Impact de la consommation de cannabis chez les utilisateurs de drogues intraveineuses

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Cannabis use correlates of syringe sharing among injection drug users

Ce manuscrit est une pré-publication d'un article paru dans The American Journal on Addictions 2010; 19(3): 231-237 url: http://onlinelibrary.wiley.com/doi/10.1111/ajad.2010.19.issue-3/issuetocIRSC et FRSQ - Réseau SIDA et maladies infectieuse

The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users

Ce manuscrit est une pré-publication d'un article paru dans Addiction 2012; 107(7): 1318-1327 url: http://www.addictionjournal.org/IRSC et FRSQ - Réseau SIDA et maladies infectieuse

Improving the self-efficacy, knowledge, and attitude of nurses regarding concurrent disorder care : results from a prospective cohort study of an interprofessional, videoconference-based programme using the ECHO model

Several challenges have been identified for patients with concurrent disorders to access adequate services and for nurses to care for them. These challenges contribute to a pressing need for continuing educational interventions, particularly within the mental health nursing workforce. To address this issue, an innovative interprofessional videoconferencing programme based on the ECHO model (Extension for Community Healthcare Outcomes) was implemented in Quebec, Canada to support and build capacity among healthcare professionals for CD management. The aim of this prospective cohort study was to examine nurses’ self-efficacy, knowledge, and attitude scores over a 12-month period. All nurses who registered in the programme between 2018 and 2020 were invited to participate in the study (N = 65). The data were collected online using a self-administered survey at baseline, after 6 months, and then 12 months following entry-to-programme. Twenty-eight nurses participated in the study (96.4% women), with a mean age of 39.1 (SD = 6.2). Compared to other professions (n = 146/174), the group of nurses also showed significant improvements in their knowledge and attitude scores, with respective effect sizes of 0.72 and 0.44 at 6 months, and 0.94 and 0.59 at 12 months. However, significant changes in self-efficacy were only found at the 12-month follow-up (P = 0.0213), among the nurses who attended more than 25% of the 20-session curriculum. ECHO is a promising intervention to improve the accessibility of evidence-based practice and to support nurses in suitably managing concurrent disorders. Further research is needed to establish the effectiveness of this educational intervention on clinical nursing practice and patient outcomes

Associations of substance use patterns with attempted suicide among persons who inject drugs: Can distinct use patterns play a role?

Background: While the elevated risk of suicide attempt among persons who inject drugs (PWID) is well documented, whether use of different substances is associated with varying degrees of risk remains unclear. We sought to examine the associations between substance use patterns and attempted suicide in a prospective cohort of PWID in Montreal, Canada. Methods: Between 2004 and 2011, participants completed an interviewer-administered questionnaire eliciting information on socio-demographic, substance use patterns, related behaviors, and mental health markers. Generalized estimating equations were used to model the relationship between self-reported use of six common substances (cocaine, amphetamine, opioids, sedative-hypnotics, cannabis and alcohol), associated patterns of use (chronic, occasional and none), and a recent (past six-month) suicide attempt. Results: At baseline, of 1,240 participants (median age: 39.1, 83.7% male), 71 (5.7%) reported a recent suicide attempt. Among 5,621 observations collected during follow-up, 221 attempts were reported by 143 (11.5%) participants. In multivariate analyses adjusting for socio-demographic and psychosocial stressors, among primary drugs of abuse, chronic [Adjusted Odds Ratio (AOR): 1.97] and occasional (AOR: 1.92) cocaine use, and chronic amphetamine use (AOR: 1.96) were independently associated with attempted suicide. Among co-used substances, chronic sedative-hypnotic use was independently associated with an attempt (AOR: 2.29). No statistically significant association was found for the remaining substances. Conclusion: Among PWID at high risk of attempted suicide, stimulant users appear to constitute a particularly vulnerable sub-group. While the mechanisms underlying these associations remain to be elucidated, findings suggest that stimulant-using PWID should constitute a prime focus of suicide prevention efforts

Portraying persons who inject drugs recently infected with hepatitis C accessing antiviral treatment : a cluster analysis

Objectives. To empirically determine a categorization of people who inject drug (PWIDs) recently infected with hepatitis C virus (HCV), in order to identify profiles most likely associated with early HCV treatment uptake. Methods.The study population was composed of HIV-negative PWIDs with a documented recent HCV infection. Eligibility criteria included being 18 years old or over, and having injected drugs in the previous 6 months preceding the estimated date of HCV exposure. Participant classification was carried out using a TwoStep cluster analysis. Results. FromSeptember 2007 to December 2011, 76 participants were included in the study. 60 participants were eligible for HCV treatment. Twenty-one participants initiated HCV treatment.The cluster analysis yielded 4 classes: class 1: Lukewarm health seekers dismissing HCV treatment offer; class 2: multisubstance users willing to shake off the hell; class 3: PWIDs unlinked to health service use; class 4: health seeker PWIDs willing to reverse the fate. Conclusion. Profiles generated by our analysis suggest that prior health care utilization, a key element for treatment uptake, differs between older and younger PWIDs. Such profiles could inform the development of targeted strategies to improve health outcomes and reduce HCV infection among PWIDs

Discrete time measures versus trajectories of drinking frequency across adolescence as predictors of binge drinking in young adulthood: a longitudinal investigation

