Characterizing opioid agonist treatment discontinuation trends in British Columbia, Canada, 2012-2018.

BACKGROUND: Given the elevated risk of mortality immediately following opioid agonist treatment (OAT) discontinuation, determining the frequency and timing of OAT discontinuation can help guide the planning of services to facilitate uninterrupted OAT. We sought to describe weekly and monthly trends in OAT episode discontinuations in British Columbia to determine the potential resource needs for implementing support services. METHODS: This population-based retrospective study utilized a provincial-level linkage of health administrative databases to identify all people with opioid use disorder (PWOUD) who received OAT between 01/2012-08/2018. We defined OAT episodes as continuous medication dispensations without interruptions in prescribed doses lasting ≥5 days for methadone and ≥6 days for buprenorphine/naloxone. We derived the percentage of PWOUD discontinuing OAT every month and we considered weekly discontinuations between 09/2017-08/2018, accounting for weeks during which monthly income assistance payments from social service programs occurred. RESULTS: Our study included 37,207 PWOUD discontinuing 158,027 OAT episodes. Discontinuations were relatively stable month-to-month, increasing from 10.6 % to 14.9 % (2012-2018). The monthly percentage of discontinuations was 21.2 % for buprenorphine/naloxone and 10.0 % for methadone. Weekly discontinuations were greater in income disbursement weeks (816; IQR: 752, 901) compared to other weeks (655; IQR: 615, 683; p < 0.01). CONCLUSIONS: We identified a high, and stable rate of monthly OAT discontinuations and a consistently higher rate of discontinuing treatment among PWOUD accessing buprenorphine/naloxone. There is an urgent need to develop the evidence base for interventions to support OAT engagement and to improve clinical management of OUD to address the opioid-related overdose crisis.

Diagnosis of Opioid Use Disorder by Youths Assessed in Acute Care Settings in British Columbia, Canada.

OBJECTIVES: To describe trends in the number of youths diagnosed with opioid use disorder (OUD) and to identify factors associated with OUD diagnosis in acute care settings. STUDY DESIGN: Data from a population-based retrospective cohort study with linkage of 6 health administrative databases for 13 009 youth age 12-24 years identified with OUD between 2001 and 2018 in British Columbia, Canada were used to describe annual diagnoses. Using a multiple logistic regression model, we estimated the association between past-year health care utilization and OUD diagnosis in acute settings, controlling for sociodemographic and OUD-related comorbid conditions. RESULTS: Annual OUD diagnoses quadrupled between 2003 and 2017 (from 326 to 1473). Among the 6579 youth diagnosed with OUD between April 1, 2013 and September 30, 2018, 88.1% had past-year health system contacts. Youth age 12-18 had higher odds of OUD diagnosis in acute care (aOR 2.04; 95% CI 1.78, 2.34). Compared with no health care contact, youth receiving outpatient care only were less likely to be diagnosed with OUD in acute care (aOR 0.69; 95% CI 0.56, 0.84) and those with >1 urgent hospitalization were more likely to be diagnosed with OUD in acute care (aOR 1.87; 95% CI 1.40,2.49). CONCLUSIONS: More than 88% of youth had past-year health system contacts prior to diagnosis. Those age 12-18 years and with urgent hospitalizations in the year prior to diagnosis were more likely to have OUD diagnosed in acute care settings. Establishing an effective evidence-based system for early detection and intervention among youth with OUD must be a priority.

"I couldn't say, I'm not a girl"--adolescents talk about gender and marijuana use.

In this paper we report on findings from a qualitative study of marijuana use by adolescents in two communities in British Columbia, Canada. During 2005 and 2006, 45 interviews were carried out at schools with students aged 13-18, with an aim of understanding how adolescents perceive their experiences with marijuana to be shaped by gender. While it has been established that patterns of use differ for girls and boys, there is relatively little qualitative research addressing marijuana smoking as gendered social practice. Drawing from contemporary social theories of gender our analysis explores the normative functions of gender discourse within adolescents' narratives, situating their descriptions of marijuana use within the context of the research interview and within the social contexts of drug use. The results highlight the challenges we encountered in asking about gender during one-to-one interviews, juxtaposed with examples from the narratives that illustrate how boys and girls use marijuana as a way of "doing" gender. To conclude, we suggest how our findings can inform the design of gender-specific health messaging on adolescent marijuana use.

Making residential cannabis growing operations actionable: a critical policy analysis.

BACKGROUND: In 2006, the British Columbia (BC) government passed amendments to its Safety Standards Act. These amendments permit the routine disclosure of electrical usage information from electrical producers to BC's municipalities, ostensibly to identify and eradicate residential cannabis growing operations (grow ops). These amendments originated in a pilot project in Surrey, BC, known as the electrical and fire safety inspection initiative (EFSI), which drew together police, firefighters and others, to identify grow ops through the process of municipal electrical inspections. METHODS: This paper draws on narrative analysis to critically explore how the report of the EFSI Surrey pilot project uses a series of linked claims to generate interpretative change in the definition of the problem of grow ops. This analysis also shows how claims about grow ops are constructed and gain their potency through links with other social problems, persons, and practices. RESULTS: Though the report of the EFSI project is a prohibitionist text replete with stock characters and themes from the history of Canadian drug policy, the problem of residential cannabis cultivation is made actionable by establishing grow operators as "superdeviants" constructed both as dangerous outsiders and as risks to a host of public safety concerns. These claims are then linked to the notion of an overwhelmed criminal justice system that establishes a "crisis" that justifies extraordinary methods of social control outside the due process of the criminal justice system. CONCLUSIONS: Construction of all cannabis cultivators as "dangerous" disavows other possibilities and shores up neo-liberal practices of government that draw on multi-partner initiatives to implement extraordinary methods of social control not necessarily subject to public accountability.

A summer outbreak of human metapneumovirus infection in a long-term-care facility.

Human metapneumovirus (hMPV), a recently discovered paramyxovirus, is thought to be primarily a winter-spring pathogen affecting young children with a clinical presentation similar to that of respiratory syncytial virus. In June-July 2006, a respiratory outbreak in a long-term-care facility was reported to the local health department and investigated. Surveillance identified 26 residents and 13 staff with acute respiratory illness; 8 residents (31%) developed radiographically confirmed pneumonia, and 2 (5%) were hospitalized. Five of 14 respiratory specimens were positive by polymerase chain reaction assay for hMPV; sequencing identified genotype A. In institutionalized elderly persons, hMPV may be an important cause of respiratory outbreaks year-round.