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

{"title":"Predictors of overdose response hotline use for mental health and fatal overdose prevention.","authors":"Will Rioux, Dylan Viste, Taylor Orr, Nathan Rider, S Monty Ghosh","doi":"10.17269/s41997-024-00981-8","DOIUrl":"10.17269/s41997-024-00981-8","url":null,"abstract":"<p><strong>Objectives: </strong>The overdose crisis remains one of the largest public health issues facing North America to date. Formalized virtual spotting services have gained popularity as a harm reduction intervention, proving early effectiveness in reducing overdose mortality. This study determined the characteristics of individuals who recurrently use one such service, Canada's National Overdose Response Service (NORS).</p><p><strong>Methods: </strong>In this retrospective study, call logs from NORS were analyzed from service inception. Demographics including age, gender, province, community size, substance used, routes of administration, and adverse events were all collected and imputed into a marginal means and rates model to determine the predictors of recurrent service use.</p><p><strong>Results: </strong>A total of 7340 unique calls were included within our analysis. Of those, 1167 (15.8%) reported their gender as male, 3744 (51.0%) as female, and 1329 (18.1%) as gender diverse, and 1100 (14.9%) did not report their gender. In terms of age, 46 (0.6%) were individuals under the age of 18 years, 3561 (48.5%) were between 18 and 30, 557 (7.6%) were between 31 and 40, 2505 (34.1%) were between 41 and 50, 525 (7.1%) were age 51 or over, and 146 (2.0%) did not report their age. Men's rate ratios for recurrent calls were significantly lower than women's (RR = 0.08, 95% CI = 0.07‒0.09), as were those for respondents aged 31‒40 years as compared with those aged 18‒30 (RR = 0.26, 95% CI = 0.15‒0.45). Between regions, rate ratios for callers from British Columbia (RR = 0.28, 95% CI = 0.17‒2.24) and Atlantic provinces (RR = 0.09; 95% CI = 0.07‒0.12) were significantly lower than those for callers from the province of Ontario. Similarly, rural callers demonstrated lower recurrent service use (RR = 0.08; 95% CI = 0.07‒0.11) than their urban counterparts.</p><p><strong>Conclusion: </strong>NORS demonstrates higher usage patterns within certain demographic groups, in particular, urban women. The results can therefore be used to target public health messaging toward those who derive the most benefit from the service and to tailor programming to those who are at highest risk to use alone.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"364-375"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450845","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":"Resident and staff experiences of structural barriers to a housing-based overdose prevention site in Vancouver, Canada: \"There is a double standard if you smoke\".","authors":"Benjamin D Scher, Benjamin W Chrisinger, David K Humphreys, Gillian W Shorter","doi":"10.17269/s41997-025-01007-7","DOIUrl":"10.17269/s41997-025-01007-7","url":null,"abstract":"<p><strong>Objectives: </strong>Most overdoses in British Columbia (BC), Canada, occur within housing settings. In response, the provincial government is increasingly implementing housing-based overdose prevention sites (HOPS). Within the context of a contaminated drug supply, and changing consumption practices, there is little research examining the effectiveness of HOPS. The aim of this study was to explore qualitatively how residents and staff experience HOPS, focusing on how this intervention fits into the day-to-day operations of a low-barrier housing facility.</p><p><strong>Methods: </strong>This study was undertaken at a non-profit housing and emergency shelter facility, with a HOPS in Vancouver, BC. We employed rapid-ethnographic methods including six weeks of non-participant observation (> 200 h), three focus groups, 20 informal interviews with residents, and 10 semi-structured interviews with staff. Data were analyzed through an inductive thematic approach.</p><p><strong>Results: </strong>Our results suggest that this facility's HOPS is underutilized due to a variety of structural factors, the most prominent of these being the lack of inhalation services. This lack of service provision exacerbates overdose vulnerability and stigma. Continued drug consumption near the building and in non-monitored areas inside the building creates challenges for staff in identifying potential overdoses and exposes residents who do not consume drugs to drug use within the building.</p><p><strong>Conclusion: </strong>Housing provision which provides a safer consumption environment to include those who smoke drugs is urgently needed to support both individuals who smoke and those looking to transition from injecting to smoking.