Benedikt Fischer

Simon Fraser University, Burnaby, British Columbia, Canada

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Publications (196)441.13 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although cannabis is an illegal drug, ‘medical marijuana programs’ (MMPs) have proliferated (e.g., in Canada and several US states), allowing for legal cannabis use for therapeutic purposes. While both health risks and potential therapeutic benefits for cannabis use have been documented, potential public health impacts of MMPs — also vis-à-vis other psychoactive substance use — remain under-explored.
    12/2015; 2:53-56. DOI:10.1016/j.pmedr.2014.12.006
  • Jürgen Rehm, Benedikt Fischer
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    ABSTRACT: Cannabis is the most prevalently used drug globally, with many jurisdictions considering varying reform options to current policies to deal with this substance and associated harm. Three policy options are available: prohibition, decriminalization, and legalization, with prohibition currently the dominant model globally.[1] This contribution gives reasons why legalization with strict regulation should be considered superior to other options with respect to public health in high income countries in North America.
    Clinical Pharmacology &#38 Therapeutics 02/2015; 97(6). DOI:10.1002/cpt.93 · 7.39 Impact Factor
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    ABSTRACT: Cannabis is the most commonly used drug in Canada; while its use is currently controlled by criminal prohibition, debates about potential control reforms are intensifying. There is substantive evidence about cannabis-related risks to health in various key outcome domains; however, little is known about the actual extent of these harms specifically in Canada. Based on epidemiological data (e.g. prevalence of relevant cannabis use rates and relevant risk behaviors; risk ratios; and annual numbers of morbidity/mortality cases in relevant domains), and applying the methodology of comparative risk assessment, we estimated attributable fractions for cannabis-related morbidity and mortality, specifically for: (i) motor-vehicle accidents (MVAs); (ii) use disorders; (iii) mental health (psychosis) and (iv) lung cancer. MVAs and lung cancer are the only domains where cannabis-attributable mortality is estimated to occur. While cannabis use results in morbidity in all domains, MVAs and use disorders by far outweigh the other domains in the number of cases; the popularly debated mental health consequences (e.g., psychosis) translate into relatively small case numbers. The present crude estimates should guide and help prioritize public health-oriented interventions for the cannabis-related health burden in the population in Canada; formal burden of disease calculations should be conducted. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
    Journal of Public Health 01/2015; DOI:10.1093/pubmed/fdv005 · 2.30 Impact Factor
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    ABSTRACT: There are an estimated several million crack-cocaine users globally; use is highest in the Americas. Most crack users are socio-economically marginalized (e.g., homeless), and feature elevated risks for morbidity (e.g., blood-borne viruses), mortality and crime/violence involvement, resulting in extensive burdens. No comprehensive reviews of evidence-based prevention and/or treatment interventions specifically for crack use exist. We conducted a comprehensive narrative overview of English-language studies on the efficacy of secondary prevention and treatment interventions for crack (cocaine) abuse/dependence. Literature searches (1990-2014) using pertinent keywords were conducted in main scientific databases. Titles/abstracts were reviewed for relevance, and full studies were included in the review if involving a primary prevention/treatment intervention study comprising a substantive crack user sample. Intervention outcomes considered included drug use, health risks/status (e.g., HIV or sexual risks) and select social outcome indicators. Targeted (e.g., behavioral/community-based) prevention measures show mixed and short-term effects on crack use/HIV risk outcomes. Material (e.g., safer crack use kit distribution) interventions also document modest efficacy in risk reduction; empirical assessments of environmental (e.g., drug consumption facilities) for crack smokers are not available. Diverse psycho-social treatment (including contingency management) interventions for crack abuse/dependence show some positive but also limited/short-term efficacy, yet likely constitute best currently available treatment options. Ancillary treatments show little effects but are understudied. Despite ample studies, pharmaco-therapeutic/immunotherapy treatment agents have not produced convincing evidence; select agents may hold potential combined with personalized approaches and/or psycho-social strategies. No comprehensively effective 'gold-standard' prevention/treatment interventions for crack abuse exist; concerted research towards improved interventions is urgently needed. Copyright © 2015 Elsevier B.V. All rights reserved.
    International Journal of Drug Policy 01/2015; 26(4). DOI:10.1016/j.drugpo.2015.01.002 · 2.40 Impact Factor
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    ABSTRACT: 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. 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. These findings suggest that reducing consumption levels of POs at the population level may be an effective strategy to limit PO-related harms.
