Author: Francois-Olivier Hebert

The Decriminalization of Drugs in British Columbia: A Step in the Right Direction for People with Drug Addictions?

In British Columbia, since January 31^st, 2023, it is no longer a criminal offence for adults to possess up to 2,5 grams of cocaine, methamphetamine and opioids. This change in legislation was made possible via an exemption from the Controlled Drugs and Substances Act granted by Health Canada. Drug decriminalization has been described as a critical step in British Columbia’s efforts to combat the harms associated with the misuse of several psychoactive substances, including opioids^1,2. The three-year pilot project developed by the province is part of a movement to reduce the harms associated with drug use, including overdose deaths and the criminalization of people with substance use disorders³ . This would move drug use and possession from being a criminal offence to being treated as a public health issue.

For many people living with substance use disorder, decriminalization represents a significant shift in the way their situation is perceived and treated. Rather than being punished for their drug use, they would be able to access health and social services without fear of criminal charges. It would also have the potential to reduce the risk of overdose deaths by removing the fear of criminal charges for people showing early signs of overdose or for people being eyewitnesses to an overdose⁴.  People who use substances conveying a high-potential of misuse and overdose could access more easily life-saving interventions such as naloxone, seek treatment, support, and harm reduction services without fear of stigma or legal repercussions.

Nevertheless, the decriminalization of drugs in British Columbia, far from being a panacea for all drug-related problems in society, represents a significant step forward in addressing the harms associated with the criminalization of drug use, and is overall a positive development for people with substance use disorder⁵.

References

1. CCSA (Canadian Centre on Substance Use and Addiction). Decriminalization of Controlled Substances: Policy Brief 2018. [Internet]. 2018 [cited 2023 Feb 23]

2. Government of British Columbia. Decriminalization [Internet]. Government of British Columbia; [updated 2022 Nov 7; cited 2023 Feb 23].

3. CBC News. What you need to know about drugs in British Columbia [Internet]. CBC News; 2021 Oct 21 [cited 2023 Feb 23].

4. CBC News. ‘Toxic drug supply’: Why some experts say decriminalization is a key step to fighting the overdose crisis [Internet]. [place unknown]: CBC News; 2022 Feb 23 [cited 2023 Feb 23].

Drug Policy Alliance. Approaches to Decriminalization [Internet]. United Nations Office on Drugs and Crime; 2015 Feb [cited 2023 Feb 23].

While Coronavirus has been a hot topic for the past few years, there’s yet another type of virus everyone should watch out for: the Hepatitis C virus (HCV). But, you shouldn’t be too worried! This one is not as easily transmitted as Coronavirus. However, HCV can still cause a non-symptomatic and long-lasting liver disease. In a small number of patients, it can even cause end-stage liver diseases such as cirrhosis and liver cancer.

HCV is a blood-borne infection, which means you need percutaneous contact with the blood or body fluids of an individual with HCV infection to contract the disease. Usually, your skin is a strong fortification against the virus. Nonetheless, this virus can pass this barrier easily through sharp objects such as tattoo needles. Yes! Tattooing can increase the risk of contracting a few infectious diseases such as hepatitis C. However, this is not the case for tattoos made by well-trained pro tattoo artists. These guys know their job and they know how to sterilize their instruments to bring the risk to zero for their clients. It is mostly in amateur or illegal tattoo parlors where we find may find a problem. A study by Poulin et al. found non-professional tattooing inside the prison as a risk factor for HCV infection in Quebec`s provincial correctional system. Any non-professional form of tattooing, such as the use of tattoo home kits, can put you at risk of HCV transmission. There are precautions and safety measures, that everyone engaged in tattoo art should follow to make tattooing safe in terms of transmission of viral infections. While this may be stressful for those with a history of non-professional tattooing, there is also some good news: HCV testing is very easy to access, and, through the available treatments, it is possible to eliminate the virus.

The laboratory of Dr. Didier Jutras-Aswad is contributing to a cohort study of HCV infection among people who inject drugs (HEPCO study) in Montreal. You can find more information here.

Join ICRAS-CRISM to discuss the clinical management of prescription opioid use disorders!

The OPTIMA Clinical Trial webinar series aims to bring together clinicians from all fields in a discussion on implementing and optimizing flexible models of care for opioid-related disorders. The regional roundtable, on December 15 at 12:00 pm EST, will be hosted by CRISM in collaboration with the CRISM Quebec-Atlantic cluster and CHUM! We will hear from a multidisciplinary panel of clinical experts, including principal investigator Dr. Didier Jutras-Aswad, physicians Dr. Suzanne Brissette and Dr. Marie-Ève Goyer, pharmacist Pierre-Benoît Tremblay, and nurse Isabelle Tetu, with moderator Julie Charbonneau.

