The proposed project establishes a provincial community of practice (CoP) in substance use, employment, and economic engagement that will advance the expansion of supported employment programming in British Columbia (BC). Despite evidence of work and employment as critical social determinants of health, existing programming that addresses equitable engagement for multiply barriered populations such as people with lived and living experience of substance use (PWLLES), has been fragmented and limited in scale and scope. The proposed initiative will bring together key informants from existing employment and economic engagement programs, PWLLES, Indigenous advisors, and subject matter experts from across BC to facilitate knowledge sharing, project development, and collaboration. Through the development of a core working group and sub-groups, this initiative: (1) facilitates capacity for best practices in knowledge generation, mobilization, and implementation of low-barrier employment programming for PWLLES; (2) expands a health and economic monitoring system that supports sustainable low-barrier employment programming; and (3) develops the capacity for a CoP to advocate for policy environments supportive of socio-economic integration.
Research Location: BC Centre on Substance Use
Evidence as a community ASSET – Establishing a circular data model to support integrated knowledge exchange in the Assessing Economic Transitions (ASSET) Study
The proposed project will expand and evaluate a circular data model that supports health and social service providers to directly access and use data from the Assessing Economic Transitions Study (ASSETS). ASSETS is a mixed-methods evaluation of the impacts of low-threshold economic opportunities for the health and economic well-being of People with Lived and Living Experience of Substance Use (PWLLES) in Vancouver’s Downtown Eastside (DTES) neighbourhood. Since 2019, ASSETS has featured multi-stakeholder engagement and an Integrated Knowledge Translation and Exchange (iKTE) platform. The proposed project seeks to expand this iKTE platform through a circular data model featuring: (1) the scale up of the study data dashboard and data literacy educational modules; (2) development of a web-based resource repository; and (3) evaluation of the effectiveness of this circular data model. Consultations with health and social service providers will refine the data dashboard, educational modules, and website. Partner feedback will support a process evaluation that produces evidence of progress on organizational outcomes. This project builds community capacity for using research data to directly inform health and social service provision.
Exploring the shifting landscape of medication-based drug treatment and safer supply in the fentanyl era: a research program to address the evolving overdose crisis in BC
Canada continues to grapple with an overdose crisis driven by illicitly manufactured fentanyl and novel psychoactive substances (e.g., etizolam, xylazine). The drug treatment landscape is rapidly evolving in response, and includes the implementation and expansion of a number of medication-based drug treatments (e.g., oral and injectable hydromorphone) and prescribed safer supply programs (SSP) that provide pharmaceutical alternatives to the toxic drug supply. However, socio-structural factors have impeded broader expansion and support, and SSP remain controversial with many healthcare providers expressing concern. This ethno-epidemiological research program will gather the views of people who use drugs, policymakers, and health system actors across BC to explore how individual, social, structural and environmental factors shape access to and outcomes from existing and emerging medication-based drug treatment programs and SSP. This is a critical opportunity examine the rapidly shifting drug treatment and overdose response landscape to better inform public health approaches to the ongoing overdose crisis. Knowledge gained will inform and guide future policy and public health developments to improve the lives of people who use drugs.
Evaluating treatment and employment outcomes in adults with prescription opioid use disorder initiating methadone maintenance or buprenorphine/naloxone opioid agonist therapies in a pan-Canadian pragmatic randomized clinical trial
Since 2016, Canada has been facing a national opioid overdose crisis that continues to have devastating effects on people who use opioids, their families, and communities across the country. Opioid agonist therapies (OATs), such as methadone and buprenorphine/naloxone, are considered first-line treatment options for people with opioid use disorder (OUD) and have shown to reduce overdoses, cravings, and withdrawal symptoms. As a response to the ongoing opioid crisis, researchers with the Canadian Research Initiative on Substance Misuse (CRISM) launched OPTIMA, a 24-week pan-Canadian clinical trial that compared the effectiveness of methadone and buprenorphine-naloxone models among adults with OUD. The OPTIMA trial was conducted between 2017 and 2020 across four provinces in Canada, including British Columbia, where Dr. M Eugenia Socías led as the regional principal investigator. To learn more about the OPTIMA trial, visit here: https://www.optima-trial.com/.
One factor, employment, has shown to have many positive associations for people with OUD, but also present challenges for people on OATs. For instance, methadone typically requires daily attendance at a dispensing pharmacy, which can be a barrier to acquire or sustain employment. On the other hand, buprenorphine-naloxone has a more flexible take-home dosing option, which may improve patient autonomy. However, there is limited research on the differences between different treatment methods. My project aims to evaluate the bidirectional effects of employment and OATs on treatment outcomes among people with OUD, using the data from the OPTIMA trial. This research has been recognized and funded by CANTRAIN-CTTP & Michael Smith Health Research BC (Health Research BC) Master’s Studentship 2023 Award Program. The proposed research aims to further the equitable expansion of evidence-based policies and practices in BC, hopefully contributing to the improvement of addiction care and harm reduction for people who use opioids.
