 to May 2022 using the Arksey and O’Malley Framework. Two independent reviewers screened a total of 4235 documents. We extracted data from 129 documents onto a data extraction form and collated results using content analytical techniques.
Results
Nearly half (48%) of the studies reported an increase/initiation of cannabis use, while 36% studies reported no change, and 16% reported a decrease/cessation of cannabis use during the pandemic. Factors associated with increased cannabis use included socio-demographic factors (e.g., younger age), health related factors (e.g., increased symptom burden), MHSU factors (e.g., anxiety, depression), pandemic-specific reactions (e.g., stress, boredom, social isolation), cannabis-related factors (e.g., dependence), and policy-related factors (e.g., legalization of medical/recreational cannabis).
Conclusion
Public health emergencies like the COVID-19 pandemic have the potential to significantly impact cannabis use. The pandemic has placed urgency on improving coping mechanisms and supports that help populations adapt to major and sudden life changes. To better prepare health care systems for future pandemics, wide-reaching education on how pandemic-related change impacts cannabis use is needed.
People who smoke crack cocaine experience a wide variety of health-related issues. However, public health programming designed for this population is limited, particularly in comparison with ...programming for people who inject drugs. Canadian best practice recommendations encourage needle and syringe programs (NSPs) to provide education about safer crack cocaine smoking practices, distribute safer smoking equipment, and provide options for safer disposal of used equipment.
We conducted an online survey of NSP managers across Canada to estimate the proportions of NSPs that provide education and distribute safer smoking equipment to people who smoke crack cocaine. We also assessed change in pipe distribution practices between 2008 and 2015 in the province of Ontario.
Analysis of data from 80 programs showed that the majority (0.76) provided education to clients on reducing risks associated with sharing crack cocaine smoking equipment and about when to replace smoking equipment (0.78). The majority (0.64) also distributed safer crack cocaine smoking equipment and over half of these programs (0.55) had done so for less than 5 years. Among programs that distributed pipes, 0.92 distributed the recommended heat-resistant Pyrex and/or borosilicate glass pipes. Only 0.50 of our full sample reported that their program provides clients with containers for safer disposal of used smoking equipment. The most common reasons for not distributing safer smoking equipment were not enough funding (0.32) and lack of client demand (0.25). Ontario-specific sub-analyses showed a significant increase in the proportion of programs distributing pipes in Ontario from 0.15 (2008) to 0.71 (2015).
Our findings point to important efforts by Canadian NSPs to reduce harm among people who smoke crack cocaine through provision of education and equipment, but there are still limits that could be addressed. Our study can provide guidance for future cross-jurisdiction studies to describe relationships involving harm reduction programs and provision of safer crack cocaine smoking education and equipment.
The overdose crisis has generated innovative harm reduction and drug market monitoring strategies. In Toronto, Ontario, Canada, a multi-site drug checking service (DCS) pilot project was launched in ...October 2019. The project provides people who use drugs with information on the chemical composition of their substances, thereby increasing their capacity to make more informed decisions about their drug use and avoid overdose. DCS also provides real-time market monitoring to identify trends in the unregulated drug supply.
Sample data were obtained through analyses of drug and used drug administration equipment samples submitted anonymously and free of charge to DCS in downtown Toronto from October 10, 2019, to April 9, 2020, representing the first six months of DCS implementation. Analyses were conducted in clinical laboratories using liquid chromatography- and/or gas chromatography-mass spectrometry (LC-MS, GC-MS) techniques.
Overall, 555 samples were submitted, with 49% (271) of samples that were found to contain high-potency opioids, of which 87% (235) also contained stimulants. Benzodiazepine-type drugs were found in 21% (116) of all samples, and synthetic cannabinoids in 1% (7) of all samples. Negative effects (including overdose, adverse health events, and extreme sedation) were reported for 11% (59) of samples submitted for analysis.
Toronto's DCS identified a range of high-potency opioids with stimulants, benzodiazepine-type drugs, and a synthetic cannabinoid, AMB-FUBINACA. This information can inform a range of evidence-informed overdose prevention efforts.