After presenting the results of the national OPTIMA trial, which ran from 2017 to 2020, this multidisciplinary panel of clinicians will discuss factors to consider, barriers, and benefits surrounding prescribing unsupervised doses of CAT, as in BUP/NX treatment, in the Quebec setting. In this discussion, the panel will explore next steps to optimize and expand flexible care models for AOT in clinical practice.

REGISTER HERE

In Canada, nearly a quarter of the adult population reported having consumed cannabis in the last 12 months in 2021. Cannabis use is considered to be fairly safe in most cases (Fischer et al., 2021). In Quebec, nearly half of the population aged 15 years and older would have experimented with cannabis use at least once in their lifetime.

The psychoactive effects of cannabis sought by consumers are mainly attributable to a specific molecule produced by the plant, namely tetrahydrocannabinol (THC). This molecule belongs to a class of compounds numbering in the dozens and called “cannabinoids”. Content in cannabinoids and their respective concentrations can vary greatly between different cannabis plants and across diverse horticultural practices. Cannabidiol (CBD), on the other hand, is a so-called “non-psychoactive” cannabinoid, meaning that it does not provide any euphoric effect to consumers. CBD products are currently growing in popularity among the general population, as they are often advertised and promoted for their potential physiological effects that may be beneficial. Studies on the effects of cannabinoids in humans have so far focused mainly on THC. On the other hand, studies on the behavioral effects of CBD have tested mostly high doses. It is therefore essential to study, in a controlled environment, the effects of CBD administration at lower doses, such as those currently available on the recreational market in Canada and the United States. The laboratory is thus currently conducting a randomized controlled trial on the effect of CBD when consumed orally (CBD-ingested). A second similar project will also be conducted on the effects of CBD when administered by the respiratory tract (CBD-inhaled).

For more information about the recruitment of our studies, please consult this link.

The participants we are looking for must meet the following criteria:

• Person in good health
• Occasional cannabis user

We are deeply saddened to learn of the death of Alexandra de Kiewit, a close collaborator.

The unexpected departure of this engaged woman, who led multiple causes not only for the rights of people who use drugs, for the rights of sex workers, but also for the advancement of research, is an important
loss for the community.

On the behalf of the Jutras-Aswad Laboratory team, and particularly those involved in the ASCME trial, we would like to express Alexandra’s family, friends and community our deepest condolences.

The pandemic, problematic internet use and eating disorders

Recently, several studies have shown that the pandemic context has led to a significant increase in the number of people living with concurrent mental health and substance use disorders. Confinement orders, along with many changes in social interactions, has directly affected the lives of people living with concurrent disorders. This circumstance has also been associated with an increase of the number of people with dual diagnoses of addiction and eating disorders (ED)[1].

The impact of the pandemic on eating disorders

Eating disorders are a major problem in their own, considering that they present very high morbidity and mortality rates[2]. The pandemic has exacerbated the presence of substance use disorders, such as alcohol, amid people with eating disorders. Among various factors, one possible cause is the synchronous increase in problematic use of social networks.

Social networks: hobby or addiction?

Another adverse effect of the pandemic has been the increase in internet use1. Distancing and confinement have contributed to the use of social networks as a primary means of communication. In some cases, excessive use of the Internet can also be expressed as an addiction: this is cyberaddiction[3].

As with other substance use disorders, people with ED are more likely to be affected by cyberaddiction[4]. Social networking may be more prevalent among this group of people as an avoidance strategy for negative emotions and as a way of increasing their sense of belonging to a group[4]. A possible exacerbated use, combined with several other sources of stress from the pandemic context, could contribute to the development of an addiction.

A vicious circle

In the same way that people living with an ED have a greater tendency to show signs of cyberaddiction, the problematic use of social networks is also a factor that could potentially contribute to the development of eating disorders[5]. Studies show that exposure to online publications increases body dissatisfaction and reinforce the belief of an ideal body shape. In addition, social networks also contribute to the internalization of certain eating habits, not necessarily healthy or applicable to everyone.

However, it is important to consider that several elements can contribute to the appearance of an eating disorder or to a problematic use of the Internet. As with other types of concurrent disorders, specialized help is needed to assist people affected by such situations. The various projects of the research laboratory directed by Dr. Didier Jutras-Aswad share this perspective and contribute to improve the understanding of concurrent disorders and their underlying mechanisms, which in turn allows to identify the best clinical intervention strategies to adopt in order to improve and expand the treatment options for individuals living with a concurrent disorder problem.

