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Traitements innovants en toxicomanie

June 2023


On April 19, 2023, Quebec media outlets announced that flavored vaping devices would be removed from sales (1). Designated by various names such as electronic cigarettes or “vapes”, these objects are hand-held devices that heat an inhalable solution containing nicotine, a humectant and synthetic volatile compounds (2). In fact, vape retailers would face a prohibition on distributing any vaping products that have flavors other than tobacco. Why has vaping consumption become a public health issue and what factors have led to this ban?


In Quebec, it is estimated that 20% of vapers are young people under the age of 18 (1). Vape’s growing popularity is partly the result of the marketing strategies involved in its sales. Data gathered in the U.S. and Canada suggest a significant increase in the use of nicotine vaping products in recent years, especially among young people (3). Its popularity could be attributable to the attractive designs of the devices, their packaging, and their appealing flavors, such as ‘’peach ice’’ and ‘’daiquiri’’(2). Another element potentially contributing to this trend is the societal perception of the health risks associated with vaping. That is, more than half of regular vape users consider it to be harmless (4). But are these devices as risk-free as one may believe?

Scientific literature suggests that vaping is associated with neurological, pulmonary, and mental health risks, in addition to containing carcinogenic metabolites (@). In 2019, a total of 39 deaths have been associated to vaping in the United States, which could be due, at least in part, to its high amount of vitamin E (2).  Vape devices also contain other hazardous metabolites that are known carcinogens as well as nicotine (4). Unfortunately, nicotine intake can have harmful impacts on neurocognitive functions, especially on youth as their brain is still developing. Vaping as a teenager also leads to an increased risk of smoking later in life (5). Lastly, many health risks associated to vaping remain unknown as its distribution and use are fairly recent (6). In the absence of evidence-based data on the safety of the product in different contexts and different populations, and in an attempt to reduce its use among young people, regulations have been issued.

Even though vaping is associated with increased risks of deleterious health consequences, could it be a safer alternative to smoking or assist in smoking cessation? Data shows that vaping increases tobacco consumption among minors (5). On the other hand, the data is not as conclusive when it comes to the adult population (6). It doesn’t seem impossible that vaping may aid in smoking reduction or cessation in specific therapeutic contexts. However, given the lack of data on vape’s efficacy in this context and its safety, individuals who live with nicotine dependence are encouraged to seek out other therapeutic modalities such as pharmacological treatments, nicotine replacement products as well as medical or psychosocial interventions (3, 7). Only further studies will determine whether vaping can become a new tool that may be included in strategies for smoking cessation.


Find more information here to get help on smoking cessation strategies.


Sabrina Bijou (she/her/elle)

References

  1. QMI A. Vapotage: Québec interdit les saveurs tvanouvelles.ca: TVA Nouvelles; 2023 [Available from: https://www.tvanouvelles.ca/2023/04/19/vapotage-quebec-interdira-les-saveurs-et-les-aromes-autres-que-ceux-du-tabac.
  2. Dinardo P, Rome ES. Vaping: The new wave of nicotine addiction. Cleveland Clinic Journal of Medicine. 2019;86(12):789-98.
  3. Hammond D, Reid JL, Burkhalter R, O’Connor RJ, Goniewicz ML, Wackowski OA, Thrasher JF, Hitchman SC. Trends in e-cigarette brands, devices and the nicotine profile of products used by youth in England, Canada and the USA: 2017-2019. Tob Control. 2023 Jan;32(1):19-29. doi: 10.1136/tobaccocontrol-2020-056371.
  4. Bernat D, Gasquet N, Wilson KO, Porter L, Choi K. Electronic Cigarette Harm and Benefit Perceptions and Use Among Youth. American Journal of Preventive Medicine. 2018;55(3):361-7.
  5. Levy DT, Warner KE, Cummings KM, Hammond D, Kuo C, Fong GT, et al. Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check. Tobacco Control. 2019;28(6):629-35.
  6. Wang RJ, Bhadriraju S, Glantz SA. E-Cigarette Use and Adult Cigarette Smoking Cessation: A Meta-Analysis. American Journal of Public Health. 2021;111(2):230-46.
  7. Soule EK, Plunk AD, Harrell PT, Hayes RB, Edwards KC. Longitudinal Analysis of Associations Between Reasons for Electronic Cigarette Use and Change in Smoking Status Among Adults in the Population Assessment of Tobacco and Health Study. Nicotine and Tobacco Research. 2020;22(5):663-71.


