e-Delphi Study: Expert Consensus on the Needs and Resources Available to Family Caregivers of Individuals with Substance Use Disorder.

Family caregivers of individuals with substance use disorder (SUD) experience a significant burden and have few evidence-based resources available.To obtain a consensus of expert views on the needs, and resources available, to family caregivers of individuals with SUD given the COVID-19 pandemic and other sociopolitical factors.Quantitative design using the Classic e-Delphi method of multiple iterations of questioning to reach a consensus among expert panelists. Purposive sampling was used to recruit a multidisciplinary, nationwide panel of SUD experts from professional contacts, professional organization list servers, websites relevant to support groups for family caregivers, flyers, and word of mouth. In round 1 panelists (n = 96) responded to open-ended questions about the support provided to family caregivers, and the additional needs of family caregivers. In subsequent rounds, the panel rated collated responses in terms of agreement (n = 54) and importance (n = 48).Thematic content analysis identified ten needs in the resources available to family caregivers. Consensus was obtained across thematic categories and the remaining items were ranked according to importance.Participatory-based SUD research that includes the expertise of healthcare providers, support leaders, and family caregivers is necessary to develop evidence-based interventions to increase caregiver resilience and facilitate coping. Several clear conclusions that address social and structural determinants of health emerged, including the need for increased access to healthcare and community services, more self-care strategies for families, and focused public advocacy to reduce SUD-related stigma.

Launching an innovative educational model addressing substance use disorders and dental pain management (Project ECHO® in dentistry).

BACKGROUND: Uninformed opioid prescribing by dentists has contributed to the current opioid crisis. This report describes the development and implementation of an innovative, interactive, multidisciplinary, and participant-centric telementoring program "Pain Management and Substance Use Disorders Dental ECHO (Extension for Community Health Care Outcomes)". We disseminated information to dentists about appropriate opioid prescribing practices and engaged them with a focus on pain management and substance use disorders. The objective of this study was to assess the effectiveness of this program for self-reported: (1) change in knowledge and confidence related to clinical skills for dental pain management of patients with substance use disorders; (2) change in clinical behavior of dentists for safe opioids prescribing; and (3) change in clinic policies regarding safe opioids prescribing. METHODS: An interdisciplinary panel of experts in medicine, pharmacy, social work, and dentistry designed and led the "Pain Management and Substance Use Disorders Dental ECHO" for invited dental care providers and dental students. Six cohorts each consisting of six, 1-h-long sessions were conducted via the Zoom videoconference platform in years 2020 and 2021. Each session included a didactic expert presentation, a participant-presented patient case and discussion. Each participant completed pre- and post-program surveys to assess the program's influence on participant knowledge, clinical confidence and behavior change. RESULTS: The participants (N = 151) were dentists (n = 109), dental faculty (n = 15), dental residents (n = 6), dental hygienists/assistants (n = 13) and nurses and clinic administrators (n = 8). Self-reported perceived medication knowledge, confidence in identification, treatment and willingness to engage with substance use disorders patients, and reported compliance with Prescription Drug Monitoring Program (PDMP) checks increased significantly from before to after the sessions (p < 0.001). Overall, participants expressed high levels of satisfaction with the content and reported that the sessions provided high benefit. CONCLUSION: The Project ECHO model is effective in rapidly disseminating evidence-based information. Dentists viewed this model as having a high degree of benefit for the optimal management of dental pain and the recognition and treatment of substance use disorders.

A qualitative examination of substance use service needs among people who use drugs (PWUD) with treatment and service experience in Ontario, Canada.