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1 Rodgers, R. F., Lombardo, C., Cerolini, S., Franko, D. L., Omori, M., Fuller‐Tyszkiewicz, M., Linardon, J., Courtet, P., & Guillaume, S. (2020). The impact of the COVID‐19 pandemic on eating disorder risk and symptoms. International Journal of Eating Disorders, 53(7), 1166–1170. https://doi.org/10.1002/eat.23318

2 Ioannidis, K., Hook, R. W., Wiedemann, A., Bhatti, J., Czabanowska, K., Roman-Urrestarazu, A., Grant, J. E., Goodyer, I. M., Fonagy, P., Bullmore, E. T., Jones, P. B., & Chamberlain, S. R. (2022). Associations between COVID-19 pandemic impact, dimensions of behavior and eating disorders: A longitudinal UK-based study. Comprehensive Psychiatry, 115, 152304. https://doi.org/10.1016/j.comppsych.2022.152304

3 Achab S. Zullino DF, Thorens G. Usage problématique d’Internet, la “Cyberaddiction” nous entoure. Neurologie & Psychiatrie 2013 ; 11(5) : 23-27

4 Ali, A. M., Hendawy, A. O., Abd Elhay, E. S., Ali, E. M., Alkhamees, A. A., Kunugi, H., & Hassan, N. I. (2022). The Bergen Facebook Addiction Scale: its psychometric properties and invariance among women with eating disorders. BMC Women’s Health, 22(1). 

5 Jahan, I., Hosen, I., al Mamun, F., Kaggwa, M. M., Griffiths, M. D., & Mamun, M. A. (2021). How Has the COVID-19 Pandemic Impacted Internet Use Behaviors and Facilitated Problematic Internet Use? A Bangladeshi Study. Psychology Research and Behavior Management, Volume 14, 1127–1138. https://doi.org/10.2147/prbm.s323570

This summer was synonymous of renewal at the laboratory of Dr. Didier Jutras-Aswad, as we welcomed several students in training for the duration of internships, rich in experiential capital. We would like to underline the exemplary work of these trainees who have demonstrated an impeccable integration:

Anita Abboud is a student in the Bachelor of Bioinformatics program at the Université de Montréal (UdM). Anita is also a representative of the Student Association of Biochemistry and Bioinformatics of the UdM (AEBBIUM). She has completed a data management internship and now holds a research assistant position where she coordinates the use and development of various databases. Anita is passionate about emerging biotechnologies and is particularly interested in genomics-oriented programming. Thank you for your dynamism and perseverance, the whole team warmly appreciates your professionalism.

Rafaëlle Valiquette is entering her third year of the Bachelor of Biomedical Sciences program at UdM.  She joined the team as part of an introductory internship to research and now holds a position as a research assistant in which her main tasks consist of recruiting and welcoming volunteers who will participate in the trial on CBD consumption. Inspired by her time with us, Rafaëlle aspires to obtain her medical degree and to pursue her journey in research. Thank you Rafaëlle for your work which proved to be essential to the success of the projects carried out this summer!

Raphaëlle Fortin is also finishing her third year of a Bachelor’s degree in Biomedical Sciences at UdM. She also joined the team as part of an introductory internship and is continuing her work with our team as a research assistant on CBD administration projects. Constantly motivated by the quest for knowledge in neuroscience and its many applications, Raphaëlle also holds a position in neurofeedback for a private clinic. Looking forward to the future, she is already planning to obtain the title of neuropsychologist. Thank you very much for your precious help this summer, without which the projects would not move forward so quickly!

The DJA team would also like to acknowledge the inspiring work of Ana Helena Campos who completed a short and intense internship in scientific communication and knowledge transfer in the laboratory. Thank you for your effective involvement in social networking and your contribution to the team of the Center of Expertise and Collaboration in Concurrent Disorders (CECTC).

A professor in the Department of Chemistry at the University of Montreal, Alexis Vallée-Bélisle, is developing a rapid detector for the presence of drugs in the blood.

A faster and more efficient detector

The device is digital, and the results are displayed on a mobile device. Compared to other existing models, this detector can provide results in approximately 2 minutes. The portable and fast aspect of the device makes it much more efficient and easier to use.

The detector will be used to measure and control the concentration of drugs in the blood. It will initially be offered to public safety and health personnel, but the developers intend to make it available to the public eventually. The detector can help, for example, in the treatment of patients in hospital emergency rooms, or even when someone wants to monitor their own consumption at home.