    Substance Abuse Treatment Prevention and Policy 10/2014; 9(1):43. DOI:10.1186/1747-597X-9-43 · 1.16 Impact Factor
  • Benedikt Fischer, Chantal Burnett, Jürgen Rehm
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    ABSTRACT: Prescription opioid (POs, i.e. opioid analgesics requiring a prescription) related harms are extensive in North America; non-medical PO use (NMPOU), PO-related morbidity (e.g. hospital or treatment admissions) and mortality (e.g. overdose deaths) are high in the general population. Most recommendations towards reducing PO-related problems to date have focused on rather narrow and specific areas (e.g. improved PO monitoring, clinical PO use guidelines, detection of patients with PO abuse, tamper-resistant PO formulations). An integrated population health framework for POs – i.e. an evidence-based approach towards largest possible reductions of PO-related harms in the population, as is well established for other psychoactive drug (e.g. alcohol) fields – is currently missing. Recent PO-focused policy initiatives launched in Canada present long lists of recommendations – the feasibility and impact of which on PO-related harms is uncertain – yet also are notably silent on population health-based considerations or approaches. We outline select principal pillars – including general and targeted prevention, and treatment – for a population health framework for PO-related harms and offer suggestions for implementation, with Canada as the principal case study. Given the extensive burden and known population-level determinants of PO-related harms, the development of an evidence-based population health approach to reduce this burden is urgently advised.
    Drugs: Education Prevention and Policy 10/2014; 22(1). DOI:10.3109/09687637.2014.936827 · 0.53 Impact Factor
  • Benedikt Fischer, Sharan Kuganesan, Robin Room
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    ABSTRACT: While prohibition has been the dominant regime of cannabis control in most countries for decades, an increasing number of countries have been implementing cannabis control reforms recently, including decriminalization or even legalization frameworks. Canada has held out from this trend, although it has among the highest cannabis use rates in the world. Cannabis use is universally criminalized, and the current (conservative) federal government has vowed not to implement any softening reforms to cannabis control. As a result of several higher court decisions, the then federal government was forced to implement a 'medical marijuana access regulations' program in 2001 to allow severely ill patients therapeutic use and access to therapeutic cannabis while shielding them from prosecution. The program's regulations and approval processes were complex and subject to extensive criticism; initial uptake was low and most medical marijuana users continued their use and supply outside the program's auspices. This year, the government introduced new 'marijuana for medical purposes regulations', which allow physicians to 'authorize' medical marijuana use for virtually any health condition for which this is considered beneficial; supply is facilitated by licensed commercial producers. It is expected that some 500,000 users, and dozens of commercial producers will soon be approved under the program, arguably constituting - as with medical marijuana schemes elsewhere, e.g. in California - de facto 'legalization'. We discuss the question whether the evolving scope and realities of 'medical cannabis' provisions in Canada offer a 'sneaky side door' or a 'better third way' to cannabis control reform, and what the potential wider implications are of these developments.
    International Journal of Drug Policy 09/2014; 26(1). DOI:10.1016/j.drugpo.2014.09.007 · 2.40 Impact Factor
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    ABSTRACT: Studies have shown important gender differences among drug (including crack) users related to: drug use patterns; health risks and consequences; criminal involvement; and service needs/use. Crack use is prevalent in Brazil; however, few comparative data by sex exist. We examined and compared by sex key drug use, health, socio-economic indicators and service use in a bi-city sample of young (18-24 years), regular and marginalized crack users in Brazil.
    International Journal for Equity in Health 08/2014; 13(1):70. DOI:10.1186/s12939-014-0070-x · 1.71 Impact Factor
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    ABSTRACT: The non-medical use of prescription opioids (PO) has increased dramatically in North America. Special consideration for PO prescription is required for individuals in methadone maintenance treatment (MMT). Our objective is to describe the prevalence and correlates of PO use among British Columbia (BC) MMT clients from 1996 to 2007. This study was based on a linked, population-level medication dispensation database. All individuals receiving 30 days of continuous MMT for opioid dependence were included in the study. Key measurements included the proportion of clients receiving >7 days of a PO other than methadone during MMT from 1996 to 2007. Factors independently associated with PO co-prescription during MMT were assessed using generalized linear mixed effects regression. 16,248 individuals with 27,919 MMT episodes at least 30 days in duration were identified for the study period. Among them, 5,552 individuals (34.2%) received a total of 290,543 PO co-prescriptions during MMT. The majority (74.3%) of all PO dispensations >7 days originated from non-MMT physicians. The number of PO prescriptions per person-year nearly doubled between 1996 and 2006, driven by increases in morphine, hydromorphone and oxycodone dispensations. PO co-prescription was positively associated with female gender, older age, higher levels of medical co-morbidity as well as higher MMT dosage, adherence, and retention. A large proportion of MMT clients in BC received co-occurring PO prescriptions, often from physicians and pharmacies not delivering MMT. Experimental evidence for the treatment of pain in MMT clients is required to guide clinical practice. (Am J Addict 2014;23:257-264).
