Prevention Update

A unique update on what is happening in the world of drug abuse prevention.

Welcome to Prevention Update, the Prevention Hub's comment on latest news, research, statistics, policy updates, information on resources and events. It is relevant in particular to practitioners and policy makers but equally valuable and interesting to all who form the drug prevention community.

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Restricting Fentanyl-related Chemicals in Canada

Between 2009 and 2014, there were approximately 655 deaths in Canada that involved fentanyl, a powerful opioid pain reliever.

Addressing the issue of fentanyl-related deaths is a complex and challenging task. To be effective, it requires coordinated efforts to reduce the amount of both pharmaceutical prescription fentanyl, as well as illicit fentanyl purchased or produced on the black market.

One strategy to reduce the amount of fentanyl-related deaths is to prevent the purchasing and importing or exporting of chemicals used to make fentanyl. Health Canada has recently released new plans to restrict six chemicals that are used to make illicit fentanyl, as Canada continues to address what is becoming a national opioid crisis. This change will help ensure that the federal government can act quickly to restrict the unauthorized import and export of these chemicals.

Provinces are also moving forward with their own strategies to reduce the number of opioid-related deaths. For example, in British Columbia, Vancouver Coastal Health announced that Insite, a supervised injection site, is now offering a drug-checking service to help people who use drugs determine if their drugs contain potentially deadly contaminants. Recently, 86% of the drugs tested at Insite contained some amount of fentanyl — this poses a danger to people both new to use and experienced with drug use.

For more information, download the August 2015 Canadian Community Epidemiology Network on Drug Use (CCENDU) bulletin, [Deaths Involving Fentanyl in Canada, 2009–2014]( Library/CCSA-CCENDU-Fentanyl-Deaths-Canada-Bulletin-2015-en.pdf).

Career Opportunity: Senior Research and Policy Analyst

Reports to: Director, Research & Policy

The Canadian Centre on Substance Abuse (CCSA) changes lives by bringing people and knowledge together to reduce the harms of alcohol and other drugs on society. We partner with public, private and non-governmental organizations to improve the health and safety of Canadians. A non-governmental organization (NGO) with a national focus, CCSA's vision is that "all people in Canada live in a healthy society free of alcohol- and other drug-related harm." The Senior Research and Policy Analyst (SRPA) is a subject-matter expert who conducts research and responds to research requests (both internal to CCSA and external), and provides research-based policy analysis relevant to CCSA's priorities. The SRPA may represent CCSA on various expert committees and associations, and provide advice on research initiatives and their impact on public policy. The SRPA works in collaboration with CCSA's external facing divisions to communicate key messages and aid in the knowledge mobilization of research results. The primary area of research focus for this particular position is the co-occurrence of gambling and substance use.

Strategic Thinking and Research Development
Facilitates and initiates national research initiatives in the addictions area, with a specific focus on the co-occurrence of gambling and substance use
Collaborates with CCSA and researchers of other agencies to determine the nature and scope of studies required, with a specific focus on the co-occurrence of gambling and substance use
Contributes to the strategic development of CCSA's research program
Plans and conducts research studies on specific aspects of addictions and substance abuse relevant to the organization's strategic directions and priorities
Implements processes to help CCSA identify and promote important emerging areas of research
Contributes to research grant proposals to gain additional research funding for CCSA

Performs internal reviews of research proposals, analyses, results and reports
Conducts media interviews, webinars and workshops, and obtains and provides expert opinions on relevant issues
Represents CCSA on committees and liaises with external scientific and clinical advisors
Provides functional advice to other analysts in conducting specific studies