A device based on bio-nanotechnology

Professor Alexis Vallée-Bélisle, who specializes in the creation of DNA-based medical technologies, is also co-founder of the company Anasens, which is collaborating in the development of the device. This company works in the field of innovation of home blood analysis technology for the monitoring of chronic diseases. The drug detector’s technology was inspired by the glucometer, a device used to know the level of sugar in the blood, but it will also use DNA’s data to detect the amount of drugs that have been consumed.

The technology has already been proven effective in the lab environment, and the program has received a grant to develop a prototype to be tested in the field. This grant comes from the Ministry of Economy and Innovation and Axelys, a non-profit organization that works to accelerate the development of high-potential innovations from public research.

For more information, you can read the interview Professor Vallée-Bélisle had with the UdeM website and his interview at CBC’s scientific radio programme Les Années Lumière.

An article from our lab, led by Dr. Didier Jutras-Aswad, was published in the American Journal of Psychiatry this month. This publication presents and discusses the most recent data generated through the Optima study, which focuses on the comparison of care models for the management of opioid use.

Specifically, the text discusses about a flexible model of care that is based on using buprenorphine/naloxone. This treatment targets opioid use reduction in individuals with prescription opioid use disorder (POUD).

The study demonstrates that this model of care, which allows the intended clientele to take home doses of buprenorphine/naloxone, is non-inferior to the use of supervised methadone in reducing opioid use among individuals with POUD. The study ran for 24 weeks and included 272 participants aged 18 to 64 years.

Monitored treatment with methadone

Intensive exposure to prescription opioids combined with several factors, such as the pandemic context of COVID-19, has contributed to an increase in estimated opioid mortality, now at 89%.

In order to address this significant increase and reduce the use of these substances, the authors determined that it is important to study and plan an implementation of opioid agonist treatment.

The typical treatment uses methadone, which has a low therapeutic index, in which the difference between therapeutic and toxic doses is small. Therefore, methadone use must be strictly monitored, especially during treatment initiation. This requirement for in-person treatment in specialized clinics, especially in a pandemic context, may demotivate participants to proceed with treatment.

The flexible buprenorphine/naloxone model: is it effective?

Dr. Jutras-Aswad’s team’s paper indicates that buprenorphine/naloxone treatment poses less of a risk at the beginning of treatment, which would allow for earlier implementation of home dosing.

According to the study, participants in the buprenorphine/naloxone usage group were 0.47 times more likely to be maintained in assigned treatment than those in the methadone group.

This model of home care is more flexible, and therefore more acceptable, less costly and better suited to the current context.

There is still room for improvement

The results also show that the overall effectiveness of treatment in a real-life setting is lower than expected. The success rate is particularly low in the context of consumption of very potent opioids (e.g., fentanyl), that are frequently used by people living with a TUO.

The text highlights the importance of developing and testing new and innovative strategies to improve treatment outcomes. A few possible solutions are proposed, such as improving integrated psychosocial interventions, pharmacological treatments and developing new models of care.

To view the article, click here.

There is a strong and complex link between opioid dependence and mental health: more than 74% of people living with an opioid use disorder (OUD) develop depression over their lifetime. It is important to address the impact of mental health status in the treatment of OUD in order to increase treatment success and ensure better management of this population. Gabriel Bastien, a PhD student in biomedical sciences, has been interested in this issue for the past two years.

His project focuses on the interrelationship between depression and opioid addiction. Through this study, Gabriel was recently awarded a scholarship from the Neurobiology of Mood Disorders Axis of the Réseau québécois sur le suicide, les troubles de l’humeur et les troubles associés (RQSHA) The $5,000 scholarship was intended to complement the funding of a graduate student member of the RQSHA to support and enhance the development of its research career.

His RQSHA-funded study analyses data taken from the OPTIMA study to assess the impact of depression on the efficacy of opioid agonist treatments, namely methadone and buprenorphine combined with naloxone.

The results of this research project will serve as a tool to help clinicians work with the complex treatment for opioid dependence in the context of comorbid depression. Overall, people living with depression and opioid addiction will have access to improved treatment options tailored to their specific psychiatric disorders and thus, have a greater chance of recovery.

The RQSHA offers four scholarship top-ups for graduate students per year.

• Clinical Research and Innovative Treatment Interventions Axis (January 15)
• Neurobiology of Mood Disorders Axis (April 15)
• Psychosocial, Ethical and Aboriginal Health Research Axis (July 15)
• Addiction Disorders Axis (October 15)

For more information, visit the RQSHA’s website.