Tara Marie Watson

Guidelines for better harm reduction: Evaluating implementation of best practice recommendations for needle and syringe programs (NSPs)

BACKGROUND The objective of this study was to evaluate needle and syringe program (NSP) policies and procedures before and after the dissemination of a set of best practice recommendations. METHODS An on-line survey of 32 core NSP managers (100% response rate) and 62 satellite NSP managers (63% response rate). The survey included items about the distribution of needles/syringes, other injection-related equipment and inhalation equipment, and use of a best practice recommendations document. RESULTS The majority of NSPs reported following needle and syringe best practice recommendations. Most core NSPs (88%, n=28) and satellite NSPs (84%, n=52) distributed cookers following the dissemination of the document. All core NSPs (100%, n=32) and nearly all satellite NSPs (97%, n=60) distributed sterile water ampoules in 2008, many more than in 2006. Although more NSPs distributed safer inhalation equipment in 2008, the majority did not distribute these items. More satellite NSPs (44%, n=27) distributed glass stems than the core NSPs (16%, n=5). Commonly cited implementation barriers included funding, senior management and decision-making. CONCLUSION Our findings demonstrate that NSPs will implement empirically based best practice recommendations and welcome such guidance. The managers we surveyed not only reported increased implementation of practices that have been empirically shown to help reduce disease transmission among injection drug users (IDUs), they also used the best practices document for additional purposes, such as planning and advocacy, and expressed interest in having sets of recommendations developed for other areas of harm reduction. Ensuring high-quality and consistent NSP services is essential to prevent transmission of HIV among people who inject drugs and others in the community. Best practice recommendations can assist in achieving these goals.

International approaches to driving under the influence of cannabis: A review of evidence on impact

BACKGROUND There are knowledge gaps regarding the effectiveness of different approaches designed to prevent and deter driving under the influence of cannabis (DUIC). Policymakers are increasingly interested in evidence-based responses to DUIC as numerous jurisdictions worldwide have legally regulated cannabis or are debating such regulation. We contribute a comprehensive review of international literature on countermeasures that address DUIC, and identify where and how such measures have been evaluated. METHODS The following databases were systematically searched from 1995 to present: Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts, and Criminal Justice Abstracts. Hand searching of relevant documents, internet searches for grey literature, and review of ongoing email alerts were conducted to capture any emerging literature and relevant trends. RESULTS Numerous international jurisdictions have introduced a variety of measures designed to deter DUIC. Much interest has been generated regarding non-zero per se laws that set fixed legal limits for tetrahydrocannabinol and/or its metabolites detected in drivers. Other approaches include behavioural impairment laws, zero-tolerance per se laws, roadside drug testing, graduated licensing system restrictions, and remedial programs. However, very few evaluations have appeared in the literature. CONCLUSIONS Although some promising results have been reported (e.g., roadside testing), it is premature to draw firm conclusions regarding the broader impacts of general deterrent approaches to DUIC. This review points to the need for a long-term commitment to rigorously evaluate, using multiple methods, the impact of general and specific deterrent DUIC countermeasures.

The Elusive Goal of Drug-Free Prisons

ABSTRACT Background: Although there is a need for well-designed evaluations, international evidence shows that drugs frequently enter prisons and enforcement efforts are said to be linked to adverse events. Objectives: This study sought to examine drug enforcement within a federal prison system, overseen by the Correctional Service of Canada (CSC), and to detail competing perspectives. Methods: Three main sources of data were used in this qualitative study: 16 interviews conducted between 2010 and 2012 with former CSC senior officials, former frontline staff, and external stakeholders; CSC research publications and other documents; and transcripts from a relevant House of Commons Standing Committee public study. All texts were coded and compared to examine emergent themes of interest. Results: Six key themes are described as contested effects of enhanced in-prison drug enforcement: (1) continued and creative efforts to bring in drugs; (2) climate of tensions and violence; (3) prisoners switching their drug use; (4) health-related harms; (5) deterrence of visitors; and (6) staff involvement in the in-prison drug trade. Conclusions/Importance: Urgently needed are rigorous evaluations of in-prison drug enforcement, along with closer scrutiny of policy recommendations that uphold the goal of drug-free prisons. Studying similar prison systems as complex risk-managing organizations may offer new information about drug enforcement policy and practice resistance despite detrimental effects.

Evaluating moderators of beneficial effects of severity-based assignment to substance use treatments in impaired drivers

Remedial programs for impaired driving offenders have proved valuable in reducing subsequent alcohol and other drug use and preventing recidivism in this population. Many of these programs are based on a severity-based assignment scheme, where individuals assessed to have greater problems or be at higher risk are assigned to longer, more intensive interventions. Recent research, using regression discontinuity analyses, provided support for severity-based assignment schemes in demonstrating that those with higher problem or risk levels assigned to longer and more intensive programming showed a significant reduction in drinking days over a follow-up interval, attributable to program assignment. Regression discontinuity analyses can also be used to assess moderators of this assignment benefit. We report an assessment of the impact of eight potential moderators of assignment benefit, derived from a factor analysis of the Research on Addictions Self-Inventory screening instrument. Five of the eight factors were found to moderate the assignment benefit: Negative Affect, Sensation Seeking, High Risk Lifestyle, Alcohol Problems, and Family History. The significance of these results for developing more effective program assignment procedures is discussed.