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"387-397"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659697","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":"Removing barriers to care: The importance of addressing nonfatal overdoses among women living with HIV in British Columbia, Canada.","authors":"Megan E Marziali, Katherine W Kooij, Silvia S Martins, Morgan M Philbin, Julio S G Montaner, Robert S Hogg","doi":"10.17269/s41997-025-01026-4","DOIUrl":"10.17269/s41997-025-01026-4","url":null,"abstract":"<p><p>The overdose and drug toxicity crisis continues to devastate communities across Canada. British Columbia has an overdose mortality rate nearly double the Canadian national average, emphasizing a dire need for proactive public health approaches. Within the general population, men experience higher overdose mortality rates in comparison to women; however, among people with HIV, the disparity is inverted such that women with HIV experience higher overdose mortality rates than men with HIV. Less is known concerning the epidemiology of nonfatal overdoses among people with HIV, and understanding gender disparities in nonfatal overdoses would allow public health practitioners and policymakers to focus evidence-informed interventions and clinical guidelines for people most in need. In this commentary, we propose that systemic and structural barriers function to hinder access to crucial services for women with HIV, thus placing them at a disproportionately high risk for nonfatal overdose. We argue that additional research is needed to understand how to completely address these barriers in order to create programmatic changes. Fatal overdoses are a failure of the healthcare system; intervening after the occurrence of a nonfatal overdose is crucial in order to prevent a subsequent fatal overdose.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"422-426"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755758","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":"Acute gastrointestinal illness burden associated with water recreation in high-income countries: A scoping review.","authors":"Henry Ngo, Charlotte Winder, Nicole Ricker, E Jane Parmley, Heather M Murphy","doi":"10.17269/s41997-024-00963-w","DOIUrl":"10.17269/s41997-024-00963-w","url":null,"abstract":"<p><strong>Objectives: </strong>The burden of acute gastrointestinal illness (AGI) attributable to natural water recreation in Canada is unknown. Understanding the burden can help prioritize public health interventions and resource allocation for reduction of disease. Our objectives were to compile estimates of AGI burden associated with natural water recreation, identify knowledge gaps in water recreation epidemiology, and evaluate methods applicable for developing a burden estimate for Canada.</p><p><strong>Methods: </strong>We conducted a scoping review of the literature. From a total of 2752 unique records identified, 35 met eligibility for inclusion. Articles were chosen if they examined burden in natural waterways, were written in English, and were based in countries of similar economic status to Canada in non-tropical regions. Burden was defined as either: incidence or prevalence, disability-adjusted life years (DALYs), quality-adjusted life years (QALYs), or economic cost.</p><p><strong>Results: </strong>Swimming or wading were the predominant forms of recreation examined (n = 32/35; 91.4%). Waterways studied were primarily marine or coastal beaches (n = 24/35; 68.6%) and were located within or adjacent to urban areas (n = 29/35; 82.9%). The most common indicator for burden was incidence or prevalence (n = 30/35; 85.7%). Prospective cohort studies (n = 17/35; 48.6%) and predictive modelling based on microorganism concentrations (n = 9/35; 25.7%) were the most common methods of estimation.</p><p><strong>Conclusion: </strong>The review highlighted several knowledge gaps regarding recreational waterborne disease burden. Freshwater recreation, rural waterways, and recreational activities other than swimming and wading require further study. We propose that quantitative microbial risk assessment may be an appropriate, cost-effective method to estimate recreational waterborne disease burden in Canada.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"464-483"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814659","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":"Safer Opioid Supply programs: Hydromorphone prescribing in Ontario as a harm reduction intervention to combat the drug poisoning crisis.","authors":"Rose A Schmidt, Adrian Guta, Nanky Rai, Andrea Sereda, Emmet O'Reilly, Jessica Hales, Gillian Kolla, Carol Strike","doi":"10.17269/s41997-024-00979-2","DOIUrl":"10.17269/s41997-024-00979-2","url":null,"abstract":"<p><strong>Setting: </strong>The crisis of unregulated fentanyl-related overdose deaths presents a significant public health challenge. This article describes the implementation and evaluation of four Safer Opioid Supply programs (SSPs) in Ontario, one in London and three in Toronto.