BACKGROUND: People who use drugs (PWUD) often have complex health and social support needs related to substance use, yet face numerous barriers to service access, resulting in unmet treatment needs and a corresponding gap in treatment. While initiatives to scale up substance use services for PWUD in Canada - and Ontario - have been undertaken, these have excluded PWUD' perspectives, and their needs have largely been defined by other actors. As end-users of services, PWUD' perspectives are vital to understanding what services are required, and whether existent services are adequate, appropriate and effective. Thus, the present study aimed to elicit in-depth knowledge from PWUD with lived experience of accessing services to better understand their unmet treatment and service needs, towards closing the service and treatment gap in Ontario. METHODS: This qualitative study included one-on-one interviews conducted with a cohort of n = 45 adult PWUD with substance use and treatment experience in Ontario, Canada. Participants were recruited from substance use services based on ConnexOntario's directory of all provincial addiction services, as well as by word-of-mouth. Questions focused on participants' experiences and perspectives on substance use services towards understanding their service needs. Data underwent an inductive thematic analysis based on key themes that emerged. RESULTS: Participants commonly engaged in polysubstance use, and identified a number of unmet substance use service needs including complex factors within the current service system that influenced access to available programs. Specifically, participants suggested the need to address stigmatization and system fragmentation, increase service provision and capacity, and scale up specific services and related supports such as harm reduction, counseling, treatment, and housing. CONCLUSIONS: This study identified PWUD' needs in relation to substance use service provision in Ontario, Canada, and highlighted important areas for policy change and program planning and implementation. Concrete recommendations include the development of a government-funded, low-barrier, comprehensive and integrated service delivery and referral models that include PWUD as collaborators and program facilitators to ensure that services are as accessible, effective, and cohesive as possible. Results from this study can be used to enhance provincial substance use treatment and service provision.

Dental Care Utilization of Hospitalized Persons Living with HIV and Substance Use.

People living with HIV (PLWH) who use drugs experience worse health outcomes than their non-using counterparts. Little is known about how often they seek dental care and the factors that influence their utilization. PLWH with substance use disorders who were inpatients at 11 urban hospitals (n = 801) participated in a National Institute on Drug Abuse Clinical Trials Network study to improve engagement in HIV outcomes. Dental care utilization at each time point during the study period (baseline, 6 months and/or 12 months) was assessed (n = 657). Univariate analysis and logistic regression were used to examine factors associated with dental care utilization. Over half (59.4%) reported not having received any dental care at any timepoint. Participants with less than high school education had lower odds of reporting dental care utilization than those with more than education (aOR = 0.60 [95% CI 0.37-0.99], p = 0.0382). Participants without health insurance also had lower odds of reporting dental care utilization than those with insurance (aOR = 0.50 [95% CI 0.331-0.76], p = 0.0012). Higher food insecurity was associated with having recent dental care utilization (OR = 1.03 [95% CI 1.00, 1.05], p = 0.0359). Additionally, those from Southern states were less likely to report dental care utilization (aOR = 0.55 [95% CI 0.38, 0.79], p = 0.0013). Having health insurance and education are key factors associated with use of dental care for PLWH with substance use disorders. The association between food insecurity and dental care utilization among this population suggests the need for further exploration.

Psychiatric and Other Medical Manifestations of Nitrous Oxide Abuse: Implications From Case Series.

BACKGROUND: Nitrous oxide (N2O), a commonly used anesthetic agent in dentistry, has emerged as a global public health threat in young population. Although N2O-related neurological sequelae such as spinal cord degeneration and sensorimotor peripheral neuropathy are well known, psychiatric manifestations of heavy N2O use remain unclear. Here, we presented 7 treatment-seeking patients with severe N2O use disorder to delineate the psychiatric profiles of N2O users in Asia. METHODS: Seven patients with severe N2O use disorder who sought treatment in Taipei City Psychiatric Center between 2017 and 2018 were enrolled. We used chart review method to retrospectively collect their clinical information including sociodemographics, psychiatric and substance history, urine toxicology findings, and treatment course. RESULTS: These N2O users all had diagnoses of severe N2O use disorder. They usually initiated N2O use in late adolescence and early adulthood. Six of them had histories of mood disorders; all of them reported other illicit substance use before using N2O. The main reasons for treatment seeking were irritability, psychotic symptoms, self-harm, or violent behaviors as four of them were given a diagnosis of substance-induced psychotic disorder. Urine drug screen showed negative for other illicit drug use except for 1 positive case for cannabis and 1 for amphetamine. Three of 7 cases were hospitalized because of the severity of their psychiatric symptoms and suicidal risk. CONCLUSIONS: These cases with severe N2O use disorder showed high prevalence of psychotic symptoms and dangerous behaviors such as suicide or violence. This study highlights the addiction potential of N2O and its related adverse consequences in the psychiatric aspect.

