This review will identify factors that are negatively and positively associated with access to me... more This review will identify factors that are negatively and positively associated with access to medically-assisted treatment (MAT) and examine the prevalence of MAT access among adolescents and young adults with opioid use disorder.
IssuesUse of crack cocaine and associated medical complications persists globally. Some reports i... more IssuesUse of crack cocaine and associated medical complications persists globally. Some reports in medical literature describe a sight‐threatening condition commonly referred to as ‘crack eye’ or ‘crack eye syndrome’. The purpose of this review is to describe what is known about crack eye from case reports in peer‐reviewed literature.ApproachA structured search was completed in MEDLINE, TOXLINE, EMBASE, PsychInfo, Scopus and Biomed Central, to collect case reports and case series on corneal complications attributed to crack cocaine smoking.Key FindingsOf 111 articles screened, 11 contained case reports or series. Thirty individual cases of ‘crack eye’ were reported. The majority (63%) of cases had bilateral involvement; 83% of all cases with microbial culture results had corneal infections. Aggressive treatment caused an improvement in 95% of all cases and 23% of all cases were lost to follow up. Of those who received treatment for corneal complications associated with crack cocaine...
BACKGROUND A mounting body of evidence suggests that polysubstance use (PSU) is common among peop... more BACKGROUND A mounting body of evidence suggests that polysubstance use (PSU) is common among people who use opioids (PWUO). Measuring PSU, however, is statistically and methodologically challenging. Person-centered analytical approaches (e.g., latent class analysis) provide a holistic understanding of individuals' substance use patterns and help understand PSU heterogeneities among PWUO and their specific needs in an inductive manner. We reviewed person-centered studies that characterized latent patterns of PSU among PWUO. METHODS We searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from inception, through to June 15, 2020, for empirical peer-reviewed studies or gray literature that reported on latent classes of PSU among PWUO. Two independent reviewers completed the title, abstract, full-text screening, and data extraction. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale, and quality of reporting was evaluated using the Guidelines for Reporting on Latent Trajectory Studies checklist. Studies' findings were summarized and presented in a narrative fashion. RESULTS Out of the 3372 initial unique studies identified, 30 were included. PSU operationalization varied substantially among the studies. We identified five distinct PSU latent classes frequently observed across the studies: Infrequent/low PSU, PSU primarily involving heroin use, PSU primarily involving heroin and stimulant use, PSU primarily involving stimulant use, and frequent PSU. Belonging to higher frequency or severity PSU classes were associated with frequent injection drug use, sharing needles and paraphernalia, high-risk sexual behaviours, as well as experiences of adversities, such as homelessness, incarceration, and poor mental health. CONCLUSION PSU patterns vary significantly across different subgroups of PWUO. The substantial heterogeneities among PWUO need to be acknowledged in substance use clinical practices and policy developments. Findings call for comprehensive interventions that recognize these within-group diversities and address the varying needs of PWUO.
North America has been experiencing an unprecedented epidemic of drug overdose. This study invest... more North America has been experiencing an unprecedented epidemic of drug overdose. This study investigated the associations of drug overdose with the risk of cardiovascular disease (CVD) and 11 major CVD subtypes. This nested case–control study was based on a cohort of 20% random sample of residents in British Columbia, Canada, who were aged 18–80 years and did not have known CVD at baseline (n = 617,863). During a 4-year follow-up period, persons who developed incident CVD were identified as case subjects, and the onset date of CVD was defined as the index date. For each case subject, we used incidence density sampling to randomly select up to five control subjects from the cohort members who were alive and did not have known CVD by the index date, were admitted to an emergency department or hospital on the index date for non-CVD causes, and were matched on age, sex, and region of residence. Overdose exposure on the index date and each of the previous 5 days was examined for each subject. This study included 16,113 CVD case subjects (mean age 53 years, 59% male) and 66,875 control subjects. After adjusting for covariates, overdose that occurred on the index date was strongly associated with CVD [odds ratio (OR), 2.9; 95% confidence interval (CI), 2.4–3.5], especially for arrhythmia (OR, 8.6; 95% CI, 6.2–12.0), ischemic stroke (OR, 5.3; 95% CI, 2.0–14.1), hemorrhagic stroke (OR, 3.1; 95% CI, 1.2–8.3), and myocardial infarction (OR, 3.0; 95% CI, 1.5–5.8). The CVD risk was decreased but remained significantly elevated for overdose that occurred on the previous day, and was not observed for overdose that occurred on each of the previous 2–5 days. Drug overdose appears to be associated with increased risk of cardiovascular diseases.
Purpose This study aims to describe knowledge of Canada’s Good Samaritan Drug Overdose Act (GSDOA... more Purpose This study aims to describe knowledge of Canada’s Good Samaritan Drug Overdose Act (GSDOA) and take home naloxone (THN) training and kit possession among people being released from provincial correctional facilities in British Columbia. Design/methodology/approach The authors conducted surveys with clients of the Unlocking the Gates Peer Health Mentoring program on their release. The authors compared the characteristics of people who had and had not heard of the GSDOA and who were in possession of a THN kit. Findings In this study, 71% people had heard of the GSDOA, and 55.6% were in possession of a THN kit. This study found that 99% of people who had heard of the GSDOA indicated that they would call 911 if they saw an overdose. Among people who perceived themselves to be at risk of overdose, 28.3% did not have a THN kit. Only half (52%) of participants had a mobile phone, but 100% of those with a phone said they would call 911 if they witnessed an overdose. Originality/valu...