</p><p><strong>Intervention and implementation: </strong>SSPs aim to curtail overdose fatalities while connecting individuals using drugs to healthcare services. The programs involve a daily dispensed prescription of immediate-release hydromorphone tablets for take-home dosing alongside an observed dose of long-acting opioids like slow-release oral morphine. Implemented within a multidisciplinary primary care framework, these programs emphasize patient-centred approaches and comprehensive health and social support.</p><p><strong>Outcomes: </strong>In our study conducted in 2020/2021, clients and service providers reported that receiving pharmaceutical opioids through these programs improved the clients' health and well-being. The regulated supply was reported to lead to decreases in overdose incidents, use of unregulated substances, and criminalized activities. Increased engagement with healthcare and harm reduction services and improvements in social determinants of health, such as food security, were also reported. Despite these positive outcomes, some implementation challenges, including capacity issues and provider burnout, were described by service providers.</p><p><strong>Implications: </strong>Our findings suggest that the combination of safer supply, wrap-around support, and harm reduction within primary care settings can lead to increased healthcare engagement, HIV/HCV prevention, testing, and treatment uptake, reducing the burden of infectious diseases and overdose risk. SSPs have the potential to meaningfully reduce overdose rates, address the ongoing overdose crisis, and if scaled up, influence population-level outcomes.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"398-407"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808323","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":"Implementation and evaluation of a novel community-based urban mobile health clinic in Toronto, Ontario.","authors":"Meghan O'Neill, Robert J Redelmeier, Camilla Michalski, Raymond Macaraeg, Maureen Gans, Alice Schoffel, Lori M Diemert, Luwam Ogbaselassie, Laura C Rosella, Andrew Boozary","doi":"10.17269/s41997-024-00962-x","DOIUrl":"10.17269/s41997-024-00962-x","url":null,"abstract":"<p><strong>Setting: </strong>Despite Canada's single-payer health system, marginalized populations often experience poor health outcomes and barriers to healthcare access. In response, mobile health clinics (MHCs) have been deployed in several cities across Canada. MHCs are well established in the United States; however, little is known about their role and impact in a country with universal healthcare. We describe the implementation of an urban MHC and early learnings from a mixed methods process and outcome-oriented evaluation.</p><p><strong>Intervention: </strong>In February 2021, Parkdale Queen West Community Health Centre, TELUS Health for Good, and University Health Network's Gattuso Centre for Social Medicine partnered to launch a nurse practitioner‒led, community-based MHC in Toronto, Ontario. The MHC provides low-barrier primary healthcare, harm reduction, and mental health services at five convenient locations.</p><p><strong>Outcomes: </strong>Through an intercept survey (n = 49) and semi-structured interviews (n = 10), we sought to understand the sociodemographic characteristics of clients, their experiences at the MHC, and barriers and facilitators to the MHC in comparison to traditional healthcare settings. Most clients surveyed reported being homeless (61%). Without the MHC, 37% of clients would have accessed care at an emergency department and 18% would not have sought care. Thematic analysis revealed two structural and two relational factors that improved care experiences and care access.</p><p><strong>Implications: </strong>We demonstrate that in a single-payer health system, MHCs alleviate major barriers to care access for marginalized populations. Learnings provide context to the most salient factors influencing clients' decisions to seek care at MHCs and can inform how these outreach models are designed.