Patricia G. Erickson

Whither RDS? An investigation of respondent driven sampling as a method of recruiting mainstream marijuana users.

BackgroundAn important challenge in conducting social research of specific relevance to harm reduction programs is locating hidden populations of consumers of substances like cannabis who typically report few adverse or unwanted consequences of their use. Much of the deviant, pathologized perception of drug users is historically derived from, and empirically supported, by a research emphasis on gaining ready access to users in drug treatment or in prison populations with higher incidence of problems of dependence and misuse. Because they are less visible, responsible recreational users of illicit drugs have been more difficult to study.MethodsThis article investigates Respondent Driven Sampling (RDS) as a method of recruiting experienced marijuana users representative of users in the general population. Based on sampling conducted in a multi-city study (Halifax, Montreal, Toronto, and Vancouver), and compared to samples gathered using other research methods, we assess the strengths and weaknesses of RDS recruitment as a means of gaining access to illicit substance users who experience few harmful consequences of their use. Demographic characteristics of the sample in Toronto are compared with those of users in a recent household survey and a pilot study of Toronto where the latter utilized nonrandom self-selection of respondents.ResultsA modified approach to RDS was necessary to attain the target sample size in all four cities (i.e., 40 users from each site). The final sample in Toronto was largely similar, however, to marijuana users in a random household survey that was carried out in the same city. Whereas well-educated, married, whites and females in the survey were all somewhat overrepresented, the two samples, overall, were more alike than different with respect to economic status and employment. Furthermore, comparison with a self-selected sample suggests that (even modified) RDS recruitment is a cost-effective way of gathering respondents who are more representative of users in the general population than nonrandom methods of recruitment ordinarily produce.ConclusionsResearch on marijuana use, and other forms of drug use hidden in the general population of adults, is important for informing and extending harm reduction beyond its current emphasis on at-risk populations. Expanding harm reduction in a normalizing context, through innovative research on users often overlooked, further challenges assumptions about reducing harm through prohibition of drug use and urges consideration of alternative policies such as decriminalization and legal regulation.

A Canadian perspective on cannabis normalization among adults

Once associated with ‘deviant’ subcultures, the use of cannabis is now common across Canadian society. This has led some to argue that cannabis use is becoming normalized in Canada with important implications for drug policy, law enforcement and public health. This article takes up these issues, reporting the results of a qualitative study involving 165, socially integrated, adult cannabis users in four Canadian cities (Vancouver, Montreal, Toronto and Halifax). The aims of this study were twofold; first, we sought to contribute to recent efforts to extend the analysis of normalization and its associated features from adolescent and young adult populations to older adults, with a particular focus on cannabis. Second, we wished to respond to recent calls for greater analysis of both the social and structural determinants of normalization, as well as its contingent, ‘micro-level’ features. Our examination of these diverse dimensions revealed significant changes in the meaning and status of cannabis use in Canada. Although some social and personal stigmas remain, our research suggests they are largely confined to the immoderate, ‘irresponsible’ use of cannabis, while more ‘controlled’ use among adults appears all but de-stigmatized. This process has involved changes in the ways risks associated with cannabis use are characterized and managed; shifts in the ways adult cannabis users seek to moderate their use; as well as broader social and cultural shifts in the meanings associated with cannabis in Canada. We conclude with a discussion of the potential impacts of these developments for drug policy debates in Canada and elsewhere.

Coping strategies of street-involved youth: exploring contexts of resilience

Literature on how street-involved youth (SIY) cope with risky environments remains very limited. This exploratory study investigates SIYs coping strategies, employing the ‘contexts of resilience’ framework (where resilience is understood as a process that changes over time and by environment) to situate an inductive thematic analysis of interviews with 10 current and former SIY. Three themes are explored: social distancing; experiences of violence; and self-harm and suicidality. The first two themes illustrate the double-edged nature of some coping strategies. While social distancing could contribute to isolation from social supports and violent self-defense to retaliatory harm, without alternative resources to prevent victimization these strategies must be acknowledged as reasoned responses to the risks associated with a violent milieu. Strategies assumed to be maladaptive among more normative youth may be among the limited resources available for SIY to utilize in attempts to make positive changes in their lives. The final theme explores self-harm and suicidality as indicative of social and structural needs and shows how in the SIY context such behaviors may not signify an outcome of non-resilience. The adaptation of assessments of coping strategies to be congruent with evaluative contexts should be applied to resilience research addressing other marginalized populations.

Frequent medical visits by cocaine-using subjects in a Canadian community: An invisible problem for health practitioners?