Determines the appropriate research methodologies, analytical techniques, designs, models, scope, timelines and costs of research projects
Determines data or information requirements and negotiates agreements with other organizations or government bodies to obtain data
Gathers information and performs appropriate qualitative or quantitative analyses
Conducts or identifies existing research knowledge syntheses to inform policy and practice
Prepares reports with conclusions and recommendations or proposals for further study
Reviews research proposals from other analysts and kindred agencies
Responds to requests for information and advice from other research analysts
Publishes in peer-reviewed journals
Presents findings of research at conferences, workshops and symposia
Policy Analysis
Conducts research-based policy analyses on topical matters related to substance use, with a specific focus on the co-occurrence of gambling and substance use
Incorporates new and emerging research knowledge into policy position papers
Conducts impact analyses of new research directions vis-à-vis existing policies and practices in the addictions field
Publishes peer-reviewed and non-peer-reviewed policy research findings
Participates in national forums, conferences and advisory boards

Ph.D. in an addictions or related field or post-doctoral training in an addictions or related field or Master's degree and a minimum of 7–10 years' experience in an addictions or related field
Strong knowledge base of the gambling literature and its various stakeholders
Experience in effectively liaising with local, national and international stakeholders from various sectors, particularly in the gambling field
Research experience in social sciences, population health, epidemiology, psychology or clinical sciences related to the addictions field or related disciplines
Bilingual (French/English)
Fully developed analytical and reasoning skills
Ability to understand, express and apply complex technical qualitative and quantitative analyses, concepts, methods and procedures
Ability to perform knowledge syntheses and critically appraise and evaluate research
Strong written and oral communications skills
Evidence of peer-reviewed publications and presentations at conferences
Significant experience with research project management, including budget management
Strong time management skills
Ability to work independently

Assets Experience in preparing successful grant proposals and reviewing grant proposals, particularly with federal research granting bodies
Experience analyzing public policy and determining the implications of new research knowledge for application by policy makers

Consideration of candidates will begin immediately and will continue until the position is filled. Interested candidates should submit a résumé and covering letter by email to hr [at] ccsa [dot] ca.​ We thank all respondents; however, only those candidates selected for an interview will be contacted.​​​

Issues of Substance Conference - Call for Abstracts

The Canadian Centre on Substance Abuse (CCSA) is pleased to announce the Call for Abstracts for IOS 2017. Abstracts must be submitted no later than January 27, 2021, as detailed below.

Individuals and teams are encouraged to submit abstracts that stimulate ideas and discussion, promote learning of knowledge and skills, and energize attendees to participate in debate.

Presentation Formats and Themes
CCSA is seeking presentations, posters and workshops on policies, programs and frameworks that include evidence-informed practices, emerging research and innovative knowledge exchange strategies. Abstracts are welcomed on all substances, including alcohol, and licit and illicit drugs, and on gambling. Although all abstracts will be considered, we are looking for submissions that support the following subthemes:

• Innovative and novel approaches to service delivery (e.g., technology-assisted therapy, mobile apps, therapy animals)
• Substance use and co-occurring issues/disorders (e.g., mental health, suicide, trauma, family violence, intimate partner violence, chronic pain, FASD)
• Responsible and problem gambling
• Overdose prevention and management
• Cannabis (e.g., policy development and implications, medical use, etc.)
• Prescription drugs, including opioids
• Indigenous approaches to addressing substance use and healing
• Health promotion, substance use prevention and early identification
• Alcohol
• Public health approaches to substance use across the continuum of care (e.g., managed alcohol programs)
• Recovery, health and well-being
• Specific populations (e.g., youth, incarcerated persons, older adults, people who are homeless, new Canadians)
• Sex- and gender-appropriate approaches to substance use
• Drugs of evolving legal status (e.g., novel psychoactive substances, e-cigarettes)
• Innovative methods to bringing research to practice
• Stigma

Applicants must submit their abstracts by January 27, 2017. Abstracts should be 250 words or less in English or French and apply to one of the aforementioned formats. If you have any questions, please contact IOS2017-Info [at] ccsa [dot] ca.

For more information, including information on how to obtain presenter subsidies if qualified, please consult the Call for Abstracts document.

2017 NIDA International Forum: Abstract Submission and Travel Awards Now Open

Online Abstract Submission and Travel Award Requests Now Open
Deadline: January 3, 2021

Present your international drug abuse research during the NIDA International Forum.

The NIDA International Program invites abstract submissions and travel award applications from researchers around the world. Join us for the Forum research symposium, interactive workshops, poster session, and networking activities.

