Canadian Journal of Public Health-Revue Canadienne De Sante Publique最新文献

{"title":"A call for upstream solutions to the unregulated drug crisis in British Columbia, Canada: Locked up or locked out.","authors":"Angela Russolillo","doi":"10.17269/s41997-025-01065-x","DOIUrl":"https://doi.org/10.17269/s41997-025-01065-x","url":null,"abstract":"<p><p>The unregulated drug crisis has raised growing concerns about the care and treatment of people experiencing complex mental health and substance use issues in British Columbia (BC). The BC government's recent plans for expansion of involuntary treatment across the province demonstrate a misguided understanding of mental health and substance use disorders. Relying on involuntary treatment as a primary response to this public health issue raises several ethical and clinical concerns. With the majority of evidence on involuntary treatment demonstrating limited effectiveness, and potential for increased harms, alternative evidence-based approaches are urgently needed. Addressing this public health challenge requires a shift away from involuntary treatment to person-centered, voluntary, integrated, and community-based solutions that address the social determinants of health. This commentary will review the limitations, clinical challenges, and policy alternatives to involuntary treatment of adults with substance use disorders.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Northwest Territories illicit drug trade and toxic drug crisis response.","authors":"Kami Kandola, Samantha Thomas","doi":"10.17269/s41997-025-01051-3","DOIUrl":"https://doi.org/10.17269/s41997-025-01051-3","url":null,"abstract":"<p><strong>Setting: </strong>The Northwest Territories (NWT) is a sparsely populated, predominantly Indigenous, northern jurisdiction with 33 communities scattered over 1.2 million square kilometres. Though the NWT has seen a delay in the effects of the larger opioid-related epidemic that Canada has been experiencing for years, organized criminals are now seeing NWT as an untapped market to exploit for higher profits. This article highlights our northern context and innovative response to the toxic drug crisis through describing harm reduction interventions such as community-informed education, coordinated early warning efforts, and community collaboration.</p><p><strong>Interventions: </strong>Interventions prompted by the 2022 cluster of deaths: • The NWT Chief Public Health Officer set up an early warning system among first responders, while working together with intergovernmental partners. The warnings received from first responders resulted in 13 out of 15 of the NWT substance-related public health advisories since 2020 (GNWT, 2024b). • Initial responses to overdose clusters and community conversations have informed numerous community/regional presentations to residents, non-government agencies, and government stakeholders. • Additional harm reduction supplies were distributed, including 2000 naloxone kits (outside of what pharmacies/health authorities already provide) and 1590 fentanyl testing strips. • Community learning has led to the development of educational materials such as \"Drugs in the NWT\" (GNWT, 2025  https://www.hss.gov.nt.ca/en/services/drugs-nwt ) that can further be used by community to inform discussions from within. • In October 2024, the addition of the Randox MultiSTAT Analyzer ( https://www.randoxtoxicology.com/post-mortem-toxicology/ ) allowed for rapid toxicology screening in the morgue by the Office of the Chief Coroner (GNWT, 2024a). • Testing for illegal drugs in the wastewater surveillance program is now captured on the Canadian Drug and Substance Watch (CDSW) ( https://health-infobase.canada.ca/canadian-drug-and-substance-watch/ ) website.</p><p><strong>Outcomes/implications: </strong>Innovative interventions paired with community calls to action are allowing the NWT to tackle the toxic drug crisis from multiple angles in the hopes of saving lives.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reclaiming urban space for children: Examining the impact of School Streets on independent mobility and active transport.","authors":"Zeinab Aliyas, Carise Thompson, Fanny Bakkali, Patricia A Collins, Katherine L Frohlich","doi":"10.17269/s41997-025-01058-w","DOIUrl":"https://doi.org/10.17269/s41997-025-01058-w","url":null,"abstract":"<p><strong>Intervention: </strong>School Street initiatives are traffic-free zones around the entrances of primary schools designed to make it safer for children to come and go from school. Beyond increasing safety, these initiatives offer opportunities for children to increase their engagement in active school travel and to become more independently mobile.</p><p><strong>Research question: </strong>How does the implementation of a School Street intervention influence children's active travel and independent mobility on their way to school?</p><p><strong>Methods: </strong>A School Street intervention was implemented every Friday at a primary school in Montreal from September 2022 to June 2023. Bi-monthly direct observations were conducted to collect data on children's modes of travel and whether they travelled independently or with an adult before the start of classes.</p><p><strong>Results: </strong>Independent, active travel was more frequently observed on School Street days compared to non-School Street days. Additionally, a progressive increase in active transportation and independent mobility was observed throughout the school year, regardless of School Street designation.</p><p><strong>Conclusion: </strong>This study underscores the potential impact of School Street interventions on enhancing children's active school travel and independent mobility. Establishing safe zones near schools can positively influence children's commuting behaviours, fostering healthier and more autonomous travel habits.