Canada

Subsections:

Page last updated June 9, 2020 by Doug McVay, Editor/Senior Policy Analyst.

21. Injection Drug Use In Prison by Drug Type

"Overall, 87% of inmates who recently injected drugs in a penitentiary reported opiates as one of their three most used drugs. Although the number of inmates who reported injecting only non-opiate drugs was small, comparisons between this group and opiate users suggests that injecting opiates may be associated with the use of someone else’s used equipment (see Table 9). Inmates who recently injected opiates were more likely, than those who recently injected non-opiates, to use someone else’s used needle, 81% vs. 48%, ?2 (1, n=251) = 13.92, p < 0.05, and works, 59% vs. 36%, ?2 (1, n=236) = 3.98, p < 0.05."

Thompson, Jennie, Zakaria, Dianne, and Jarvis, Ashley, "Use of bleach and the methadone maintenance treatment program as harm reduction measures in Canadian Penitentiaries 2010," Correctional Service of Canada, Research Report R-210, August 2010.
http://www.csc-scc.gc.ca/text/...

22. Number of People in Canada Living with HIV, by Transmission Method

"HIV/AIDS remains an issue of concern for Canada. The number of people living with HIV (including AIDS) continues to rise, from an estimated 64,000 in 2008 to 71,300 in 2011 (an 11.4% increase) (Table 1, Figure 1). The increase in the number of people living with HIV is due to the fact that new infections continue at a not insignificant rate which is greater than HIV-related deaths, as new treatments have improved survival. The estimated prevalence rate in Canada in 2011 was 208.0 per 100,000 population (range: 171.0–245.1 per 100,000 population). Nearly half (46.7%) of those living with HIV were men who have sex with men (MSM). Those who acquired their infection through heterosexual contact and were not from an HIV-endemic region comprised the next largest group (17.6%), followed by those who acquired their infection through injection drug use (IDU) (16.9%) and those exposed through heterosexual contact and were also from an HIV-endemic region (14.9%)."

"Summary: Estimates of HIV Prevalence and Incidence in Canada, 2011" (Ottawa, Ontario: Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, 2012), p. 1.
http://www.phac-aspc.gc.ca/aid...
http://www.phac-aspc.gc.ca/aid...

23. Estimated Number of New HIV Infections, by Transmission Method

"Although estimates of the number of new HIV infections are uncertain, the number of new infections in 2011 was estimated at 3,175 (range between 2,250 and 4,100) which was about the same as or slightly fewer than the estimate in 2008 (3,335; range of 2,370 to 4,300) (Table 2, Figure 2). In terms of exposure category, MSM continued to comprise the greatest proportion (46.6%) of new infections in 2011, which was slightly higher than the proportion they comprised in 2008 (44.1%). In 2011, the proportion of new infections among IDU was lower than in 2008 (13.7% compared to 16.9%). The proportion of new infections attributed to the heterosexual/non-endemic and heterosexual/endemic exposure categories were about the same in 2011 compared to 2008 (20.3% vs 20.1% and 16.9% vs 16.2%, respectively) (Figure 3)."

"Summary: Estimates of HIV Prevalence and Incidence in Canada, 2011" (Ottawa, Ontario: Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, 2012), p. 2.
http://www.phac-aspc.gc.ca/aid...

24. Reported Drug Harms

"The most commonly reported drug-related harm involves physical health, reported by 30.3% of lifetime and 23.9% of past-year users of illicit drugs excluding cannabis, and 15.1% of lifetime and 10% of past-year users of any illicit drug . Following physical health, a cluster of harms, represented somewhat equally, includes harms to one’s friendships and social life (22.3% and 16.4% of users excluding cannabis, 10.7% and 6.0% of any illicit users), home and marriage (18.9% and 14.1% excluding cannabis, 8.7% and 5.1% of any illicit users), work (18.9% and 14.2% excluding cannabis, 9.2% and 5.1% of any illicit users) and financial position (19.6% and 18.9% excluding cannabis, 8.4% and 6.5% of any illicit users)."

"Canadian Addiction Survey: A National Survey of Canadians' Use of Alcohol and Other Drugs: Prevalence of Use and Related Harms," Canadian Executive Council on Addictions, Health Canada, March 2005, p. 56.
http://www.ccsa.ca/Resource%20...

25. Police Crackdowns On Public Drug Markets Make Situations Worse

"We detected no reduction in druguse frequency or drug price in response to a large-scale police crackdown on drug users in Vancouver's DTES. The evidence that drugs became more difficult to obtain was consistent with reports of displacement of drug dealers and was supported by the significantly higher rates of reporting that police presence had affected where drugs were used, including changes in neighbourhood and increases in use in public places. These observations were validated by examination of needle-exchange statistics.

"Our findings are consistent with those showing that demand for illicit drugs enables the illicit drug market to adapt to and overcome enforcement-related constraints. Although evidence suggested that police presence made it more difficult to obtain drugs, this appeared to be explained by displacement of drug dealers."

Wood, Evan, Patricia M. Spittal, Will Small, Thomas Kerr, Kathy Li, Robert S. Hogg, Mark W. Tyndall, Julio S.G. Montaner, Martin T. Schechter, "Displacement of Canada's Largest Public Illicit Drug Market In Response To A Police Crackdown," Canadian Medical Association Journal, May 11, 2004: 170(10), p. 1554.