Catégories

Traitements innovants en toxicomanie

Cannabis Harm Reduction for Youth Living with Psychosis and Using Cannabis


Cannabis use can be more problematic for individuals who have experienced an episode of psychosis. Stephanie Coronado-Montoya, a PhD candidate in the Didier Jutras-Aswad laboratory, advocates for harm reduction as a means of helping people manage problematic cannabis use.

Through her review of over 11,400 scientific articles, Stephanie found that few cannabis-focused interventions existed for people with psychosis who wanted to reduce or prevent cannabis-related harms. Her national survey of patient preferences found two significant demands which emerged from the population: that interventions be short and technology-based.

The CHAMPS app responds to these demands (a mobile app containing a brief psychosocial intervention aiming to reduce cannabis-related harms in people with psychosis). To learn more about this initiative, please listen to the full episode and follow Stephanie on Instagram (@the.brain.diaries).


Catégories
Traitements innovants en toxicomanie

March 2023

Genetic Basis of Cannabis Use

Cannabis is one of the most widely used psychoactive substance worldwide. The increased risk of developing a cannabis use disorder has recently been associated with specific genetic variants. These findings have led to numerous studies focused on the characterization of the complex relationship between genetic background and cannabis use. In this context, the article entitled “Genetic basis of cannabis use: a systematic review” aims to summarize some of the current knowledge on the genetic determinants underlying cannabis use, identify genetic variants associated with increased risk of cannabis misuse and its related harms, and highlight the importance of further research to better understand the genetic susceptibilities associated with cannabis use.

One of the genes commonly identified among the results of genomic approaches is the CNR1 gene, which codes for the cannabinoid 1 receptor (CB1R). CB1R is highly expressed in the brain and it is the primary target of the euphoric compound found in cannabis, i.e., delta-9-tetrahydrocannabinol (THC). Studies have shown that certain variants of the CNR1 gene are associated with a greater inclination to consume cannabis, as well as increased sensitivity to the effects of THC. The same can be said about the AKT1 gene, which codes for a protein involved in the regulation of cell growth and survival. In addition, other genes that have been associated with cannabis use include the DRD2 gene, which codes for a dopamine receptor involved in reward and motivation, and the FAAH gene, which codes for an enzyme involved in the breakdown of cannabinoids in the body.

It is important to note that the genetic basis of cannabis use is complex, multifactorial and polygenic, and individual genetic variants probably have little effect on an individual’s propensity to consume. Interactions between specific genetic susceptibilities and environmental factors, such as peer pressure, product availability, and social norms, also play an important role in cannabis use and its related consequences. However, the study of genetic factors makes it possible to explain the mechanisms involved in the response to psychoactive substances, which in turn ensures the ability to identify susceptibility factors that could be used to prevent possible harm or optimize certain benefits. It is thus important to consider genetic factors in the response to different cannabis products, an effort that we are promoting in the laboratory by including different genomic approaches to experimental designs involving cannabinoid administration in humans. This approach will be implemented in our next projects that will start in the upcoming months. Stay tuned to our projects to learn more.

References

Hillmer A, Chawar C, Sanger S, D’Elia A, Butt M, Kapoor R, Kapczinski F, Thabane L, Samaan Z. Genetic basis of cannabis use: a systematic review. BMC Med Genomics. 2021 Aug 12;14(1):203. doi: 10.1186/s12920-021-01035-5. PMID: 34384432; PMCID: PMC8359088.

Catégories
Traitements innovants en toxicomanie

February 2023

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

In British Columbia, since January 31st, 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 opioids1,2. 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].

Catégories
Traitements innovants en toxicomanie

Hepatitis C and Tattooing: Mind the Needle!

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.

Catégories
Traitements innovants en toxicomanie

Clinical Roundtable Webinar – December 15, 2022

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

Catégories
Traitements innovants en toxicomanie

November 2022

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
Catégories
Traitements innovants en toxicomanie

A tribute to Alexandra de Kiewit

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.


Catégories
Traitements innovants en toxicomanie

October 2022

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.


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

Catégories
Traitements innovants en toxicomanie

September 2022

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).