The Impact of Remedial Programme Participation on Convicted Drinking Drivers’ Alcohol and Other Drug Use 6 Months Following Programme Completion

Back on Track (BOT) is Ontario’s remedial measures programme for convicted drinking drivers. Based on a pre-workshop assessment, individuals are assigned to complete either an 8-h Education workshop or a 16-h Treatment workshop. Six months later, participants are required to complete a 30-min follow-up interview by telephone. This report presents an outcome evaluation of the BOT programme, examining levels of substance use and related problems assessed during the follow-up interview. This evaluation is based on data from 9202 participants who completed the programme between October 1, 2008 and June 1, 2010. Results indicate that completion of BOT is associated with significant reductions in frequency of alcohol and other drug use, negative consequences as a result of drug use, number of drinks consumed per drinking occasion, and total number of substance users (alcohol and otherwise). There were also significantly more participants who changed substance-using status from ‘users’ at assessment to ‘non-user’ at follow-up than those from non-user at assessment to user at follow-up. These beneficial changes were seen in both the Education and Treatment workshop groups. Recommendations are presented to guide future efforts to improve the effectiveness of BOT and similar programmes in reducing alcohol- and drug-related problems, including impaired driving.

Creating and sustaining cooperative relationships between supervised injection services and police: A qualitative interview study of international stakeholders

BACKGROUND Supervised injection services (SIS) operate with special exemptions from drug law enforcement. Given the expansion of SIS and the opioid overdose crisis in numerous jurisdictions, now is a critical time to examine factors that contribute to cooperative SIS-police relationships. We sought to learn about SIS-police relationships from international jurisdictions with well-established as well as newer SIS. METHODS We conducted 16 semi-structured telephone interviews with SIS managers (n = 10) and police liaisons (n = 6) from 10 cities in seven different countries (Australia, Canada, Denmark, France, Germany, Netherlands, and Spain). All participants provided informed consent. We focused our coding and analysis on themes that emerged from the data. RESULTS Five key contributors to cooperative SIS-police relationships emerged from the data: early engagement and dialogues; supportive police chiefs; dedicated police liaisons; negotiated boundary agreements; and regular face-to-face contact. Most participants perceived the less formalised, on-the-ground approach to relationship-building between police and SIS adopted in their city to be working well in general. SIS managers and police participants reported a lack of formal police training on harm reduction, and some thought that training was unnecessary given the relatively positive local SIS-police relationships they reported. CONCLUSION Our qualitative study provides new, in-depth empirical examples of how police in varied international jurisdictions can come to accept and work cooperatively with, not against, SIS staff and clients. Investing ongoing effort in SIS-police relationships, in a manner that best suits local needs, may hold greater and more sustainable public health value than delivering specific curricula to police.

Relationships, Training, and Formal Agreements Between Needle and Syringe Programs and Police

Needle and syringe programs (NSPs) are key public health and HIV prevention programs. We sought to compare over time the quality of relationships between NSPs and police, and implementation of best practices. We conducted cross-sectional surveys in 2008 (n = 32) and 2015 (n = 28) with NSP managers in Ontario, Canada. Participants were recruited via e-mail to complete an online survey. Over the period studied, self-reported quality of NSP–police relationships did not change—roughly two thirds of NSP managers reported a positive/mostly positive relationship. In 2015, higher proportions of programs offered training to police about the following: the purpose and goals of NSPs (48% vs. 41% in 2008), NSP effectiveness (55% vs. 34%), the health and social concerns of people who use drugs (52% vs. 40%), and needlestick injury prevention (44% vs. 31%). Few managers reported formal conflict resolution procedures with the police (22% in 2015, 9% in 2008). Our findings show that NSP–police relationships did not deteriorate during a time when such programs fell into disfavor with the federal government. More research is needed to understand if and when formal versus informal agreements with police serve the needs of NSPs.

Cannabis legalization in Canada: how might ‘strict’ regulation impact youth?

Canada is on course to become, in October 2018, the second country in the world, after Uruguay, to federally legalize cannabis for recreational use. Prime Minister Justin Trudeau’s Liberal governme...

Driving under the influence of prescription opioids: Self-reported prevalence and association with collision risk in a large Canadian jurisdiction

BACKGROUND Motor vehicle collisions are an important contributor to prescription opioid use-related morbidity and mortality. The purpose of the current study was to estimate the prevalence of driving under the influence of prescription opioids (DUIPO) in Ontario, Canada, and to measure the association between this behaviour and the risk of a motor vehicle collision. METHODS Data were based on telephone interviews with 7857 respondents who reported having driven in the past year. Data were derived from the 2011-2016 cycles of the CAMH Monitor, an ongoing cross-sectional representative survey of adults aged 18 years and older. A binary logistic regression analysis of collision involvement in the previous 12 months was conducted and included demographic characteristics (sex, age, marital status, education, income, region), driving exposure, poor mental health, non-medical use of prescription opioids, and driving after use of alcohol. RESULTS The prevalence of past-year DUIPO was 3.1%. Controlling for demographic characteristics, driving exposure, and other risk factors, self-reported DUIPO significantly increased the odds of a collision (AdjOR = 1.97; 95% CI 1.08, 3.60; p = 0.026). CONCLUSION Based on these findings, DUIPO is a notable road safety issue. Research focused on better understanding the impact of prescription opioids on driver behaviour, reducing the prevalence of DUIPO, and improving drug-impaired driving policy and interventions should be prioritized in public health strategies.