The consequences of substance use have had a devastating impact on British Columbia’s (BC) healthcare system. Since the declaration of the province’s public health emergency in 2016, over 10,000 British Columbians have died from an overdose. The lack of a coordinated addiction treatment system provincially is a significant contributor to BC’s present state. To address this, Providence Health Care is implementing the Road to Recovery Initiative (R2RI), an innovate model of care to address two aspects of BC’s addiction treatment crisis through: 1) increasing access to on-demand addiction care; and 2) reorganizing existing clinical services to support patients at every phase of recovery. The proposed Program of Research seeks to evaluate key health and social outcomes associated with the implementation of R2RI. Participants of this program will be followed for 5 years with data collection focused on: substance use, illness trajectory, community engagement, health care utilization, health risk behaviours, quality of life, overdose, and death. Knowledge gained through this research will identify outcomes associated with the provision of a coordinated addiction treatment system and will inform successful scale-up of this new approach.
Award Partner: BC Centre on Substance Use
Evaluating the use of prescription psychostimulants for the treatment of methamphetamine use disorder
Crystal meth is a powerful stimulant that is increasingly implicated in the ongoing overdose crisis in BC. Despite steadily increasing rates of crystal meth detection in overdose deaths, little is understood about the specific role that it may be playing in the overdose crisis, and treatment options for those suffering from crystal meth use disorder (MUD) are limited.
One class of medications that has previously shown some promise in the treatment of MUD are prescription stimulants such as those used to treat ADHD. While research in this area remains inconclusive, there is some suggestion that these medications may play a helpful role in the treatment of MUD, especially among patients with an overlapping diagnosis of opioid use disorder.
This proposal will employ a variety of research methodologies to explore two related questions: (1) Can we identify patients who use crystal meth and opioids that are at particularly high risk of overdose, and (2) Are prescription stimulants a helpful tool in the treatment of MUD in a population of patients who use opioids? These results will have significant implications for both healthcare providers and those suffering from MUD, at a time where new tools are sorely needed.
Investigating women’s socio-structural risk environment of overdose
British Columbia, Canada, continues to grapple with an overdose epidemic. Substantial gaps remain in the implementation and scale up of overdose prevention strategies, including attention to gender equity. Little has been said regarding how marginalized women (trans inclusive) are impacted by the crisis, or how they might be differently navigating overdose risk environments or access to life-saving health services.
The ultimate goal is to generate new evidence to reduce overdose-related harms among women who use drugs and increase the responsiveness of existing and emerging overdose interventions to gender inequities. The objectives of this research program are to:
- Identify how women’s overdose risk is shaped by evolving individual, social, structural, and environmental factors;
- Investigate factors that create barriers to (or that facilitate) women’s engagement with existing, novel and emerging overdose prevention interventions; and
- Document perspectives, experiences, and impact of women who use drugs working in overdose-related interventions to inform how best to optimize their engagement in ongoing and future initiatives.
Opioid addiction research program to improve prescribing practices and reduce overdose
Canada is amid an opioid crisis, with six or seven deaths a day due to opioid overdose. Prescription opioid misuse can also transition to illicit opiate and intravenous drug use, substantially increasing the risk for overdose and blood-borne infections. Rates of overdose death due to counterfeit fentanyl have also risen and represent a growing crisis in most regions in Canada, with British Columbia (BC) being particularly hard hit. Half of the 800 anticipated overdose deaths for 2016 in BC are expected to involve fentanyl.
Dr. Fairbairn’s research will:
- Address the effectiveness of a randomized controlled trial to evaluate a designated opioid prescriber intervention using BC’s centralized prescription network to reduce inappropriate opioid dispensation and overdose risk.
- Inform overdose prevention strategies by characterizing the inter-relationships between medication prescribing patterns and patterns of illicit drug use.
- Evaluate the longitudinal impacts of new overdose prevention initiatives and addiction treatment guidelines on overdose outcomes.
This research directly responds to BC’s recent declaration of a public health emergency, Health Canada’s urgent call to develop strategies to tackle the overdose epidemic, and the global challenge of prescription opioid abuse by generating evidence for safer prescribing practices and informing and broadening the evidence base for the treatment of opioid addiction.