    American Journal on Addictions 05/2014; 23(3):257-64. DOI:10.1111/j.1521-0391.2014.12091.x · 1.74 Impact Factor
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    Elliot M Goldner, Emily K Jenkins, Benedikt Fischer
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    ABSTRACT: Objective: Attention to knowledge translation (KT) has increased in the health care field in an effort to improve uptake and implementation of potentially beneficial knowledge. Weprovide an overview of the current state of KT literature and discuss the relevance of KT for health care professionals working in mental health. Method: A systematic search was conducted using MEDLINE, PsycINFO, and CINAHL databases to identify review articles published in journals from 2007 to 2012. We selected articles on the basis of eligibility criteria and then added further articles deemed pertinent to the focus of our paper. Results: After removing duplicates, we scanned 214 review articles for relevance and, subsequently, we added 46 articles identified through hand searches of reference lists or from other sources. A total of 61 papers were retained for full review. Qualitative synthesis identified 5 main themes: defining KT and development of KT science; effective KT strategies; factors influencing the effectiveness of KT; KT frameworks and guides; and relevance of KT to health care providers. Conclusions: Despite limitations in existing evidence, the concept and practice of KT holds potential value for mental health care providers. Understanding of, and familiarity with, effective approaches to KT holds the potential to enhance providers’ treatment approaches and to promote the use of new knowledge in practice to enhance outcomes.
    Canadian journal of psychiatry. Revue canadienne de psychiatrie 03/2014; 59(3):160. · 2.41 Impact Factor
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    Benedikt Fischer, Wayne Jones, Jürgen Rehm
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    ABSTRACT: 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. 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). 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. 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.
    BMC Health Services Research 02/2014; 14(1):90. DOI:10.1186/1472-6963-14-90 · 1.66 Impact Factor
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    ABSTRACT: To determine the level and changes in public opinion between 2003 and 2009 among adult Canadians about implementation of supervised injection facilities (SIFs) in Canada. Population-based, telephone survey data collected in 2003 and 2009 were analyzed to identify strong, weak, and intermediate support for SIFs. Ontario, Canada PARTICIPANTS: Representative samples of adults aged 18 and over. Analyses of the agreement with implementation of SIFs in relation to four individual SIF goals and a composite measure. The final sample sizes for 2003 and 2009 were 1212 and 968, respectively. Between 2003 and 2009, there were increases in the proportion of participants who strongly agreed with implementing SIFs to: reduce neighbourhood problems (0.309 versus 0.556, respectively); increase contact of people who use drugs with health and social workers (0.257 versus .479, respectively); reduce overdose deaths or infectious disease among people who use drugs (0.269 versus 0.482, respectively); and encourage safer drug injection (0.213 versus 0.310, respectively). Analyses using a composite measure of agreement across goals showed 0.776 of participants had mixed opinions about SIFs in 2003, compared with only 0.616 in 2009. There was little change among those who strongly disagreed with all SIF goals (0.091 versus 0.113 in 2003 and 2009, respectively). Support for implementation of supervised injection facilities in Ontario, Canada increased between 2003 and 2009, but at both time points a majority still held mixed opinions.
    Addiction 02/2014; 109(6). DOI:10.1111/add.12506 · 4.60 Impact Factor
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    ABSTRACT: Drug - including opioid - dependence is common in correctional populations, however little research exists on interventions for women offenders. Based on retrospective administrative data, we examined rates of return to custody (RTC) among three samples of Canadian federal women offenders with problematic opioid use (total n = 137): (1) a group initiated on MMT during incarceration who continued MMT post-release (MMT-C; n = 25); (2) a group initiated on MMT but who terminated treatment post-release (MMT-T; n = 67), and (3) a non-MMT control group (MMT-N; n = 45). Study groups were similar regarding socio-demographic, drug use and criminogenic indicators. Based on an unadjusted Cox proportional hazards model, the MMT-C group had a 65% lower risk of RTC than the MMT-N (reference) group (HR 0.35, CI 0.13-0.90); RTC risk was not different between the MMT-T and the reference group. Most RTCs were for technical revocations (e.g. violation of a legal condition of their release). Continuous MMT following release from corrections appears to be effective in reducing recidivism in women offenders with opioid problems; barriers to MMT in the study population should be better understood and ameliorated. © 2014 S. Karger AG, Basel.