Substance Use and Co-occurring Physical Health Problems: File Review of a Residential Drug and Alcohol Treatment Service.

Objectives: Physical health conditions cause significant disability and mortality among people living with alcohol and other drug problems. There has been limited research on the prevalence of health problems among clinical samples of people with substance use disorders, particularly among those in residential treatment. Yet residential settings provide unique opportunity for responding to health needs. To better understand the health of people attending treatment for substance use disorders, this study conducted a file review to examine the prevalence of physical health problems as identified during routine residential care. Methods: A retrospective review of client files collected between 2013 and 2017 (N = 172) was completed at a residential treatment service in NSW, Australia. Data were extracted to examine the prevalence of physical health problems recorded at entry into treatment. Correlates of health problems were estimated using bivariate descriptive analyses and logistic regression. Results: The majority of clients in treatment for substance use had a comorbid physical health problem (80.7%). Musculoskeletal problems were the most frequently reported medical issue (38.6%). Odds for some physical health problems were related to client gender, age, and primary substance of concern. Male gender remained the strongest predictor of dental health problems when controlling for age and substance type (odds ratio [OR] = 3.60). Primary alcohol use remained the strongest predictor of nutritional deficiencies when controlling for client age (OR = 4.43). Among clients with a physical health problem and who had a treatment episode of at least 14 days (n = 110), just over half (55.5%) were referred to a health-related practitioner or service during their treatment episode. Conclusions: This study contributes to the literature by reporting on the incidence of physical health problems among people in residential treatment for substance use disorders. The high prevalence of physical health morbidity iterates the role of non-medical staff working within drug and alcohol services in the identification of client health needs. The findings support calls for systematic screening of physical health as part of routine care for substance use disorders improved integration of substance treatment and the broader primary health care system.

Results of a participatory needs assessment demonstrate an opportunity to involve people who use alcohol in drug user activism and harm reduction.

BACKGROUND: Drug users' organizations have made progress in recent years in advocating for the health and human rights of people who use illicit drugs but have historically not emphasized the needs of people who drink alcohol. METHODS: This paper reports on a qualitative participatory needs assessment with people who use illicit substances in British Columbia, Canada. We held workshops in 17 communities; these were facilitated by people who use illicit drugs, recorded with ethnographic fieldnotes, and analyzed using critical theory. RESULTS: Although the workshops were targeted to people who use illicit drugs, people who primarily consume alcohol also attended. An unexpected finding was the potential for drug users' organizations and other harm reduction programs to involve "illicit drinkers": people who drink non-beverage alcohol (e.g. mouthwash, rubbing alcohol) and those who drink beverage alcohol in criminalized ways (e.g., homeless drinkers). Potential points of alliance between these groups are common priorities (specifically, improving treatment by health professionals and the police, expanding housing options, and implementing harm reduction services), common values (reducing surveillance and improving accountability of services), and polysubstance use. CONCLUSIONS: Despite these potential points of alliance, there has historically been limited involvement of illicit drinkers in drug users' activism. Possible barriers to involvement of illicit drinkers in drug users' organizations include racism (as discourses around alcohol use are highly racialized), horizontal violence, the extreme marginalization of illicit drinkers, and knowledge gaps around harm reduction for alcohol. Understanding the commonalities between people who use drugs and people who use alcohol, as well as the potential barriers to alliance between them, may facilitate the greater involvement of illicit drinkers in drug users' organizations and harm reduction services.

Improving medicaid health incentives programs: lessons from substance abuse treatment research.

This commentary addresses the efforts of Medicaid programs in several US states to employ financial incentives to increase healthy behavior among their beneficiaries. While these Medicaid incentive programs have been successful at boosting rates of less effortful behaviors, like semiannual dental visits, they have fallen short in promoting more complex behaviors, like smoking cessation, drug abstinence, and weight management. Incentives have been extensively studied as a treatment for substance use disorders for over 20years, with good success. We identify two variables shown by meta-analysis to moderate the efficacy of incentive interventions in substance abuse treatment, the immediacy of incentive delivery and size (or magnitude) of the incentive, that are lacking in current Medicaid incentive program. We also offer some guidance on how these moderating variables could be addressed within Medicaid programs. This is a critical time for such analysis, as more than 10 states are employing incentives in their Medicaid programs, and some are currently reevaluating their incentive strategies.