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining opioid agonist treatment (OAT) site operations and early signals of change in the first year of British Columbia's drug decriminalization policy: Insights from a provincial survey.","authors":"Cayley Russell, Justine Law, Kate Hodgson, Laura MacKinnon, Rita Shahin, Frank Crichlow, Sean Patenaude, Sameer Imtiaz, Jürgen Rehm, Farihah Ali","doi":"10.17269/s41997-025-01060-2","DOIUrl":"10.17269/s41997-025-01060-2","url":null,"abstract":"<p><strong>Objective: </strong>On January 31, 2023, the province of British Columbia (BC) introduced a 3-year drug decriminalization initiative, with a goal of increasing access, engagement, and retention in drug use treatment. There is limited information on the operational characteristics of opioid agonist treatment (OAT) sites in BC. These data are required to monitor the impacts of decriminalization on these outcomes. This study sought to characterize OAT service operations and examine any preliminary operational changes following decriminalization, from the perspectives of OAT site staff.</p><p><strong>Methods: </strong>Between March and April 2024, a cross-sectional, online self-report survey was distributed to OAT sites across BC, completed by site representatives. Questions focused on OAT service operations, including service capacity, treatment retention, and clientele demographics, as well as potential changes to service operations due to decriminalization. Data were analyzed descriptively.</p><p><strong>Results: </strong>A total of 28 OAT sites from across BC completed the survey. Findings suggest that decriminalization has had limited impacts on OAT site operations within the first year of the policy's implementation. However, several sites reported early signals of change related to client socio-demographics, including seeing more male and younger clients, as well as an increase in demand on their staff and resources.</p><p><strong>Conclusion: </strong>Despite minimal changes to OAT site operations within the first year of BC's decriminalization policy, findings suggest the need for increased staff training on decriminalization and continued investments into OAT to better support the anticipated demand on services if decriminalization is to successfully reach its goal of improving access to treatment.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of take-home naloxone kits on opioid-related deaths in Alberta, Canada: An ecological analysis.","authors":"Eldon Spackman, Shainur Premji, Amy Woroniuk, Eddy Lang, Katrina Milaney, Kerry McBrien","doi":"10.17269/s41997-025-01056-y","DOIUrl":"https://doi.org/10.17269/s41997-025-01056-y","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the association between publicly provided take-home naloxone kits and opioid-related deaths.</p><p><strong>Methods: </strong>We analyzed 2732 opioid-related deaths and the distribution of 147,814 naloxone kits between January 2015 and June 2019 across five health zones in Alberta, Canada. We used a Poisson pseudo-maximum likelihood regression model with fixed effects to estimate the association between the number of kits in circulation and the number of monthly opioid-related deaths, controlling for population demographics, socio-economic indicators, other harm reduction strategies, police seizures of fentanyl and carfentanil, and an estimate of awareness.</p><p><strong>Results: </strong>Every 10,000 kits in circulation was associated with a 23.9% (95% confidence interval (CI), 12.6-33.7) reduction in opioid-related deaths. Marginal analysis suggests that if no kits had been distributed, Alberta would have had 3548 deaths (95% CI, 2264-4831), 816 more deaths than were recorded during this 4.5-year period. If during this time 200,000 kits were consistently in circulation, Alberta would have had an estimated 1587 deaths (95% CI, 705-2468), 1145 fewer deaths than recorded.</p><p><strong>Conclusion: </strong>This analysis provides evidence that the availability of naloxone kits is associated with a reduction in opioid-related deaths and suggests that a publicly funded program that allows the distribution of naloxone kits to all who request them reduces mortality.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responding to the toxic drug crisis: Promising innovations, gaps, and calls to action.","authors":"Karen Urbanoski, David Moore, Cory Neudorf, Elaine Hyshka, Rodney Knight","doi":"10.17269/s41997-025-01068-8","DOIUrl":"10.17269/s41997-025-01068-8","url":null,"abstract":"","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"335-339"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent behavioural intentions: Secondary outcomes from a cluster randomized controlled trial of the Health4Life school-based lifestyle modification intervention.","authors":"Siobhan O'Dean, Scarlett Smout, Matthew Sunderland, Tim Slade, Lauren A Gardner, Cath Chapman, Louise Thornton, Bridie Osman, Emily Hunter, Lyra Egan, Maree Teesson, Nicola C Newton, Katrina E Champion","doi":"10.17269/s41997-024-00955-w","DOIUrl":"10.17269/s41997-024-00955-w","url":null,"abstract":"<p><strong>Intervention: </strong>Health4Life: a school-based eHealth intervention targeting multiple health behaviour change (MHBC).</p><p><strong>Research question: </strong>Does Health4Life impact secondary outcomes of self-reported intentions regarding six lifestyle behaviours in adolescents (alcohol use, tobacco smoking, screentime, physical activity, discretionary beverage consumption, and sleep)?</p><p><strong>Methods: </strong>We implemented a cluster randomized controlled trial within secondary schools across three Australian states. Schools were randomly assigned (1:1) to receive either the Health4Life intervention, which consisted of a six-module, web-based program and accompanying smartphone app, or an active control (standard health education). Randomization was stratified by site and school gender composition (using Blockrand in R). All students aged 11-13 years who attended the participating schools and were fluent in English were eligible. Students completed self-report questionnaires at baseline, post-intervention, 12 months, and 24 months. Outcomes were intentions to try alcohol, try tobacco, reduce screentime, engage in physical activity on most or all days, swap discretionary beverages for water, and meet sleep guidelines. Mixed effects models estimated between-group differences in the outcomes over 24 months.</p><p><strong>Results: </strong>Immediately post-intervention, Health4Life significantly reduced intentions to try alcohol and tobacco and increased intentions for longer sleep and reduced screentime compared to control. Intervention effects on screentime intentions persisted at 12 months but not at 24 months. No lasting effects were observed on intentions for physical activity or discretionary beverage consumption.</p><p><strong>Conclusion: </strong>Health4Life shows promise in influencing adolescent intentions across various MHBC areas, especially immediately after intervention. However, further investigation is needed to sustain these intention changes beyond short term to facilitate behaviour change.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"432-445"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical narcissism and Ontario's opioid crisis.","authors":"Emily Groot","doi":"10.17269/s41997-025-01019-3","DOIUrl":"10.17269/s41997-025-01019-3","url":null,"abstract":"<p><p>Northern Ontario is the largest and least populated region of the Canadian province of Ontario. Like other rural, remote, and northern regions, Northern Ontario has been disproportionately impacted by the opioid crisis, with an opioid-related mortality rate more than twice that of the province as a whole. Social exclusion is a predictor of drug use, and the urban core-hinterland periphery socioeconomic relationship that undergirds Northern Ontario's economy results in social degradation and economic marginalization. Along with deindustrialization and increased employment precarity, lack of access to health services, and higher rates of work-related pain, the exclusion inherent to the core-hinterland relationship increases risk of opioid-related mortality. Although the inequities in both the determinants and outcomes of substance use in Northern Ontario are stark, research, policy, and intervention continue to focus on Southern Ontario.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"418-421"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decriminalization undone: Assessing the amendment to British Columbia's decriminalization of personal drug possession framework.","authors":"Kelsey A Speed, Kat Gallant, Mathew Fleury, Erica McAdam, Tyson Singh Kelsall","doi":"10.17269/s41997-025-01012-w","DOIUrl":"10.17269/s41997-025-01012-w","url":null,"abstract":"<p><p>The Province of British Columbia (BC) is in the midst of an ongoing public health emergency, declared in 2016 in response to significant levels of drug poisonings/overdoses stemming from the unregulated drug supply. In response, BC implemented decriminalization in 2023, removing criminal sanctions for adults possessing up to 2.5 cumulative grams of opioids, cocaine, methamphetamine, and MDMA. Approximately 15 months later, BC amended their decriminalization framework, effectively re-criminalizing public drug consumption and possession in public spaces across BC to prioritize safety to an undefined \"public\" over the health and safety of people who are structurally marginalized by dominant, intersecting systems of power. This commentary assesses BC's amended decriminalization framework through a public health lens, to examine how this unbalanced prioritization of \"public safety\" (as defined by law enforcement bodies) contributes to health and social inequities. By focusing on the (1) discursive exclusion of members of the public who already endure structural marginalization in the weaponization of \"public safety,\" (2) escalation of efforts to displace these groups from public spaces, and (3) opportunity costs of law enforcement prioritization, we argue that BC's most recent drug policy shift is incompatible with its stated goal of balancing public safety and public health.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"427-431"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-related deaths in Northern Ontario in the early COVID-19 pandemic period.","authors":"Alexandra Nunn, Amanda M Perri, Hilary Gordon, John P D Harding, C K Jennifer Loo, John Tuinema","doi":"10.17269/s41997-024-00906-5","DOIUrl":"10.17269/s41997-024-00906-5","url":null,"abstract":"<p><strong>Objectives: </strong>In the first year of pandemic measures, opioid-related deaths across Ontario's (ON) 34 public health units (PHUs) increased by 60%. Death rates for all seven Northern ON PHUs were above the provincial average. This study describes and compares factors surrounding opioid-related deaths before and after pandemic measures were introduced, for Northern ON compared to the rest of ON.</p><p><strong>Methods: </strong>Aggregate data were provided for Northern ON and the rest of the province by the Office of the Chief Coroner/Ontario Forensic Pathology Services. Opioid-related deaths were cohorted by date of death for the year before and after pandemic measures were introduced on March 16, 2020. Chi-square tests were used to compare between cohorts and geographies to determine significant differences for each variable, and for dichotomized levels within variables. P-values < 0.05 were considered statistically significant a priori.</p><p><strong>Results: </strong>In Northern ON, the number of opioid-related deaths approximately doubled from the pre-pandemic cohort (n = 185) to the early pandemic cohort (n = 365). Compared to the rest of ON, higher proportions of deaths occurred in Northern ON among individuals who lived and died in private residences, among women (although the majority of decedents were male) and among individuals employed in mining, quarrying, and oil and gas industries. Compared to the pre-pandemic year, in Northern ON, higher proportions of opioid-related deaths involved fentanyl and stimulants as direct contributors, and the majority involved evidence of inhaled drugs.</p><p><strong>Conclusion: </strong>Differences between the circumstances of death in Northern ON and in the rest of ON suggest opportunities to tailor interventions.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"344-355"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}