This review will identify factors that are negatively and positively associated with access to me... more This review will identify factors that are negatively and positively associated with access to medically-assisted treatment (MAT) and examine the prevalence of MAT access among adolescents and young adults with opioid use disorder.
IssuesUse of crack cocaine and associated medical complications persists globally. Some reports i... more IssuesUse of crack cocaine and associated medical complications persists globally. Some reports in medical literature describe a sight‐threatening condition commonly referred to as ‘crack eye’ or ‘crack eye syndrome’. The purpose of this review is to describe what is known about crack eye from case reports in peer‐reviewed literature.ApproachA structured search was completed in MEDLINE, TOXLINE, EMBASE, PsychInfo, Scopus and Biomed Central, to collect case reports and case series on corneal complications attributed to crack cocaine smoking.Key FindingsOf 111 articles screened, 11 contained case reports or series. Thirty individual cases of ‘crack eye’ were reported. The majority (63%) of cases had bilateral involvement; 83% of all cases with microbial culture results had corneal infections. Aggressive treatment caused an improvement in 95% of all cases and 23% of all cases were lost to follow up. Of those who received treatment for corneal complications associated with crack cocaine...
BACKGROUND A mounting body of evidence suggests that polysubstance use (PSU) is common among peop... more BACKGROUND A mounting body of evidence suggests that polysubstance use (PSU) is common among people who use opioids (PWUO). Measuring PSU, however, is statistically and methodologically challenging. Person-centered analytical approaches (e.g., latent class analysis) provide a holistic understanding of individuals' substance use patterns and help understand PSU heterogeneities among PWUO and their specific needs in an inductive manner. We reviewed person-centered studies that characterized latent patterns of PSU among PWUO. METHODS We searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from inception, through to June 15, 2020, for empirical peer-reviewed studies or gray literature that reported on latent classes of PSU among PWUO. Two independent reviewers completed the title, abstract, full-text screening, and data extraction. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale, and quality of reporting was evaluated using the Guidelines for Reporting on Latent Trajectory Studies checklist. Studies' findings were summarized and presented in a narrative fashion. RESULTS Out of the 3372 initial unique studies identified, 30 were included. PSU operationalization varied substantially among the studies. We identified five distinct PSU latent classes frequently observed across the studies: Infrequent/low PSU, PSU primarily involving heroin use, PSU primarily involving heroin and stimulant use, PSU primarily involving stimulant use, and frequent PSU. Belonging to higher frequency or severity PSU classes were associated with frequent injection drug use, sharing needles and paraphernalia, high-risk sexual behaviours, as well as experiences of adversities, such as homelessness, incarceration, and poor mental health. CONCLUSION PSU patterns vary significantly across different subgroups of PWUO. The substantial heterogeneities among PWUO need to be acknowledged in substance use clinical practices and policy developments. Findings call for comprehensive interventions that recognize these within-group diversities and address the varying needs of PWUO.
North America has been experiencing an unprecedented epidemic of drug overdose. This study invest... more North America has been experiencing an unprecedented epidemic of drug overdose. This study investigated the associations of drug overdose with the risk of cardiovascular disease (CVD) and 11 major CVD subtypes. This nested case–control study was based on a cohort of 20% random sample of residents in British Columbia, Canada, who were aged 18–80 years and did not have known CVD at baseline (n = 617,863). During a 4-year follow-up period, persons who developed incident CVD were identified as case subjects, and the onset date of CVD was defined as the index date. For each case subject, we used incidence density sampling to randomly select up to five control subjects from the cohort members who were alive and did not have known CVD by the index date, were admitted to an emergency department or hospital on the index date for non-CVD causes, and were matched on age, sex, and region of residence. Overdose exposure on the index date and each of the previous 5 days was examined for each subject. This study included 16,113 CVD case subjects (mean age 53 years, 59% male) and 66,875 control subjects. After adjusting for covariates, overdose that occurred on the index date was strongly associated with CVD [odds ratio (OR), 2.9; 95% confidence interval (CI), 2.4–3.5], especially for arrhythmia (OR, 8.6; 95% CI, 6.2–12.0), ischemic stroke (OR, 5.3; 95% CI, 2.0–14.1), hemorrhagic stroke (OR, 3.1; 95% CI, 1.2–8.3), and myocardial infarction (OR, 3.0; 95% CI, 1.5–5.8). The CVD risk was decreased but remained significantly elevated for overdose that occurred on the previous day, and was not observed for overdose that occurred on each of the previous 2–5 days. Drug overdose appears to be associated with increased risk of cardiovascular diseases.
Purpose This study aims to describe knowledge of Canada’s Good Samaritan Drug Overdose Act (GSDOA... more Purpose This study aims to describe knowledge of Canada’s Good Samaritan Drug Overdose Act (GSDOA) and take home naloxone (THN) training and kit possession among people being released from provincial correctional facilities in British Columbia. Design/methodology/approach The authors conducted surveys with clients of the Unlocking the Gates Peer Health Mentoring program on their release. The authors compared the characteristics of people who had and had not heard of the GSDOA and who were in possession of a THN kit. Findings In this study, 71% people had heard of the GSDOA, and 55.6% were in possession of a THN kit. This study found that 99% of people who had heard of the GSDOA indicated that they would call 911 if they saw an overdose. Among people who perceived themselves to be at risk of overdose, 28.3% did not have a THN kit. Only half (52%) of participants had a mobile phone, but 100% of those with a phone said they would call 911 if they witnessed an overdose. Originality/valu...
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Papers by Jane Buxton