The games: what can the sports medicine community learn from raves?

Electronic dance music festivals, also known as raves, are increasing in popularity. Despite the occasional tragedy in the lay press regarding medical incidents at raves, such events are relatively safe when compared to other mass gatherings. While the medical usage rates are lower than rock concerts and marathons, there are many similarities to both types of events with regard to the types of injuries and medical complaints. This article may assist in planning medical support for raves in the future.

Providing better access to oral health care for people receiving substance use treatment: A timely discussion.

Substance use disorders are a risk factor for poor oral health which in turn impacts quality of life. Resultant oral problems contribute to chronic illness, premature mortality, social stigma, embarrassment and reduced opportunities for employment and social interaction. Providing dental services to people with substance use disorders is often difficult due to high rates of oral disease, anxiety, behavioural and drug use changes, and lifestyle factors. Previous studies have demonstrated that alcohol and other drug service clients find accessing and navigating oral health services complex and suggest a multidisciplinary care approach to improve outcomes. In this commentary, we describe individual and structural barriers that limit the use of oral health care among people with substance use disorders, alcohol and other drug clinicians' challenges to integrating oral health into their practice and identify key issues for oral health services in delivering care. We draw on our experience to recommend a multidisciplinary approach be used to develop strategies in order to increase access to oral health services at a standard similar to the general population for clients of alcohol and other drug services.

Screening, brief intervention, and referral to treatment in oral health settings: A scoping review.

OBJECTIVES: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective evidence-based model to provide early intervention and treatment to people with substance use disorders across diverse health settings. Yet, how SBIRT has been implemented within oral health settings and its associated outcomes has not been explored. This scoping review assessed how SBIRT has been implemented in oral health settings in the U.S. and discusses the implications for SBIRT integration in dentistry and oral health research, education and practice. METHODS: Five scholarly databases were searched using a scoping review methodology for relevant literature, yielding seven articles that met inclusion criteria. RESULTS: Findings from seven U.S. studies show that SBIRT has been implemented into oral health settings in three distinct ways: through education/training, as an intervention and in one national survey. Findings of this scoping review support the inclusion of SBIRT education for oral health professionals in both practice and clinical environments and offer examples of existing models for future implementation and study. CONCLUSIONS: The scant literature on SBIRT intervention effects in dental settings-both within and outside of the U.S.-underscores the need for more empirical work to better understand how SBIRT impacts dental providers' knowledge, practices, referrals and ultimately, patient outcomes.

Sexualized substance use among gbMSM: Their perspectives on their intervention needs and counsellor competencies.

INTRODUCTION: Treatments for problematic substance use by gay, bisexual and other men who have sex with men (gbMSM) in sexualized contexts must be adapted to take sociocultural aspects of these sexual practices into account. When treatment programs factor in sexuality, they most commonly address it from a biological perspective (STTBIs, HIV). This article sets out to identify intervention needs related to sexualized substance use (SSU) from the perspective of gbMSM, taking into consideration different dimensions of sexuality to offer more effective support. METHODS: Twenty adult gbMSM, each of whom had previously participated in addiction-related treatment programs, took part in this study. We recruited through medical clinics, community organizations, social media advertising and word of mouth. Through one-on-one semi-structured interviews, participants shared their perspectives on the treatment they had received, how their sexuality had been addressed during treatment, and their perceptions of their treatment-related needs and requirements. The study analyzed and interpreted the data gathered during these interviews using a conceptual framework of sexual health combined with The Competencies, a model for addiction counselling training. RESULTS: When the study asked participants what they would consider beneficial in terms of SSU-related treatment, they identified certain key competencies. These can be broken down into three categories - knowledge, skills and attitudes - that, together, participants perceived as critical to the development of adequate programs and services. While participants reported addiction-related knowledge was important, so too was an understanding of sexuality (e.g., sexual practices, gbMSM communities, sociocultural norms). With regard to attitudes, the study identified respect, non-judgment, acceptance and empathy as themes for most participants. Lastly, the desired skills were those permitting counsellors and other treatment providers to better align programs and services with each individual's singular reality within the context of their substance use. CONCLUSIONS: The results of this study suggest that, to provide treatment programs adapted to the needs of gbMSM in a context of SSU, knowledge must be consolidated and new skills developed. Furthermore, both knowledge and skills need to be placed within an overarching perspective of cultural humility. Overall, improving these various competencies should improve the continuum of care in addiction treatment.