• Submit Abstracts and Apply for Travel Awards: December 1, 2020 – January 3, 2021
• Abstract and Travel Award Notifications: March 6, 2021
• Online Registration: February 27 – May 5, 2020
• Request Visa and Invitation Letters: February 27 – May 5, 2020

Held in conjunction with the 79th Annual Scientific Meeting of the College on Problems of Drug Dependence (CPDD), the NIDA International Forum has separate registration and abstract submission processes from the CPDD meeting.

Submit your abstract for the 2017 NIDA International Forum

Drug Checking: Does it Work?

As one component of a harm reduction approach, a drug checking or testing service enables people who use drugs to find out about the contents of their pills and powders before they ingest them. The idea behind drug checking is that a small, high-risk group of individuals will use substances despite the associated health risks or unknown harms associated with taking illicit drugs. Providing people who use drugs with information about what they are taking can help them make informed decisions and avoid the potentially life threatening effects of certain drugs (e.g., fentanyl overdose or opioid poisonings).

Insite, North America’s first legal supervised injection site, has been offering drug checking services as part of a pilot study to test the effectiveness of this harm reduction strategy, as well as to get a better understanding of the contaminants commonly found in illicit street drugs.

So far, there is limited evidence available to show whether or not drug checking is effective. However, the evidence that is available suggests that drug checking can reduce harms associated with substance use, but studies like the one going on at Insite are needed to validate these findings.

Initial results of the Insite pilot reveal that 86% of all drugs tested were positive for fentanyl — the dangerous drug responsible for hundreds of fatal overdoses in Canada alone. This finding is enough to show that fentanyl contamination is a serious health concern for those using illicit drugs — especially heroin. Insite will continue to offer drug checking services for several months so that staff can evaluate whether it is effective at helping clients and reducing harms. The results will dictate the future of drug checking services at Insite and probably elsewhere in Canada.

The results at Insite will also contribute to a growing evidence base that will guide future decisions on the opening of supervised injection sites in other communities across Canada, and also whether drug checking services should be made available as part of a harm-reduction strategy.

Drug checking is one part of a much larger strategy. To effectively prevent harms associated with drug use, other forms of prevention like education and awareness are important first steps. It is also important to pair drug checking with opportunities for trained professionals to talk with individuals who choose to use substances, and make sure the limitations of drug checking are fully explained and that results can be interpreted accurately. By providing easy access to substance use treatment programs and access to naloxone kits to treat overdoses, comprehensive harm reduction strategies can help minimize the harms associated with substance use.

For more information, see this article on the Vancouver Coastal Health website.

Is it worth the wait?

How does age of onset change marijuana’s effects on impulsivity?

Did you know that in 2013 Canadian youth were reported to be the highest users of marijuana in the developed world?

Marijuana continues to be the most commonly used illegal drug among Canadian youth, 15–24 years old. According to Statistics Canada’s Canadian Tobacco, Alcohol and Drug Survey, the rate of marijuana use among youth and young adults in 2013 was more than double the rate of use among people over 25 years old.

Why is it important to address youth marijuana use?

Neuroscience research has shown that adolescents are at greater risk for experiencing harms associated with marijuana than are adults. A young person’s brain is still going through extremely important developmental changes; its neural networks are not fully set up until the early to mid 20s. A great deal of brain development takes place throughout adolescence and into early adulthood.

Chronic marijuana use has been associated with memory impairment (either the ability to store memories or the ability to recall memories can be impaired) and difficulties thinking and paying close attention to things. The longer a young person has been using marijuana, the stronger these effects are. Connections have also been made between early and chronic use of marijuana and increased risk of psychosis, depression and anxiety, as well as respiratory conditions and maybe even lung cancer — all of this is true for both youth and adults.

Can age of onset change marijuana’s effects on brain development?

A recent study [1] showed that marijuana smokers of age 25, particularly those who began regular use prior to age 16, had significantly reduced white matter development than non-marijuana smoking controls. White matter can be thought of as insulation for brain cells — just like a telephone wire needs insulation to send a signal, brain cells do too. The youth with lower levels of white matter development also scored higher on impulsivity tests.