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"484-492"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980649","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":"Innovation through collaboration: Identifying opportunities to improve congenital anomalies surveillance in Canada.","authors":"Yonabeth Nava de Escalante, Tanya Bedard, Cora Cole, Kitty Dang, Maya Jeyaraman, Kathryn Johnston, Qun Miao, Lauren Rickert","doi":"10.17269/s41997-024-00949-8","DOIUrl":"10.17269/s41997-024-00949-8","url":null,"abstract":"<p><strong>Setting: </strong>The burden of congenital anomalies is a significant public health concern. In response to the World Health Organization's recommendations, Canada developed and strengthened congenital anomalies surveillance to build capacity for prevention and optimal health outcomes. Historically, the Public Health Agency of Canada (PHAC) exclusively used hospital discharge data for the Canadian Congenital Anomalies Surveillance System (CCASS). A primary objective of the CCASS is to report prevalence, trends, and factors associated with congenital anomalies in Canada. However, the purpose of hospital discharge data is not for congenital anomalies surveillance; therefore, enhanced local data, which have more complete case ascertainment and additional data quality measures, are necessary.</p><p><strong>Intervention: </strong>Recognizing these significant limitations, PHAC, the provincial and territorial governments, physicians, public health practitioners, and academics collaborated on a project to enhance the CCASS with regional data and expertise. Subsequently, the Government of Canada InfoBase platform will use this enhanced dataset for national reporting.</p><p><strong>Outcomes: </strong>We developed standardized case definitions, a data submission form, and data quality tools, and surveyed programs to describe local congenital anomalies surveillance practice, and to identify barriers and facilitators that impact congenital anomalies surveillance efforts.</p><p><strong>Implications: </strong>This synergistic collaboration across jurisdictions, disciplines, and health care sectors is essential to support Canada's enhanced congenital anomalies surveillance. We identified common themes on funding, operational requirements, data standardization, and legal and privacy considerations from the survey. These themes can be used to inform policy and decision-makers for sustainable congenital anomalies surveillance and to amplify the current momentum.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"456-463"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792836","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":"Novel adulterants in unregulated opioids and their associations with adverse events.","authors":"Samuel Tobias, Jennifer Angelucci, Evan Wood, Jane A Buxton, Lianping Ti","doi":"10.17269/s41997-024-00990-7","DOIUrl":"10.17269/s41997-024-00990-7","url":null,"abstract":"<p><strong>Objective: </strong>In recent years, Canada's unregulated drug supply has become permeated by novel adulterants (e.g., fentanyl analogues, benzodiazepines, xylazine). While fentanyl has been shown to be associated with overdose mortality and other non-fatal health outcomes, adverse events (AE) associated with these adulterants remain poorly described. This study seeks to identify whether common adulterants identified through drug checking services are associated with increased prevalence of specific adverse events reportedly experienced by people who use drugs.</p><p><strong>Methods: </strong>Drug checking samples were analyzed using Fourier-transform infrared spectroscopy and immunoassay strips at harm reduction sites in British Columbia. Self-reported AE (e.g., non-fatal overdose, prolonged sedation, seizures) were recorded from individuals who checked opioids post-consumption. Adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) of AE among common adulterants were calculated using generalized linear models with a Poisson distribution, controlled for presence of other adulterants, expected drug, geographic location, and month.</p><p><strong>Results: </strong>Between February 2022 and May 2024, 80,415 samples were analyzed at community sites. Among eligible samples, 36.1% were expected opioids, 42.2% of which were checked post-consumption. AE were noted among 10.7% of post-consumption opioid drug checks. After adjustment, the presence of benzodiazepines in opioid samples was associated with increased prevalence of any AE (aPR 1.97; 95% CI 1.70-2.27), as was the presence of xylazine (aPR 1.50; 95% CI 1.09-2.07). Considering specific AE, benzodiazepines were associated with increased prevalence of overdose (aPR 2.05; 95% CI 1.68-2.51) and prolonged sedation (aPR 3.35; 95% CI 2.54-4.43).</p><p><strong>Conclusion: </strong>Non-fatal AE associated with unregulated opioids have been largely undescribed. Our findings report specific AE associated with different adulterants in the unregulated opioid supply. With this information, tailored public health interventions and services focused on these adulterants can be developed.