Service priorities and unmet service needs among people living with HIV/AIDS: results from a nationwide interview of HIV/AIDS housing organizations.

Housing for people living with HIV/AIDS (PLWHA) has been linked to a number of positive physical and mental health outcomes, in addition to decreased sexual and drug-related risk behavior. The current study identified service priorities for PLWHA, services provided by HIV/AIDS housing agencies, and unmet service needs for PLWHA through a nationwide telephone survey of HIV/AIDS housing agencies in the USA. Housing, alcohol/drug treatment, and mental health services were identified as the three highest priorities for PLWHA and assistance finding employment, dental care, vocational assistance, and mental health services were the top needs not being met. Differences by geographical region were also examined. Findings indicate that while housing affords PLWHA access to services, there are still areas (e.g., mental health services) where gaps in linkages to care exist.

Treatment of chronic hepatitis C infection among current and former injection drug users within a multidisciplinary treatment model at a community health centre.

The aim of the present prospective observational study was to assess uptake and success of hepatitis C virus (HCV) treatment among a group of former and current injection drug users with chronic HCV infection at the Street Health Centre in Kingston, Ontario. The Street Health Centre offers hepatitis C education, assessment and treatment within a multidisciplinary, integrated and collaborative treatment model of care delivered by primary care professionals. The study enrolled a convenience sample of 34 patients. Seventy per cent of study patients had no postsecondary education, 85% were unemployed and one-third were unstably housed. A majority of study patients self-reported mental health problems. Of the 14 patients who initiated antiviral treatment in the study period, eight (57%) achieved sustained virological response. Regardless of virological outcome, patients who initiated treatment showed positive trends toward increased social and psychiatric stability, and decreases in high-risk behaviours. These results suggest that not only is successful treatment of chronic HCV infection in current and former injection drug users with concurrent psychiatric disorders possible, but the benefits of such treatment delivered in a community-based, multidisciplinary, primary care model may extend beyond narrowly defined virological outcomes.

Doctors and dentists with mental ill health and addictions: outcomes of treatment from the Practitioner Health Programme.

BACKGROUND: The Practitioner Health Programme (PHP) was developed to provide expert assessment and support to practitioners (doctors and dentists) with mental and physical health problems affecting their ability to work. AIMS: This paper examines the treatment outcomes of the practitioner-patients utilising PHP. METHOD: We assessed outcomes on consecutive patients using the PHP. The Clinical Outcomes in Routine Evaluation Outcome Measure and the Work and Social Adjustment Scale were completed at initial assessment, 8- and 26-week follow-up. We also report the percentages of practitioner-patients off work at each interval, and examine global improvement and satisfaction scores for both follow-up intervals. RESULTS: Two hundred practitioner-patients entered PHP due to a mental health or substance abuse problem and subsequently completed questionnaires at baseline; 102 patients returned questionnaires after 8 weeks and 95 returned questionnaires after 26 weeks. Results suggested that patients reported less distress and less impairment of functioning at 8 and 26 weeks. Scores for satisfaction and global improvement were consistently high. CONCLUSIONS: The PHP is providing a valuable service to practitioner-patients, significantly helping to decrease levels of distress and improve work and social functioning.

Promoting research engagement among women with addiction: Impact of recovery peer support in a pilot randomized mixed-methods study.