OBJECTIVES: We compared discrete time measures with trajectories of adolescent drinking frequency as predictors of sustained binge drinking in young adulthood. DESIGN: Prospective longitudinal study. SETTING: 10 high schools in Montreal, Canada. PARTICIPANTS: 1293 high-school students followed from mean (SD) age 12 (0.6) to 24 (0.7) years. PRIMARY OUTCOME MEASURES: Patterns of drinking frequency (self-reports every 3 months from ages 12 to 17) identified using group-based trajectory modelling. Sustained binge drinking was defined as binging monthly or more often at both ages 20 and 24. ANALYSES: Using logistic regression, sustained binge drinking was regressed on trajectory group membership and on four discrete time measures (frequency of drinking at age 12; frequency of drinking at age 17; age at drinking onset; age at onset of drinking monthly or more often). RESULTS: We identified seven drinking trajectories: late triers (15.2%), decreasers (9.5%), late escalators (10.4%), early slow escalators (16.5%), steady drinkers (14.4%), early rapid escalators (15.8%) and early frequent drinkers (18.2%). Sustained binge drinking was reported by 260 of 787 participants (33.0%) with complete data at both ages 20 and 24. Decreasers did not differ from late triers; all other patterns were associated with higher odds of sustained binge drinking (adjusted ORs: AORs=1.4-17.0). All discrete time measures were associated with sustained binge drinking, notably frequency at age 12 (a bit to try and drinking monthly: (AORs=2.6 (1.7; 3.9) and 2.8 (1.3; 6.1), respectively), age of drinking onset \u3c 13 years (AOR=7.6 (3.0; 24.1)), and any age of onset of drinking monthly or more often (AORs=5.1-8.2). CONCLUSION: Youth at risk of sustained binge drinking as young adults can be identified with indicators of early drinking as early as 7th grade (aged 12-13 years). Identification of easy-to-obtain indicators can facilitate screening and intervention efforts

Cannabidiol as a treatment for craving and relapse in individuals with cocaine use disorder : a randomized placebo‐controlled trial

Background and Aims Cocaine use disorder (CUD) is a significant public health concern for which no efficacious pharmacological interventions are available. Cannabidiol (CBD) has attracted considerable interest as a promising treatment for addiction. This study tested CBD efficacy for reducing craving and preventing relapse in people with CUD. Design Single site double‐blind randomized controlled superiority trial comparing CBD with placebo. Setting Centre hospitalier de l'Université de Montréal, Canada. Participants Seventy‐eight adults (14 women) with moderate to severe CUD participated. Intervention Participants were randomly assigned (1:1) by stratified blocks to daily 800 mg CBD (n=40) or placebo (n=38). They first underwent an inpatient detoxification phase lasting 10 days. Those who completed this phase entered a 12‐week outpatient follow‐up. Measurements Primary outcomes were drug‐cue induced craving during detoxication and time‐to‐cocaine relapse during subsequent outpatient treatment. Findings During drug‐cue exposure, craving scores (mean ± SD) increased from baseline by 4.69 (2.89) versus 3.21 (2.78) points respectively in CBD (n=36) and placebo (n=28) participants (CI = ‐0.33 to 3.04; p = 0.069; Bayes factor = 0.498). All but three participants relapsed to cocaine by week 12 with similar risk for CBD (n=34) and placebo (n=27) participants (Hazard Ratio =1.20, CI=0.65 to 2.20, p=0.51; Bayes factor = 0.152). CBD treatment was well tolerated and associated mainly with diarrhea. Conclusions Cannabidiol did not reduce cocaine craving or relapse among people being treated for cocaine use disorder

Hepatitis C Virus seroconversion among persons who inject drugs in relation to primary care physician visiting: The potential role of primary healthcare in a combined approach to Hepatitis C prevention

Background: Meaningful reductions in Hepatitis C Virus (HCV) transmission rates among persons who inject drugs (PWID) require a comprehensive prevention approach, including access to harm reduction measures and to healthcare-related interventions, such as HCV screening, testing and antiviral treatment. Little is known, however, about the role of visiting a primary care physician (PCP) in relation to HCV infection risk among PWID, when integrated within a combined prevention approach. This study assessed the association between PCP visiting and HCV seroconversion among PWID attending needle exchange programs (NEP). Methods: A prospective cohort study, HEPCO, was conducted among active PWID in Montréal (2004-2013). Interviews scheduled at three- or six-month intervals included completion of an interviewer-administered questionnaire, and collection of blood samples for HCV antibody testing. HCV-seronegative participants who reported NEP attendance at baseline and had at least one follow-up visit were eligible for this study. HCV incidence was calculated using the person-time method. Time-varying Cox regression modeling was conducted to evaluate the relationship between self-reported recent PCP visiting and HCV incidence. Results: At baseline assessment, of 226 participants (80.5% male; median age: 30.6 years), 37.2% reported having recently visited a PCP. During 449.6 person-years of follow-up, 79 participants seroconverted to HCV [incidence rate: 17.6 per 100 person-years, 95% confidence interval (CI): 14.0-21.8]. Covariate-adjusted analyses indicated that visiting a PCP was associated with a lower risk of HCV infection [Adjusted Hazard Ratio: 0.54, 95% CI: 0.31-0.93]. Other independent predictors of HCV infection included unstable housing, cocaine injection and prescription opioid injection. Conclusion: Among PWID attending NEP, visiting a PCP was associated with a lower risk of HCV infection. Yet, only a minority of participants reported PCP visiting. Efforts to intensify engagement with PCP among PWID could potentially contribute to lower HCV transmission when integrated within a combined approach to prevention

Technology-based psychological interventions for young adults with early psychosis and cannabis use disorder : qualitative study of patient and clinician perspectives

Background: The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. Objective: The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention. Methods: A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. Results: Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians). Conclusions: This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis