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Harms of Prescription Opioid Use in the United States

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2014
Abstract: 

Background

Consumption levels of prescription opioids (POs) have increased substantially worldwide, particularly the United States. An emerging perspective implicates increasing consumption levels of POs as the primary system level driving factor behind the observed PO-related harms. As such, the present study aimed to assess the correlations between consumption levels of POs and PO-related harms, including non-medical prescription opioid use (NMPOU), PO-related morbidity and PO-related mortality.

Findings

Pearson’s product-moment correlations were computed using published data from the United States (2001 – 2010). Consumption levels of POs were extracted from the technical reports published by the International Narcotics Control Board, while data for NMPOU was utilized from the National Survey on Drug Use and Health. Additionally, data for PO-related morbidity (substance abuse treatment admissions per 10,000 people) and PO-related mortality (PO overdose deaths per 100,000 people) were obtained from published studies. Consumption levels of POs were significantly correlated with prevalence of NMPOU in the past month (r =0.741, 95% CI =0.208–0.935), past year (r =0.638, 95% CI =0.014–0.904) and lifetime (r =0.753, 95% CI =0.235-0.938), as well as average number of days per person per year of NMPOU among the general population (r =0.900, 95% CI =0.625-0.976) and NMPOU users (r =0.720, 95% CI =0.165–0.929). Similar results were also obtained for PO-related morbidity and PO-related mortality measures.

Conclusion

These findings suggest that reducing consumption levels of POs at the population level may be an effective strategy to limit PO-related harms.

Document type: 
Article
File(s): 

Trends and Changes in Prescription Opioid Analgesic Dispensing In Canada 2005-2012: An Update with a Focus on Recent Interventions

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2014
Abstract: 

Background

Prescription opioid analgesic (POA) utilization has steeply increased globally, yet is far higher in established market economies than elsewhere. Canada features the world’s second-highest POA consumption rates. Following increases in POA-related harm, several POA control interventions have been implemented since 2010.

Methods

We examined trends and patterns in POA dispensing in Canada by province for 2005–2012, including a focus on the potential effects of interventions. Data on annual dispensing of individual POA formulations – categorized into ‘weak opioids’ and ‘strong opioids’ – from a representative sub-sample of 5,700 retail pharmacies across Canada (from IMS Brogan’s Compuscript) were converted into Defined Daily Doses (DDD), and examined intra- and inter-provincially as well as for Canada (total).

Results

Total POA dispensing – driven by strong opioids – increased across Canada until 2011; four provinces indicated decreases in strong opioid dispensing; seven provinces indicated decreases specifically in oxycodone dispensing, 2011–2012. The dispensing ratio weak/strong opioids decreased substantively. Major inter-provincial differences in POA dispensing levels and qualitative patterns of POA formulations dispensed persisted. Previous increasing trends in POA dispensing were reversed in select provinces 2011–2012, coinciding with POA-related interventions.

Conclusions

Further examinations regarding the sustained nature, drivers and consequences of the recent trend changes in POA dispensing – including possible ‘substitution effects’ for oxycodone reductions – are needed.

Document type: 
Article
File(s): 

Comparing Key Characteristics of Young Adult Crack Users in and Out-Of-Treatment in Rio De Janeiro, Brazil

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2014
Abstract: 

Background

Crack use is prevalent among street drug users in Brazilian cities, yet despite recent help system reforms and investments, treatment utilization is low. Other studies have identified a variety of – often inconsistent – factors associated with treatment status among crack or other drug users. This study compared socio-economic, drug use, health and service use characteristics between samples of young adult crack users in- and out-of-treatment in Rio de Janeiro, Brazil.

Findings

Street-involved crack users (n = 81) were recruited by community-based methods, and privately assessed by way of an anonymous interviewer-administered questionnaire as well as biological methods, following informed consent. In-treatment users (n = 30) were recruited from a public service in-patient treatment facility and assessed based on the same protocol. Key indicators of interest were statistically cross-compared. Not-in-treatment users were less likely to: be white, educated, stably housed, to be involved in drug dealing, to report lifetime marijuana and current alcohol use, to report low mental health status and general health or addiction/mental health care; they were more likely to: be involved in begging and utilize social services, compared to the in-treatment sample (statistical significance for differences set at p < .05).

Conclusions

In-treatment and not-in-treatment crack users differed on several key characteristics. Overall, in-treatment users appeared to be more socio-economically integrated and connected to the health system, yet not acutely needier in terms of health or drug problems. Given overall low treatment utilization but high need, efforts are required to facilitate improved treatment access and use for marginalized crack users in Brazil.

Document type: 
Article
File(s): 

Positive Coping with Health Conditions

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2009
Abstract: 

Positive Coping with Health Conditions, A Self-Care Workbook (Dan Bilsker, PhD, RPsych, Joti Samra, PhD, RPsych, Elliot Goldner, MD, FRC(P), MHSc) is a self-care manual authored by scientist-practitioners with expertise in issues relating to coping with health conditions.  This manual is designed for individuals who deal with health conditions, including patients, physicians, psychologists, nurses, rehabilitation professionals and researchers.

Document type: 
Report

Psychological Health and Safety: An Action Guide for Employers

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2012
Abstract: 

As the burden of workplace mental health problems on the public and private sectors in Canada increases, the management of workplace mental health issues will be of increasing importance. Yet, strategies for the assessment, prevention and treatment of mental health problems in the workplace are underdeveloped and underused.

In order to help remedy this the Workforce Advisory Committee of the Mental Health Commission of Canada  asked CARMHA to examine the relevant scientific and ‘grey’ literature on approaches to improving the mental health of employees and create practical resource for employers. The aim of Psychological Health and Safety: An Action Guide for Employers, is to help employers to create a psychologically healthy workplace, one that supports the psychological health of employees in a manner that also furthers the goals of the organization. Promoting psychological health for the entire workforce is an excellent strategy for reducing the risk of psychological harm. A psychologically healthy workplace helps keep workers safe, engaged and productive.

The Guide is based on a comprehensive implementation model, the P6 Framework, that describes the change process in terms of six successive components: Policy, Planning, Promotion, Prevention, Process and Persistence.

For each component of the P6 Framework, three practical actions are provided. These actions are consistent with research evidence and represent a promising practice in the field of psychological health and safety. Each action also includes an explanation of why it matters, how to implement it and access to supportive tools that are web-based, primarily Canadian and available at no or minimal cost.

The guide also includes stories that illustrate how workplaces have tackled psychological health and safety. The Guide is available in French and English and is consistent with, and complementary to, the National Standard of Canada for Psychological Health and Safety in the Workplace.

Document type: 
Report

A Roadmap to Men's Health: Current Status, Research, Policy & Practice

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2010
Abstract: 

A Roadmap to Men’s Health was commissioned by the Men’s Health Initiative of BC to raise awareness of Men's Health among healthcare providers, researchers, policymakers and the public at large. The report explains the field of Men's Health, develops a framework for making sense of male health conditions and makes recommendations for improving service delivery and the knowledge base in this important area.

A Roadmap to Men’s Health is not a clinical guide to treating health conditions, nor does it cover the full range of male health problems. Instead, it highlights key issues related to a set of high‐priority health conditions strongly affecting male health and longevity.

The ultimate aims of this report are:

  • to engage men more fully with the healthcare system
  • to respond to male health needs more appropriately
  • to contribute to the goal of eventually extending men’s lifespan to match that of women’s.
Document type: 
Report

Quality Indicators for International Benchmarking of Mental Health Care

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2006
Abstract: 

Objective. To identify quality measures for international benchmarking of mental health care that assess important processes and outcomes of care, are scientifically sound, and are feasible to construct from preexisting data.

Design. An international expert panel employed a consensus development process to select important, sound, and feasible measures based on a framework that balances these priorities with the additional goal of assessing the breadth of mental health care across key dimensions.

Participants. Six countries and one international organization nominated seven panelists consisting of mental health administrators, clinicians, and services researchers with expertise in quality of care, epidemiology, public health, and public policy.

Measures. Measures with a final median score of at least 7.0 for both importance and soundness, and data availability rated as ‘possible’ or better in at least half of participating countries, were included in the final set. Measures with median scores ≤3.0 or data availability rated as ‘unlikely’ were excluded. Measures with intermediate scores were subject to further discussion by the panel, leading to their adoption or rejection on a case-by-case basis.

Results. From an initial set of 134 candidate measures, the panel identified 12 measures that achieved moderate to high scores on desired attributes.

Conclusions. Although limited, the proposed measure set provides a starting point for international benchmarking of mental health care. It addresses known quality problems and achieves some breadth across diverse dimensions of mental health care.

Document type: 
Article

Relaxation Method Audio

Peer reviewed: 
No, item is not peer reviewed.
Abstract: 

Listen to the the Relaxation Method Audio - a three part exercise in releasing tension and relaxation. 18min

Document type: 
Audio
File(s): 
Relaxation Method Audio

Health Service Patterns Indicate Potential Benefit of Supported Self-Management for Depression in Primary Care

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2007
Abstract: 

Objective: To examine health service delivery in a Canadian province (British Columbia) toconsider how Canadian health care services might be developed to best address the large numberof individuals with mildly to moderately severe depressive illnesses.Method: We used provincial administrative data to describe patterns of medical servicesprovided to individuals suffering from depression during 3 different time periods (1991–1992,1995–1996, and 2000–2001) and to determine the frequency with which depression patientsreceive treatment from primary care physicians and psychiatrists. We then used these findings toconsider the feasibility and potential applicability of the various approaches that have beendescribed to decrease the burden of disease related to depression.Results: In the fiscal year 1991–1992, the “treated prevalence” rate was 7.7%; in 1995–1996, itwas 8.7%; and in 2000–2001, it was 9.5%. In each cohort over the 10-year period, theproportion of individuals who received a diagnosis of depression and who were then treated byprimary care physicians alone (no psychiatric services were provided) remained constant at 92%.Conclusions: Supported self-management is identified as a promising intervention that could beintegrated into primary health care within the context of the Canadian health care system. Itconstitutes a feasible and practical approach to enhance the role of family physicians in thedelivery of services to individuals with milder forms of depression and promotes the activeengagement of individuals in their recovery and in prevention of future episodes.

Document type: 
Article
File(s): 

Dealing With Depression: Antidepressant Skills for Teens

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2005
Abstract: 

 

Dealing with Depression is a workbook for teens that explains depression and teaches three main antidepressant skills you can use to help overcome or prevent it. The skills are presented in a step-by-step way so that you may learn them easily and apply them to your life. Sometimes these antidepressant skills can be used on their own, when the mood problem isn't too severe, and sometimes they have to be used along with treatments prescribed by professionals. Either way, practicing these antidepressant skills will help you deal more effectively with low mood and depression.

Document type: 
Report