Serge Brochu

Illicit opioid use in Canada: Comparing social, health, and drug use characteristics of untreated users in five cities (OPICAN study)

Most of the estimated 125,000 injection drug users (IDUs) in Canada use illicit opioids and are outside treatment (i.e., methadone maintenance treatment). Empirical data suggest that illicit opioid users outside treatment are characterized by various health and social problem characteristics, including polydrug use, physical and mental morbidity, social marginalization, and crime. Although required for evidence-based programming, systematic information on this specific substance-user population is sparse in Canada to date. This article presents and compares key characteristics of population of illicit opioid users outside treatment in five cities across Canada (OPICAN cohort). Overall, the majority of OPICAN participants regularly used both a variety of illicit opioids and cocaine or crack, reported physical and mental health (e.g., mood disorder) problems, lacked permanent housing, were involved in crime, and had their “ideal” treatment not available to them. However, key local sample differences were shown, including patterns of heroin versus prescription opioid use and levels of additional cocaine versus crack use as well as indicators of social marginalization. Illicit opioid user population across Canada differ on key social, health, and drug use indicators that are crucial for interventions and are often demonstrated between larger and smaller city sites. Differentiated interventions are required.

Determinants of overdose incidents among illicit opioid users in 5 Canadian cities

Background: Drug overdose is a major cause of death and illness among illicit drug users. Previous research has indicated that most illicit drug users experience nonfatal overdoses and has suggested a variety of factors that are associated with risk of overdose. In this study, we examined the occurrence of and the factors associated with nonfatal overdoses within a Canadian sample of illicit opioid users not enrolled in treatment at the time of study recruitment. Methods: Interviewers used a standard questionnaire to collect data on sociodemographic characteristics, drug use, health and health care, experience in the criminal justice system and treatment for drug problems; they also performed standard assessments for mental health and infectious disease. The association between overdose and sociodemographic and drug-use factors was examined with χ2 and t test analyses; marginally significant variables were examined with logistic regression to determine independent effects. Results: A total of 679 subjects were interviewed; 651 provided answers sufficient for this analysis. One hundred and twelve (17.2%) of the 651 respondents reported an overdose episode in the previous 6 months. In the logistic regression analysis (after adjustment for sociodemographic factors), homelessness, noninjection use of hydromorphone in the past 30 days and involvement in drug treatment in the past 12 months were predictors of overdose (p < 0.05). Interpretation: Overdose poses a considerable health risk for illicit opioid users. We found that a diverse set of factors was associated with overdose episodes. Prevention efforts will likely be more effective if they can be directed to specific causal factors.

Dropout and completion of treatment among spouse abusers

This study examines a population of spouse abusers undertaking a treatment program. Its purpose was to identify the variables associated with dropout and completion of treatment and to build a predictive model. Data were collected on 286 men who began group treatment in one of eight community programs in the province of Quebec, Canada. Results show that men who complete treatment are older, better educated and have better economic conditions than men who drop out. They also have a more stable family life, have been in a relationship for a longer period of time and have more children with their actual spouse. Men who completed treatment showed more commitment, better working capacities and a higher level of agreement with their therapists, thus developing a stronger therapeutic alliance. Support provided by people in the environment was significantly related to treatment completion. Social and judicial pressures were not related to completion.

Comparative Profiles of Addicted Adult Populations in Rehabilitation and Correctional Services

For many years, clinicians, especially those working in rehabilitation centers for alcohol and drug users, have been preoccupied with clients presenting with dual diagnosis: substance abuse and legal problems. Comparative analyses of three groups of addicted men, 553 offenders and 499 nonoffenders in treatment for addiction problems and 103 addicted inmates were made to ascertain the biopsychosocial profile of these persons. Results showed that dual-diagnosis clients experienced more severe biopsychosocial problems than the nonoffending group of subjects. Offenders in prison experienced more social maladjustment than offenders in drug addiction treatment, they were less preoccupied by their drug consumption, and less motivated to change. Implications for treatment are discussed.