Canada continues to experience an escalating opioid overdose crisis that has claimed more than 8000 lives in the country since 2016. The presence of the synthetic opioid fentanyl and its analogues is ...a central contributor to the increases in preventable opioid-related deaths. However, a number of converging social-structural factors (e.g., the continued criminalisation of drug use, political changes) and political barriers are also complicating and contributing to the current crisis. We briefly outline four harm reduction interventions (i.e., injectable opioid agonist treatment, naloxone distribution programs, overdose prevention sites, and drug checking services) as emerging and rapidly expanding responses to this crisis in Canada. These examples of innovation and expansion are encouraging but also occurring at the same time that the opioid overdose crisis shows few signs of abating. To truly address the crisis, Canada needs political environments at all government levels that are responsive and foster harm reduction innovation and drug policy experimentation.
IntroductionThe concept of a ‘public health approach’ to substance use is frequently but inconsistently invoked. This inconsistency is reflected in public policy, with governments using the term ...‘public health approach’ in contradictory ways. This aim of this study is to clarify what is meant and understood when the term ‘public health approach’ is used in the context of substance use.Methods and analysisWe will conduct a systematic search of Medline, Embase, Scopus, CINAHL, PsycINFO, Sociological Abstracts and PAIS Index. Eligible articles will be from peer-reviewed journals, in English, with full text available. There will be no limits on year of publication. Substance use must be the primary topic of the article. Editorials, commentaries and letters to the editor will be included, but not commentaries on other articles, unless the definition of a public health approach is central to the commentary. Data selection and collection will be conducted independently by two researchers, with a third separately resolving any disagreement. To answer the research question, we will extract authors’ definitions of a public health approach to substance use as well as any descriptions of the central principles, characteristics and components of such an approach. To synthesise the data, we will employ thematic synthesis. Coding will be conducted by one researcher and verified by a second; two researchers will then group the codes into themes using an inductive process. Finally, the full research team will develop a set of analytic themes, which will be presented as a narrative.Ethics and disseminationEthics approval is not needed since the research will only involve published work. Our findings will be disseminated in a peer-reviewed journal and, if possible, at conferences.PROSPERO registration numberCRD42021270632.
Receiving passes and privileges to leave secure hospital settings has important therapeutic value for forensic patients. However, events involving patient unauthorized leave of absence (ULOA) prompt ...public safety concerns. To better understand how to address ULOA, we reviewed literature on patient leave and ULOA from forensic mental health settings, and technological monitoring of forensic patients. We systematically searched the following databases: MEDLINE, PsycINFO, and CINAHL. Searches were not restricted by language, study type, or time period. While the literature lacks a consistent convention to calculate ULOA rates, it suggests that forensic ULOA events are generally infrequent and benign. Common motivations for absconding include boredom and frustration. Structured professional guidelines may enhance transparency and confidence in decision-making about patient leave, but there is a need for validation of tools specific to ULOA risk. More research on interventions designed to reduce forensic ULOA, including use of electronic monitoring, is also needed. The therapeutic risk of forensic patient absconding will never be fully eliminated. Literature to date suggests promising avenues for future research and efforts to address ULOA, such as increasing opportunities for therapeutic and recreational activities, and evaluation of existing and development of new interventions.
Highlights • Best practice recommendations encourage positive needle-and-syringe-programs (NSP)–police relationships. • Majority of NSP managers surveyed reported positive relationships with police. ...• Many NSPs do not provide in-service training to police. • Provision of in-service training is related to positive NSP-police relationships. • Research and evaluation are needed to uncover in-service training needs and impacts.
Background: Although there is a need for well-designed evaluations, international evidence shows that drugs frequently enter prisons and enforcement efforts are said to be linked to adverse events. ...Objectives: This study sought to examine drug enforcement within a federal prison system, overseen by the Correctional Service of Canada (CSC), and to detail competing perspectives. Methods: Three main sources of data were used in this qualitative study: 16 interviews conducted between 2010 and 2012 with former CSC senior officials, former frontline staff, and external stakeholders; CSC research publications and other documents; and transcripts from a relevant House of Commons Standing Committee public study. All texts were coded and compared to examine emergent themes of interest. Results: Six key themes are described as contested effects of enhanced in-prison drug enforcement: (1) continued and creative efforts to bring in drugs; (2) climate of tensions and violence; (3) prisoners switching their drug use; (4) health-related harms; (5) deterrence of visitors; and (6) staff involvement in the in-prison drug trade. Conclusions/Importance: Urgently needed are rigorous evaluations of in-prison drug enforcement, along with closer scrutiny of policy recommendations that uphold the goal of drug-free prisons. Studying similar prison systems as complex risk-managing organizations may offer new information about drug enforcement policy and practice resistance despite detrimental effects.
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