The purpose of this study was to examine the frequency of medical visits by cocaine-using subjects in a Canadian community. A sample of 100 subjects reporting cocaine use at least 10 times in the previous 12 months were recruited in an urban setting in Canada and interviewed in a structured manner to address aspects of their use of cocaine and their responses to those agents. The respondents reported a total of 488 medical visits in the 12 months prior to interview. The frequency of visits correlated with the use of cocaine, barbiturates, hallucinogens, narcotics, and amphetamines. Medical visits also varied with the frequency with which the subjects reported certain adverse reactions to cocaine. Logistic regression modeling was used to assign subjects into a higher medical contact group (three or more medical visits per 12 months) and a lower medical contact group (two or fewer medical visits per 12 months). Membership in the higher or lower contact group was differentiated by a simple model in which the classifying variables were whether or not the subjects reported using crack cocaine in the previous year, whether or not they reported using hallucinogens in the previous year, and whether or not they reported experiencing aggressive reactions with the use of cocaine. Thus, users of cocaine report frequent visits to physicians. Medical visits are more likely if they also used crack cocaine, if they experienced aggressive reactions to cocaine, and if other substances were also used. Recognition of this behavior may facilitate earlier intervention by primary care physicians.

Drug treatment courts--a viable option for Canada? Sentencing issues and preliminary findings from the Toronto court.

The first drug treatment court in Canada began operation in Toronto in December of 1998. This paper describes some aspects of the evolution, structure, and operation of this court. In addition, the federally-funded evaluation of the new program has produced data from the first 18 months of its full operation when 198 drug-dependent individuals were admitted. These preliminary results are described and compared to the findings of an Australian study and to select American studies. Important differences in sentencing practices and options for drug offenses between Canada and the United States are highlighted. Even at this early stage of development, it is suggested that the types of clients retained and more successful in this Canadian experiment may be quite different from the more typical American drug treatment court clientele. The need for careful monitoring and more complete, long-term information is emphasized before the viability of this approach is established for Canada.

Concurrent Mental Health and Substance Use Problems among Street-Involved Youth

Among marginalized populations, homeless adults are known to have elevated rates of mental health and substance use problems compared to the general population, but less is known about their youthful homeless counterparts. While few studies currently exist, what research has been conducted among street-involved youth has confirmed high rates of comorbidity among this population. However, few of these studies explore predictors of concurrent mental health and substance use problems among street-involved youth and consider broader health and social implications. The aim of the current study was to expand on current knowledge of comorbidity among street-involved youth by examining prevalence and correlates of self-reported concurrent mental health and substance use problems among a sample of 150 street-involved youth in Toronto, Canada. Results of descriptive and bivariate analyses revealed that a quarter of the participants experienced concurrent mental health and substance use problems, and that more youth with concurrent problems had experienced physical child maltreatment, greater transience, street victimization and previous arrest compared to youth without concurrent problems. Logistic regression results showed that street-involved youth with concurrent problems were almost four times more likely to have been victimized in the last 12xa0months. These results highlight a more disadvantaged health and social profile among street-involved youth with concurrent mental health and substance use problems, and underscore the need for increased research attention on treatment accessibility and needs among this population.

Factors associated with attitudes toward harm reduction among judges in Ontario, Canada

Abstract Responses from a questionnaire on knowledge and attitudes toward drugs were received from 89 criminal court judges in Ontario, Canada. Younger judges and females were significantly more likely ( P

Attention Deficit Hyperactivity Disorder Symptoms, Comorbidities, Substance Use, and Social Outcomes among Men and Women in a Canadian Sample

Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%–3.85%) screened positively for ADHD symptoms (women = 3.6%; men = 3.0%). For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific.

Suicide attempts and suicidal ideation among street-involved youth in Toronto

Abstract A considerably higher rate of suicide exists among youth who are street-involved or homeless than among the general youth population. Research is needed to better understand the risk factors that predict suicidality within this vulnerable population. Our research makes a specifi c contribution in that it examines both suicidal ideation and attempts. Using data from a sample of 150 homeless and street-involved youth in Toronto, Canada we examine the relative impact of a range of background, street-related, drug use, and mental health variables. The results underscore the particular impact of depression and non-suicidal self-harm behaviour on suicidal ideation and attempts. The fi ndings draw attention to the under-appreciated impact of experiences of bullying and on-street discrimination among this population. These two factors suggest a multi-dimensional process of rejection and social exclusion that begins in school and that continues on the street.

Child Maltreatment and Its Relationship to Drug Use in Latin America and the Caribbean: An Overview and Multinational Research Partnership

Child maltreatment and substance abuse are both international public health priorities. Research shows that child maltreatment increases the risk for substance use and problems. Thus, recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to prevent and treat substance use and related problems. Latin America and the Caribbean is a rich and diverse region of the world with a large range of social and cultural influences. To date, relatively little work has addressed the link between child maltreatment and substance use in the region. A working group constituted by the Inter-American Drug Abuse Control Commission (CICAD) and the Centre for Addiction and Mental Health (CAMH) in June, 2010 identified this area as a priority area for a multinational research partnership. This paper summarizes existing information on drug use and child maltreatment in six participating countries, Colombia, El Salvador, Jamaica, Nicaragua, Panama and Uruguay, and considers the implications of child maltreatment prevention for demand reduction strategies to address substance use issues. A CICAD/CAMH-sponsored multinational research partnership has been formed, which will involve research on the link between child maltreatment and substance misuse, expertise exchange and resource sharing.