Profiles of alcoholics according to the SCL-90-R : a confirmative study

The Symptom Checklist-90-Revised (SCL-90-R) has often been used in studies of alcoholic populations. Based on findings reported in the literature and data gathered on 712 alcoholics in treatment, this paper investigates the general trends in the responses of alcoholics to the SCL-90-R. On global measures as well as on each of the symptom scales, the scores of alcoholic groups reveal a symptomatology two to five times as severe as that observed in the general population. The Psychoticism dimension shows the most marked divergence with the general population. In almost each of the study groups, the Depression Scale registers the highest scores, followed by Obsessive-Compulsive, Interpersonal Sensitivity, and Anxiety.

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.

Comorbid Depression Among Untreated Illicit Opiate Users: Results From a Multisite Canadian Study

Objectives: This study aimed to describe patterns of major depression (MDD) in a cohort of untreated illicit opiate users recruited from 5 Canadian urban centres, identify sociodemographic characteristics of opiate users that predict MDD, and determine whether opiate users suffering from depression exhibit different drug use patterns than do participants without depression. Method: Baseline data were collected from 679 untreated opiate users in Vancouver, Edmonton, Toronto, Montreal, and Quebec City. Using the Composite International Diagnostic Interview Short Form for Major Depression, we assessed sociodemographics, drug use, health status, health service use, and depression. We examined depression rates across study sites; logistic regression analyses predicted MDD from demographic information and city. Chi-square analyses were used to compare injection drug use and cocaine or crack use among participants with and without depression. Results: Almost one-half (49.3%) of the sample met the cut-off score for MDD. Being female, white, and living outside Vancouver independently predicted MDD. Opiate users suffering from depression were more likely than users without depression to share injection equipment and paraphernalia and were also more likely to use cocaine (Ps < 0.05). Conclusions: Comorbid depression is common among untreated opiate users across Canada; targeted interventions are needed for this population.

Drugs in prison: A break in the pathway

The use of psychoactive substances by offenders is a major preoccupation among correctional network clinicians, researchers and administrators. However, very little is known about this phenomenon during incarceration. The research presented here explores patterns of inmate drug use during imprisonment. Selected at random, 317 respondents in 10 Canadian penitentiaries were interviewed in 1999 to complete self-reported questionnaires. The data indicate various types of important changes, notably with regard to substances used, frequency of use, motivations for use, and inmates’ perception of their psychological state during periods of intoxication.

Does the transtheoretical model predict attrition in domestic violence treatment programs

Attrition in intervention programs for domestically violent men is considered to be a serious and enduring problem. Researchers have found a number of sociodemographic variables that partially explain this phenomenon; however, models based on these variables have a limited predictive power. Scott (2004) argues that a firm theoretical base is needed in future investigations of the problem and suggests the use of the transtheoretical model of behavior change (TTM), which was found to predict dropout with accuracy in other areas of behavioral change. This study investigated the relationship between four TTM constructs (Stages of Change, Decisional Balance, Self-Efficacy, and Processes of Change) and premature termination with a sample of Canadian French-speaking men (N = 302) in five domestic violence treatment programs. Contrary to the initial hypotheses, the TTM constructs did not predict dropout. Discussion investigates how social desirability bias affects results being obtained by current TTM measures and whether more motivation to change at intake necessarily relates to involvement in treatment for longer periods of time.

Understanding treatment impact on drug-addicted offenders.

This study examines variables that could predict treatment perseverance and impact for offenders (N = 124) admitted to one of five rehabilitation centers for alcoholics/drug addicts representing different regions of the province of Quebec. Information was collected on time spent in treatment, alcohol/drug use–related problems, motivation to change, criminal profile, subjects perception of judicial pressure, subjective assessment of importance/probability of judicial consequences tied to treatment dropout or substance use, quality of the therapeutic relationship, assessment of client commitment to treatment, and social support. Results indicate that judicial pressure only have impact on retention into treatment for those who are not already sentenced but this “forced” retention is not linked with positive results. The studys limitations are noted.