Capacity to Consent to Treatment of Substance Use Disorders at Ontario's Consent and Capacity Board: A Review of Past Reported Decisions.

Capacity to consent to treatment of substance use disorders at Ontario's Consent and Capacity Board: A review of past reported decisions.

An Ontario review of legal cases which have considered patients' ability to consent to substance use treatmentsPlain Language SummaryIn general, prescribers must consider whether informed consent was provided prior to starting a treatment. A patient is presumed to be capable to consent to a proposed treatment but could be incapable with respect to any medical treatment. While incapacity is often considered for psychiatric treatments, it could be relevant to substance use treatment like methadone or suboxone, which are also called "Opioid Agonist Therapies" or OAT. OAT is lifesaving and prevents relapse and overdose when a person has an opioid use disorder. If a patient is found incapable of consenting to a treatment, a Substitute Decisions Maker would become the decision maker. In such cases, the patient has the ability to contest or disagree with the finding, and this results in a tribunal hearing at the Consent and Capacity Board in Ontario (CCB). In certain circumstances, the CCB publishes what are known as its Reasons for Decision (RDs), which explain the tribunal's reasoning in coming to a decision in favour of the physician or the person found incapable. This information is publicly searchable. Our methods involved a search of all available CCB RDs in Ontario for search terms related to substance use treatment, such as "methadone". We found that between June 1, 2003 (the date on reporting of RDs began) and June 27, 2023, only 71 RDs involved substance use search terms, out of a total of 10,463 reported RDs. Only one case involved the CCB upholding a finding of incapacity with respect to methadone treatment. These results imply that there are few cases in which the CCB has considered incapacity with respect to substance use treatment, although it is possible that these cases are reported at a lower frequency than other cases.

Coronavirus Disease 2019 and the Impact on Substance Use Disorder Treatments.

Coronavirus disease 2019 (COVID-19)-related stressors and restrictions, in the absence of social and institutional support, have led many individuals to either increase their substance consumption or relapse. Consequently, treatment programs for substance use disorders (SUDs) made a transition from in-person to remote care delivery. This review discusses the following evidence regarding changes prompted by the COVID pandemic to the clinical care of individuals with SUDs: (1) reduction in availability of care, (2) increase in demand for care, (3) transition to telemedicine use, (4) telemedicine for treatment of opioid use disorders, and (5) considerations for use of telemedicine in treating SUDs.

Benefits of Digital Health Resources for Substance Use Concerns in Women: Scoping Review.

BACKGROUND: Digital health resources are being increasingly used to support women with substance use concerns. Although empirical research has demonstrated that these resources have promise, the available evidence for their benefit in women requires further investigation. Evidence supports the capacity of interventions that are sex-, gender-, and trauma-informed to improve treatment access and outcomes and to reduce health system challenges and disparities. Indeed, both sex- and gender-specific approaches are critical to improve health and gender equity. Violence and trauma are frequent among those with substance use concerns, but they disproportionately affect those who identify as female or women, further underscoring the need for trauma-informed care as well. OBJECTIVE: The objective of this investigation was to evaluate the evidence supporting the efficacy or effectiveness of online or mobile interventions for risky or harmful substance use in adults who identify as female or women, or who report a history of trauma. METHODS: This scoping review is based on an academic search in MEDLINE, APA PsycINFO, Embase, Cochrane Central, and CINAHL, as well as a grey literature search in US and Canadian government and funding agency websites. Of the 7807 records identified, 465 remained following title and abstract screening. Of these, 159 met all eligibility criteria and were reviewed and synthesized. RESULTS: The 159 records reflected 141 distinct studies and 125 distinct interventions. Investigations and the interventions evaluated predominantly focused on alcohol use or general substance use. Evaluated digital health resources included multisession and brief-session interventions, with a wide range of therapeutic elements. Multisession online and mobile interventions exhibited beneficial effects in 86.1% (105/122) of studies. Single-session interventions similarly demonstrated beneficial effects in 64.2% (43/67) of study conditions. Most investigations did not assess gender identity or conduct sex- or gender-based analyses. Only 13 investigations that included trauma were identified. CONCLUSIONS: Despite the overall promise of digital health interventions for substance use concerns, direct or quantitative evidence on the efficacy or effectiveness of interventions in females or women specifically is weak.

Protecting vulnerable groups from tobacco-related harm during and following the COVID-19 pandemic. / Protection des groupes vulnérables contre les méfaits du tabac pendant et après la pandémie de COVID-19.

