Research Bulletin October 2018: Substance Use, Treatment, and Recovery

This month’s research bulletin focuses on research and reports related to substance use, treatment, and recovery as well as perceptions and stigma related to drug use and the ongoing overdose crisis.

The articles and reports below discuss strategies for improving recovery services and treatment programs, recommendations to guide drug policy reform, as well as ways to reduce stigma and counter misinformation about substance use programs and policies. And they include a number of practical implications and ideas for a range of audiences—service providers, community leaders, policy makers, and politicians.

  1. Strategies to Strengthen Recovery in BC: The Path Forward
  2. Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada
  3. The World Drug Perception Problem
  4. 2018 BC Overdose Action Exchange Report

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1. Strategies to Strengthen Recovery in BC: The Path Forward

This report by the BC Centre on Substance Use builds on findings from the 2017 Survey of Life in Recovery from Addiction in Canada (by the Canadian Centre on Substance Use and Addiction and the National Recovery Advisory Committee). The goal of this report is to outline a “new path” toward recovery by taking a systems-wide approach to analyzing and addressing gaps in substance use policies and services in BC.

The authors echo calls from direct service providers and other recent reports (such as those by the BC Coroner’s Service) by highlighting the need for long-term recovery-oriented services in addition to life-saving measures and acute treatment options.

Also included are the leading factors in starting and maintaining recovery, the most common barriers to starting recovery, as well as leading recovery resources and programs. The report concludes with a range of suggested ways to strengthen recovery in BC—from education and awareness to drug policy and enforcement.

2. Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada

This article reports on a longitudinal cohort study (1998-2015) that looked at the relationship between methadone maintenance treatment programs and overdose deaths (as well as other causes of mortality).

The authors main finding was a significantly lower risk of mortality during periods when methadone was dispensed. However, in spite of increasing evidence that prevention and treatment options such as methadone may prevent deaths, they note significant barriers remain for offenders and those with criminal histories (in addition to an underutilization of substitution treatments by the same populations).

The findings in this report will be helpful for anyone trying to create or support community-based treatment programs. The practices discussed can increase methadone adherence among opioid-dependent offenders (i.e., making treatment more accessible, integrated, and comprehensive) and can help prevent premature death in populations with complex health and social challenges including those involved in the criminal justice system.

3. The World Drug Perception Problem: Countering prejudices about people who use drugs

This report, by the UN’s Global Commission on Drug Policy, examines how existing perceptions and language about substance use (and the people who use substances) create and sustain harmful responses such as criminalization and prohibition.

It includes analysis of the most common myths that inform drug policies and provides facts to counter these while also showing the key distinctions between perception-based and evidence-based policy development. The 25-member commission argues that shifting policies and laws away from criminalization and abstinence to harm-reduction and decriminalization will remain difficult unless we can change our perceptions of drug use and people who use drugs.

The report concludes with six recommendations (and four principles) to guide drug policy reform in the future and can be a valuable tool for service providers and policy-makers. It contains ways to counter public condemnation and fear about programs and policies, offers ways to correct misinformation and harmful language, suggests frameworks for reviewing and designing drug policies, and illuminates the roles we all play—community leaders, politicians, practitioners, media, religious figures—in shaping, supporting, and changing public perception.

4. 2018 BC Overdose Action Exchange

This report is the result of the third meeting of the BC Overdose Action Exchange—created by the BC Centre for Disease Control in 2016 to help guide the provincial response to the overdose crisis.

The latest session brought together representatives from a wide range of stakeholder groups (including people with lived experience, policy-makers, community organizations, public health leaders, government, academia, emergency health services, law enforcement, researchers and medical experts).

An array of recommendations were expressed by participants (ranging from practical to provocative) and were organized into six themes to make them relevant and useful for all those responding to the opioid crisis: drug policy, safer drug supply, drug use prevention, overdose-prevention services, naloxone, and treatment and recovery.

The report was also explicit about the importance of Indigenous engagement (given overrepresentation of Indigenous peoples in overdose figures and the TRC Calls to Action) and the importance of “peers”—people with lived experience of substance use. Participants agreed that peers should increasingly be considered experts in the field, should be embedded in research, service delivery, and prevention efforts, and should be supported and compensated accordingly.