    European Addiction Research 02/2014; 20(4):192-199. DOI:10.1159/000357942 · 2.07 Impact Factor
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    ABSTRACT: Cannabis use and driving (CUD) is a growing public health concern. This study's main objective was to identify distinguishing characteristics associated with high-frequency CUD (HFCUD) activity (i.e., CUD > 12 times) in a multi-site sample of university students who had self-identified as having driven a car within 4 hours of cannabis use in the past year. Participants for the study (n = 248; age 18-28 years) were recruited by mass advertising at five universities in Ontario. Participants were screened for eligibility and assessed by an anonymous interview between April 2005 and March 2006. Bivariate analyses determined factors associated with HFCUD (i.e., > 12 times) vs. a low frequency of CUD (LFCUD); significant factors were subsequently entered into a discriminant function analysis model. HFCUD was associated with several variables, including frequent (i.e., at least weekly) cannabis use; daily driving; perception of own ability to drive not being impaired by cannabis use; and expectation of CUD in the next 12 months (all p < 0.0001). CUD among young drivers is an important health and safety risk requiring effective interventions. Given the strong association of HFCUD with frequent cannabis use, these phenomena need to be addressed conjointly. Furthermore, preventive interventions responsive to the specific socio-cultural contexts of possible CUD need to be developed and implemented.
    Canadian Journal of Criminology and Criminal Justice 02/2014; 56(2):185-200. DOI:10.3138/cjccj.2014.ES03
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    Addiction 02/2014; 109(2):186-8. DOI:10.1111/add.12423 · 4.60 Impact Factor
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    ABSTRACT: 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. 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). 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 for marginalized crack users in Brazil.
    Substance Abuse Treatment Prevention and Policy 01/2014; 9(1):2. DOI:10.1186/1747-597X-9-2 · 1.16 Impact Factor
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    ABSTRACT: Five years ago, we highlighted Canada's emerging problem of prescription opioid (PO)-related harms and emphasized the need for targeted surveillance, research and interventions. Overall levels of PO use in the Canadian population have grown by 70% since then, while at the same time levels of non-medical PO use (NMPOU) in general and in key risk populations have continued to be high; furthermore, PO-related harms - specifically morbidity (e.g., treatment admissions) and mortality (e.g., overdose deaths) - have risen substantively. Unfortunately, major knowledge gaps related to systematic monitoring of PO-related harms continue to exist; for example, no national morbidity or mortality statistics are available. Investigator-driven research has generated important insights into the epidemiology and impacts of PO-related harms: high correlations between population-level PO dispensing and/or PO dosing and harms; high rates of co-occurrence of NMPOU and co-morbidities; and distinct NMPOU-related risk dynamics among street drug users. Select policy measures have been implemented only recently at the federal and provincial levels; these interventions remain to be systematically evaluated, especially given preliminary indications of reductions in PO-related harms (e.g., NMPOU) unfolding prior to the interventions. For these purposes, improvements in surveillance tools and research resources devoted to the extensive public health problem of PO-related harms in Canada continue to be urgently needed.
  • Benedikt Fischer, Sharan Kuganesan, Robin Room
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    ABSTRACT: While prohibition has been the dominant regime of cannabis control in most countries for decades, an increasing number of countries have been implementing cannabis control reforms recently, including decriminalization or even legalization frameworks. Canada has held out from this trend, although it has among the highest cannabis use rates in the world. Cannabis use is universally criminalized, and the current (Conservative) federal government has vowed – despite extensive pressures – not to implement any softening reforms to cannabis control. As a result of several higher court decisions, the then federal government was forced to implement a ‘medical marijuana access program’ in 2001 to allow severely ill patients therapeutic use and access to therapeutic cannabis while shielding them from prosecution. The program's regulations and approval processes were complex and subject to extensive criticism; initial uptake was low and most medical marijuana users continued their use and supply outside the program. This year, the government introduced new ‘medical marijuana’ regulations, which allow doctors to ‘authorize’ medical marijuana use for virtually any health condition; supply is facilitated by licensed commercial producers. It is expected that some 500,000 users, and dozens of commercial producers will soon be approved under the program, arguably constituting – as with medical marijuana schemes elsewhere, e.g. in California - de facto ‘legalization’. We discuss the question whether the evolving scope and realities of ‘medical cannabis’ provisions in Canada offer a ‘sneaky side door’ or a ‘better third way’ to cannabis control reform, and what the potential wider implications are of these developments.