OBJECTIVE: The impact of involving peers on research engagement is largely unknown. The purpose of this pilot study, a part of a larger research, was to evaluate the impact of recovery peer involvement as a study team member on recruitment/retention of persons with lived experience of SUD during pregnancy and to assess participant perceptions about factors impacting engagement of this population and their children in research, especially brain magnetic resonance imaging (MRI). METHODS: This study randomly assigned participants (1:1) to either Peer or Research Coordinator (RC) arms. Eligible participants were English-speaking adult, non-pregnant females with lived experience of substance use during pregnancy. Certified Peers were recruited word of mouth and completed study-specific training. The impact of trained, certified Peer versus RC on research engagement was assessed by between-arm comparison of retention rates. Quantitative and qualitative survey data on participant perceptions were summarized. RESULTS: Thirty-eight individuals enrolled into the study (19 Peer, 19 RC). Peer versus RC had 7.2 times greater odds of completing Visit 2 (Fisher's exact test; 95%CI: 1.2, 81.8; p = 0.03). The majority (70.4%) of respondents identified being accompanied by a peer and getting a tour of the MRI facility/procedures as 'extremely' helpful for improving participant comfort and engagement in future studies. Motivators of future research engagement also included creating a trusting, supportive, non-judgmental research environment, and linkages to treatment and other services. CONCLUSION: Findings support the notion that peers involved as research team members could boost research engagement among persons with substance use during pregnancy.

[Current data on methamphetamine]. / Données actuelles sur la méthamphétamine.

Methamphetamine is an illicit drug used in North America, Asia, and East European countries. Methamphetamine addiction is a serious public health problem in those countries. it is a very powerful psychostimulant drug. It is derived from amphetamine and illegally manufactured from ephedrine. Cause of abuse and dependence it causes significant somatic, psychiatric and cognitive complications. Because of its vasoconstrictor properties, methamphetamine is the cause of cardiovascular diseases but also pulmonary, neurological, dental diseases... Its neurotoxicity is responsible for significant cognitive impairment. It also causes acute psychotic disorders, depressive disorders and suicidal behavior. Treatment of somatic or psychiatric complications should be integrated within a global addiction treatment. To date, no pharmacological therapeutic is specific. However, recent studies with naltrexone, modafinil and bupropion show promising leads. More, dopamine agonist drugs (dextroamphetamine, methylphenidate) are proposed as possible replacement medications. Despite those pharmacological treatments, psychotherapy has to be associated to offer a combined approach with pharmacological treatments.

Life- and career-saving information for families, colleagues and staffs of dentists.

This article addresses the dilemma faced by those concerned for the health of a practitioner due to abuse of alcohol and drugs, but fearful and unaware of the enlightened and supportive role the Florida Department of Health (DOH) and the Board of Dentistry (BOD) play in rehabilitating the addicted dentist and dental hygienist. The BOD was recommended to receive the American Dental Association's Golden Apple Award' for their intelligent and humane support of chemically-dependent dental personnel.

Perceived health needs and receipt of services during pregnancy - Oklahoma and South Carolina, 2004-2007.

Prenatal care visits present an opportunity for health-care providers to offer services recommended by professional societies and educate women regarding behaviors and exposures that might affect their pregnancies. To determine whether women who identified a need for a service during pregnancy received that service, CDC analyzed 2004-2007 data (the most recent available) from the Pregnancy Risk Assessment Monitoring System (PRAMS) for Oklahoma and South Carolina, the only two states to include questions on the topic on their PRAMS questionnaires. This report summarizes the results of that analysis, which indicated substantial differences between perceived need and receipt of 1) assistance in reducing violence in the home, 2) counseling information for family or personal problems, 3) help to quit smoking, 4) help with an alcohol or drug problem, and 5) dental care. In South Carolina and Oklahoma, respectively, 1.7% and 2.9% of pregnant women stated a need for help to reduce violence in the home. Of those, only 12.8% and 21.0% reported receiving that help. In South Carolina and Oklahoma, respectively, 7.4% and 12.6% of pregnant women stated a need for help to quit smoking during pregnancy; of those, only 29.1% and 30.4% reported receiving that help. Adherence by health-care providers to established guidance for treating pregnant women might help reduce the differences between perceived need and receipt of services. Additional research to identify obstacles to receipt of services might enable state programs to further narrow these differences.