Marginalized populations are being disproportionally affected by the current pandemic. Direct effects include higher infection rates with greater morbidity and mortality; indirect effects stem from the societal response to limit the spread of the virus. These same groups also have smoking rates that are significantly higher than the general population. In this commentary, we discuss how the pandemic has been acting to further increase the harm from tobacco endured by these groups by applying the syndemic framework. Using this approach, we elaborate on the factors that promote clustering of harms from tobacco with harms from COVID-19. These include the worsening of psychological distress, a potential increase in smoking behaviour, greater exposure to second-hand smoke and less access to smoking cessation services. Then, we offer mitigation strategies to protect disadvantaged groups from tobacco-related harm during and following the COVID-19 pandemic. These strategies include affordable smoking cessation services, a proactive approach for smoking treatment using information technology, opportunistic screening and treatment of tobacco dependence among individuals presenting for COVID-19 vaccination, policy interventions for universal coverage of cessation pharmacotherapy, comprehensive smoke-free policies and regulation of tobacco retail density. Now more than ever, coordinated action between clinicians, health care systems, public health organizations and health policy makers is needed to protect vulnerable groups from the harm of tobacco.

Vulnerable groups with socioeconomic disadvantage have disproportionally high rates of tobacco use. The syndemic framework is a biosocial approach for exploring risk for harm from tobacco in vulnerable groups that is augmented by changes brought about by the pandemic. Worsening of economic status and stress levels compounded by limited access to health care and tobacco treatment act to an increase tobacco use and second-hand smoke exposure. Coordinated action is needed to protect vulnerable groups by lowering barriers for tobacco treatment, enforcing smoke-free policies and integrating tobacco treatment into community, workplace and health care organizations that serve socioeconomically disadvantaged groups.

Les groupes vulnérables et défavorisés sur le plan socioéconomique présentent des taux de tabagisme disproportionnellement élevés. Le cadre syndémique est une approche biosociale qui permet de prendre en compte les risques de méfaits liés au tabac au sein des groupes vulnérables, risques qui sont renforcés par les changements induits par la pandémie. La détérioration de la situation économique et l'aggravation des niveaux de stress, conjuguées à un accès limité aux soins de santé et au traitement du tabagisme, conduisent à une augmentation de la consommation de tabac et de l'exposition à la fumée secondaire. Pour protéger les groupes vulnérables, il faut une action coordonnée qui passe par la réduction des obstacles au traitement du tabagisme, l'application de politiques antitabac et l'intégration du traitement du tabagisme dans les collectivités, sur les lieux de travail et dans les établissements de soins de santé qui offrent des services aux groupes défavorisés sur le plan socioéconomique.

COVID-19 and persons with substance use disorders: Inequities and mitigation strategies.

The COVID-19 pandemic disproportionately disrupts the daily lives of marginalized populations. Persons with substance use disorders are a particularly vulnerable population because of their unique social and health care needs. They face significant harm from both the pandemic itself and its social and economic consequences, including marginalization in health care and social systems. Hence, we discuss: (1) why persons with substance use disorders are at increased risk for infection with COVID-19 and a severe illness course; (2) anticipated adverse consequences of COVID-19 in persons with substance use disorders; (3) challenges to health care delivery and substance use treatment programs during and after the COVID-19 pandemic; and (4) the potential impact on clinical research in substance use disorders. We offer recommendations for clinical, public health, and social policies to mitigate these challenges and to prevent negative outcomes.

WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women.

OBJECTIVES: These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS: We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication. RESULTS AND DISCUSSION: There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.

Applying a 'stages of change' model to enhance a traditional evaluation of a research transfer course.

The aim of this study was to utilize an evaluation tool based on Prochaska's model of change in order to assess behaviour change as part of an evaluation process for a research transfer training programme (RTTP). The RTTP was a training programme offered to scientists in a psychiatry department and research institute to gain skills in research transfer. In addition to a traditional course evaluation framework evaluating overall satisfaction with the course and whether or not learning objectives were met, an additional 'stages of change' evaluation tool designed to assess change along a continuum was utilized. This instrument measured change in participants' attitudes, intentions and actions with respect to research transfer practice and consisted of a 12-question survey completed by participants prior to taking the course and 3 months post-course. In two out of the three categories, attitudes and intention to practice, there was positive change from pre- to post-course (P < 0.05). Although there was a trend of increased RT-related action, this was less robust and did not reach significance. For the RTTP transfer course, a 'stages of change' model of evaluation provided an enhanced understanding by showing changes in participants that would otherwise have been overlooked if only changes in RT behaviour were measured. Additionally, evaluating along a change continuum specifically identifies areas for improvement in future courses. The instrument developed for this study could also be used as a pre-course, participant needs assessment to tailor a course to the change needs of participants. Finally, this 'stages of change' approach provides insight into where barriers to change may exist for research transfer action.