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"356-363"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493754","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":"Factors associated with low self-compassion in young adults.","authors":"Erin K O'Loughlin, Maryam Marashi, Shannon Beer, Catherine M Sabiston, Amy E Nesbitt, Roxy H O'Rourke, Marie-Pierre Sylvestre, Jennifer L O'Loughlin","doi":"10.17269/s41997-024-00965-8","DOIUrl":"10.17269/s41997-024-00965-8","url":null,"abstract":"<p><strong>Objective: </strong>Self-compassion comprises treating oneself non-judgementally with kindness and understanding during life challenges. Our aim was to identify, from among a diverse set of sociodemographic, lifestyle behavioural, psychological, family/peer social influence, and health indicators, factors associated with low self-compassion in a population-based sample of young adults.</p><p><strong>Methods: </strong>Data on 37 factors potentially associated with low self-compassion were drawn from cycle 23 of the ongoing 24-year Nicotine Dependence in Teens (NDIT) study for 682 participants (M_age 30.5, SD = 1.0, 41% male). Self-compassion data were drawn from cycle 25 (M_age 35.2, SD = 0.6). Crude and adjusted multivariable logistic regression models were fit separately for each factor studied.</p><p><strong>Results: </strong>Sixteen percent of participants reported low self-compassion. Factors associated with low self-compassion included female sex, poor sleep quality, higher frequency of overeating, trying to lose weight, higher depressive symptoms, low self-esteem, higher daily stress, body-related emotions, higher introjected regulation for physical activity, receiving negative comments about weight, poor self-rated health, and diagnosis of a mood or anxiety disorder.</p><p><strong>Conclusion: </strong>A complex array of factors may influence self-compassion, underscoring the need for better understanding of causality as well as the relationships across factors to determine which factors hold promise in terms of intervention.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"446-455"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734463","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":"Comprehensive substance use services within primary care settings: The Safer Opioid Supply program at London InterCommunity Health Centre.","authors":"Kaitlin Fajber, Andrea Sereda, Sean Warren, Cassidy Morris, Greg Nash, Bernie Pauly, Karen Urbanoski, Gillian Kolla","doi":"10.17269/s41997-025-01006-8","DOIUrl":"10.17269/s41997-025-01006-8","url":null,"abstract":"<p><strong>Setting: </strong>This paper describes the Safer Opioid Supply (SOS) program, a public health intervention in London, Ontario, in response to the toxic unregulated drug supply which is driving the overdose crisis in Canada.</p><p><strong>Intervention: </strong>The London InterCommunity Health Centre (LIHC) SOS program provides comprehensive harm reduction and primary health care services to individuals at risk of overdose from the toxic drug supply. Clients are prescribed high-dose pharmaceutical opioids as replacement for unregulated toxic substances within a low-barrier primary care clinic, with wraparound interdisciplinary social services, embedded in the Ontario Community Health Centre model of care. The program serves people dependent on street-acquired fentanyl who are experiencing medical issues due to their substance use, and who are experiencing challenges accessing other forms of healthcare.</p><p><strong>Outcomes: </strong>A qualitative analysis of interviews and focus groups conducted in 2022-2023 with staff (n=5) and clients (n=20) was used to explore impacts of the SOS program. Four outcomes are discussed: safer supply as crucial to engage clients in primary care; safer supply as one component of comprehensive care; the use of a harm reduction approach; and challenges with limited medication options and program capacity.</p><p><strong>Implications: </strong>Positive health and social outcomes demonstrate the utility of embedding comprehensive substance use services within a primary health care model to address health and social complexity among people who use drugs amid the continuing toxic drug crisis. Responding to an increasingly volatile unregulated supply of drugs, having limited medication options, and providing comprehensive care without long-term funding remain ongoing challenges.</p>","PeriodicalId":51407,"journal":{"name":"Canadian Journal of Public Health-Revue Canadienne De Sante Publique","volume":" ","pages":"408-417"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617776","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}