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    ABSTRACT: Crack use is prevalent across the Americas, and specifically among marginalized urban street drug users in Brazil. Crack users commonly feature multiple physical and mental health problems, while low rates of and distinct barriers to help service use have been observed in these populations. This study examined profiles and determinants of social and health service utilization, and unmet service needs, in a bi-city sample of young (18-24 years), marginalized crack users in Brazil. N = 160 study participants were recruited by community-based methods from impoverished neighborhoods in the cities of Rio de Janeiro (n = 81) and Salvador (n = 79). A mixed methods protocol was used. Participants' drug use, health, and social and health service utilization were assessed by an anonymous interviewer-administered questionnaire completed in a community setting; descriptive statistics on variables of interest were computed. Service needs and barriers were further assessed by way of several focus groups with the study population; narrative data were qualitatively analyzed. The study protocol was approved by institutional ethics review boards; data were collected between November 2010 and June 2011. The majority of the sample was male, without stable housing, and used other drugs (e.g., alcohol, marijuana). About half the sample reported physical and mental health problems, yet most had not received medical attention for these problems. Only small minorities had utilized locally available social or health services; utilization appeared to be influenced by sex, race and housing characteristics in both sites. Participants cited limited service resources, lack of needs-specific professional skills, bureaucratic barriers and stigma as obstacles to better service access. However, most respondents stated strong interest and need for general social, health and treatment services designed for the study population, for which various key features were emphasized as important. The study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users' social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also.
    BMC Health Services Research 12/2013; 13(1):536. DOI:10.1186/1472-6963-13-536 · 1.66 Impact Factor
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    ABSTRACT: Non-medical prescription opioid use (NMPOU) constitutes a substantial clinical and public health concern in North America. Although there is evidence of elevated rates of mental health problems among people with NMPOU, the extent of these correlations specifically in treatment samples has not been systematically assessed. A systematic review and meta-analysis were conducted for Axis-1 psychiatric diagnoses and symptoms with a principal focus on depression and anxiety disorders in substance use treatment samples reporting NMPOU at admission to treatment (both criteria within past 30days). 11 unique studies (all from either the United States or Canada) met inclusion criteria and were included in the meta-analysis. The pooled prevalence of 'any' mental health problems (both diagnosis and symptoms) among substance abuse treatment patients reporting NMPOU was 43% (95% CI: 32%-54%; I(2) for inter-study heterogeneity: 99.5%). The pooled prevalence of depression diagnosis among substance abuse treatment patients reporting NMPOU was 27% (95% CI: 9%-45%; I(2): 99.2%); the pooled prevalence of anxiety diagnosis in the sample was 29% (95% CI: 14%-44%; I(2): 98.7%). The prevalence rates of psychiatric problems (both diagnosis and symptoms), depression diagnosis and anxiety diagnosis are disproportionately high in substance use treatment samples reporting NMPOU relative to general population rates. Adequate and effective clinical strategies are needed to address co-occurring NMPOU and mental health in substance use treatment systems, especially given rising treatment demand for NMPOU. Efforts are needed to better understand the temporal and causal relationships among NMPOU, mental health problems, and treatment seeking in order to improve interventions.
    Addictive behaviors 12/2013; 39(3). DOI:10.1016/j.addbeh.2013.11.022 · 2.44 Impact Factor

Publication Stats

3k Citations
441.13 Total Impact Points

Institutions

  • 2009–2015
    • Simon Fraser University
      • • Centre for Applied Research in Mental Health and Addiction (CARMHA)
      • • Faculty of Health Sciences
      Burnaby, British Columbia, Canada
    • University of British Columbia - Vancouver
      • British Colombia Centre for Excellence in HIV/AIDS
      Vancouver, British Columbia, Canada
  • 1998–2014
    • University of Toronto
      • Department of Psychiatry
      Toronto, Ontario, Canada
  • 2006–2010
    • University of Victoria
      • Centre for Addictions Research of BC (CARBC)
      Victoria, British Columbia, Canada
  • 2002–2009
    • Centre for Addiction and Mental Health
      • Social and Epidemiological Research Department (SER)
      Toronto, Ontario, Canada