26. Police Crackdowns On Public Drug Markets Make Situation Worse

"Our results probably explain reports of increased injection drug use, drug-related crime and other public-order concerns in neighbourhoods where activities related to illicit drug use and the sex trade emerged or intensified in the wake of the crackdown. Such displacement has profound public-health implications if it 'normalizes' injection drug use among previously unexposed at-risk youth. Furthermore, since difficulty in obtaining syringes has been shown to be a significant factor in promoting syringe sharing among IDUs in Vancouver, displacement away from sources of sterile syringes may increase the rates of bloodborne diseases. Escalated police presence may also explain the observed reduction in willingness to use a safer injection facility.33 It is unlikely that the lack of benefit of the crackdown was due to insufficient police resources. Larger crackdowns in the United States, which often involved helicopters to supplement foot and car patrols, have not had measurable benefits and have instead been associated with substantial health and social harms."

Wood, Evan, Patricia M. Spittal, Will Small, Thomas Kerr, Kathy Li, Robert S. Hogg, Mark W. Tyndall, Julio S.G. Montaner, Martin T. Schechter, "Displacement of Canada's Largest Public Illicit Drug Market In Response To A Police Crackdown," Canadian Medical Association Journal, May 11, 2004: 170(10), pp. 1554-1555.

27. Effectiveness of Heroin-Assisted Treatment Compared With Methadone Maintenance

"Diacetylmorphine was found to be a dominant strategy over methadone maintenance treatment in each time horizon studied (Table 2). Over a lifetime horizon, people in the methadone cohort lived 14.54 years on average following entry into the model, spending 8.79 years (60% of their remaining life) in treatment and 5.52 years in relapse. They accumulated 7.46 discounted QALYs and generated a societal cost of $1.14 million. People in the diacetylmorphine cohort lived 15.45 years on average, spending 10.41 years (67% of their remaining life) in treatment (2.34 years of which was in post-diacetylmorphine methadone treatment) and 4.05 years in relapse. They accumulated 7.92 discounted QALYs and generated a societal cost of $1.10 million. Based on these findings in the baseline model, over a lifetime horizon the provision of diacetylmorphine in the hypothetical cohort provided greater incremental health benefits and reduced the total costs to society compared with methadone maintenance treatment."

Bohdan Nosyk PhD., et al., "Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment," Canadian Medical Association Journal, April 3, 2012, 184(6):E317-E328.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

28. Effectiveness of Heroin-Assisted Treatment Compared With Methadone Maintenance

"Our results on the cost-effectiveness of diacetylmorphine are consistent with those of an economic analysis based on data from two Dutch heroin-assisted treatment trials,21 despite differences in the design of the Dutch trials and the North American Opiate Medication Initiative, and the time horizon and analytic design of the economic analyses.

"The Dutch trials compared methadone maintenance treatment with a combination of methadone and diacetylmorphine (prescribed concurrently), which changed the profiles of health utility and health resource use. Furthermore, participants in the Dutch trials were recruited from methadone maintenance programs, whereas participants in the North American Opiate Medication Initiative had to have been out of treatment for at least six months before trial entry. We considered a range of time horizons, using external parameters where necessary to extrapolate results to longer time horizons. The other economic analysis used trial data exclusively and focused only on a 12-month study period. The consistency in results between our analysis and the analysis of the Dutch trials appears to be due primarily to the advantages diacetylmorphine provides in retaining individuals in treatment.

"We believe a lifetime horizon is the most appropriate period for evaluating treatments of chronic, recurrent diseases such as opioid dependence, because treatment is available indefinitely in practice and will have a long-term impact. The key outcomes, such as progressing to a drug-free state or death, would likely not be realized within the 12-month period of the North American Opiate Medication Initiative."

Bohdan Nosyk PhD., et al., "Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment," Canadian Medical Association Journal, April 3, 2012, 184(6):E317-E328.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

29. Comparison of Client Satisfaction Between Those Treated With Oral Methadone Versus Injectable Heroin

"The present study determined participants’ satisfaction with received treatments in the first North American RCT [Randomized Controlled Trial] to provide injectable diacetylmorphine or hydromorphone compared to oral methadone for the treatment of long-term, treatment resistant, opioiddependency. At 3 and 12 months, participants were satisfied with the treatment received during the study period, although satisfaction was greater for those randomized to receive injectable treatments. At 3 months, participants who reported that the program met their needs were more likely to be retained at 12 months. To our knowledge this is the first study to assess treatment satisfaction among participants receiving supervised injectable diacetylmorphine or hydromorphone.

"Regardless of the outcome of the randomization, participants in the trial were highly satisfied with the treatment received. This follows previous studies which have consistently found that patients tend to report high levels of treatment satisfaction, including community health services [45], services for mental health [13], addiction [46], and opioid dependence [20]."

Marchand et al., "Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency," BMC Health Services Research, 2011, 11:174.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

30. Comparison of Client Satisfaction Between Those Treated for Opioid Dependence With Oral Methadone Versus Injectable Heroin

"Among long-term chronic opioid injectors participating in a randomized clinical trial prescribing injectable diacetylmorphine or hydromorphone and oral methadone, those receiving injectable medications were more satisfied with treatment. Independent of treatment group, treatment satisfaction was also an indicator of retention in treatment, as well as treatment response, including a reduction in substance use. As the first study in North America to provide injectable OST, these findings have valuable implications for future RCTs, which should continue to measure satisfaction in order to identify areas of improvement. These findings also provide evidence-based knowledge for good clinical practice guidelines in the treatment of chronic opioid dependence in Canada as they highlight the association between treatment satisfaction and improved treatment outcomes, particularly for those receiving more innovative treatment medications."

Marchand et al., "Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency," BMC Health Services Research, 2011, 11:174.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

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