End of Award Update – January 2025
Results
Preliminary analysis revealed that part- or full-time employment is a strong positive factor linked to better treatment retention for individuals starting opioid agonist therapy (OAT) for opioid use disorder. Additionally, we discovered differences in treatment outcomes between methadone and buprenorphine/naloxone, depending on whether individuals were employed or not. These findings provide valuable insights into how employment status influences treatment success.
Impact & Potential Influence
As this project is ongoing, we hope to engage with key stakeholders, including community organizations, clinicians, and people with lived or living experience, to ensure the findings inform evidence-based practices. By highlighting the connection between employment and treatment outcomes, this research has the potential to advocate for policies that improve addiction care and harm reduction strategies in British Columbia, with broader implications throughout Canada.
Next Steps
Our next steps include sharing these findings on the relationship between employment and opioid use disorder through conference presentations, plain language summaries, and informational pamphlets targeted at researchers, clinicians, and people with lived or living experience. We also plan to collaborate with stakeholders to develop strategies for knowledge mobilization and advocate for policies and practices that improve both employment and treatment outcomes for people who use opioids.
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.
Housing, homelessness, and care trajectories among young people who use drugs in Vancouver
The proposed study will employ longitudinal qualitative and ethnographic methods to examine how urban young people who use drugs (YPWUD) navigate experiences of housing and homelessness across time. Cities like Vancouver are creating more comprehensive and integrated systems of services for YPWUD, including programs that aim to simultaneously address their housing and care needs (e.g. supportive housing with on-site access to harm reduction, opioid agonist therapies). Innovative social science research is needed to describe how particular supportive and temporary modular housing models can both ameliorate and exacerbate health and social harms among YPWUD, including overdose. The proposed anthropological and community-based participatory action research study will generate new knowledge to support the development, adaptation and scale up of targeted housing and substance use care interventions for YPWUD. Working together with a Youth Advisory Council comprised of YPWUD and youth co-researchers, study findings will be disseminated via youth-driven outputs aimed at a broad public; presentations and community reports for youth, their providers and key decision makers; and press releases, media interviews, and social media engagement.
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.
Investigating the impact of evolving cannabis access and use on high-risk drug use behaviours and addiction treatment
Cannabis remains the most widely produced, trafficked and consumed illicit drug worldwide, and at this time Canada and many other countries are implementing alternative regulatory approaches to cannabis. While research on cannabis has traditionally focused on the harms of cannabis use, an emerging body of evidence suggests that cannabis use can also alter high-risk drug practices, such as reducing cocaine use, opioid use and associated overdose. Much of this work suggests that cannabis is often used as a substitute for harder drugs of abuse which may have important implications for health policy responses to the current opioid epidemic in British Columbia.
However, this evidence has been primarily cross-sectional and ecological in nature, and lacking are rigorous longitudinal studies unpacking the precise impacts of cannabis use and evolving cannabis policy on the development of high-risk drug use behaviours. Further, the impacts of cannabis use on HIV and addiction treatment outcomes remains unclear. In light of the recent legalization of non-medical cannabis, identifying the impacts of cannabis on high-risk substance use and drug treatment outcomes will be important for informing clinical and public health practice, as well as policy.
Prevalence, patterns, and harms associated with the co-injection of illicit opioids and crystal methamphetamine
Crystal methamphetamine use is associated with a wide array of physical and social harms. In spite of this, its prevalence is rising in many parts of North America. Several small studies have suggested increasing rates of co-injection of methamphetamine and opioids, though no research has focused on the specific harms associated with this trend. In Vancouver, preliminary reports have noted a similar pattern, in a context where fentanyl has become the most widely used form of illicit opioid.
In this study we propose to use a prospective cohort of people who inject drugs to ask how trends in the co-injection of methamphetamine and opioids are changing over time, and to explore the health consequences associated with this pattern of substance use as it relates to overdose risk and response to treatment.
Answering these questions will provide insight into important changes in the evolving epidemiology of substance use, and will provide information on potential implications. An appreciation of these changing patterns is not only crucial in developing evidence-based harm reduction and treatment strategies, but also in understanding how to devote treatment resources appropriately in the fight to reduce opioid-related deaths.
Improving substance use care for gay, lesbian and bisexual youth in British Columbia
Gay, lesbian, and bisexual youth (GLBY) are at increased risk of experiencing substance use disorders (SUD) in comparison to their heterosexual counterparts. The aim of Dr. Ferlatte’s research is to identify the factors associated with SUD experienced by GLBY to inform interventions.
This will include:
- Examining individual, social and structural factors that influence SUD among GLBY through photovoice methods.
- Identifying challenges experienced by GLBY in accessing SUD-related care by gathering experiences through an online survey.
- Identifying how a coordinated set of interventions and policies could best be adapted to address SUD among GLBY through two world cafés, where GLBY and other stakeholders (e.g., intervention decision makers) will be invited to identify solutions to this issue.
The findings of this research will be shared through presentations, articles, and photovoice exhibitions to inform policy and programming decision-making that improves SUD care for GLBY.