So what?

These findings suggest that age is a factor in the effects of marijuana use on the developing brain: the earlier one begins to use marijuana, the greater the effects on that person’s brain development can be.

Implications for Prevention Practice
To reduce the negative impacts of marijuana use — for medical purposes or otherwise — among youth, delaying the age of onset should be a prevention goal.

Implications for Policy
These findings should also be used to inform policies and legislation related to the legal age at which one can use or possess or purchase marijuana.

For more information on how marijuana use effects the adolescent brain, download The Effects of Cannabis Use during Adolescence, published by the Canadian Centre on Substance Abuse (CCSA).

[1] Gruber, S.A., Dahlgren, M.K., Sagar, K.A., Gonenc, A., & Lukas, S.E. (2014). Worth the wait: effects of age of onset of marijuana use on white matter and impulsivity. Psychopharmacology, 231(8), 1455–1465.

The Rise of Edible Marijuana Products

How common are edible marijuana products?

The legalization of marijuana has become a popular topic of discussion for Canadians, as the federal government has said that changes are coming to the legal status of marijuana in Canada.

With all the buzz surrounding our marijuana legalization, head shops and retailers have opened ahead of new laws. However, dried, cured marijuana flowers — the typical substance bought, sold and smoked on the street — is not the only product one can get at these shops.

Edible marijuana products — brownies, cookies, candies, infused beverages and so on — are becoming more and more popular as a way to get high. These products look a lot like their marijuana-free counterparts, making them hard spot, so people are choosing them if they want a more subtle way to get high. But because these products look just like any other brownie, candy or chocolate bar, they can be eaten by children and adults without them knowing about their contents or possible effects.

How common are edible marijuana products?

Between January 2013 and December 2015, there were 430 cases of human exposure to marijuana brownies, candies, cookies, beverages or other foods reported to the National Poison Data System (NPDS) in the United States. The number of calls reported increased over time throughout the study, and the majority of the reported cases, not surprisingly, came from states with decriminalized marijuana laws (i.e., Colorado and Washington).

Are there harms associated with consuming edible marijuana products?

Of all the cases reported to the NPDS, the most common age-groups were those less than five years old, and those between 13 and 19 years old! Edible marijuana products pose real danger to these children; marijuana interferes with normal brain development and children under the age of five and between 13 and 19 years old are undergoing rapid and extensive brain development.

For more information on the effects of marijuana on brain development, check out The Effects of Cannabis Use during Adolescence, a report published by the Canadian Centre on Substance Abuse.

The good news is that no one has died as a results of being exposed to edible marijuana products. The main symptoms reported to the NPDS were drowsiness, tachycardia (fancy way of saying a very fast heart beat), agitation and irritability, and confusion.

While most of the clinical effects associated with exposure to edible marijuana products were minor, the increasing numbers of exposure over time is of major concern. These data are from American sources, and most exposures happened in states that have already relaxed their laws around marijuana consumption. Will the same trends happen in the provinces and territories if marijuana is legalized in Canada?

For more information, see Characterization of edible marijuana product exposures reported to United States poison centers.

Assessing the Harms of Opioids

Opioid misuse is a pressing issue in Canada with rates of drug-related overdose deaths rising drastically across the country. Canada is the second largest per capita consumer of prescription opioids (1) and increasingly more patients are being treated for harms related to these drugs. Between 2009 and 2014, fentanyl, a potent synthetic opioid, was identified as a cause or a contributing cause in at least 655 deaths in Canada. (2) Despite the prevalence of this epidemic, reliable pan-Canadian data about the burden of harms associated with opioid use on Canadian hospitals is currently lacking.

A collaborative report between the Canadian Centre on Substance Abuse (CCSA) and Canadian Institute for Health Information (CIHI) fills this evidence gap. Hospitalizations and Emergency Department Visits due to Opioid Poisonings in Canada is the newest addition to CCSA’s resources on the costs and impacts of substance use. Its development is part of CCSA’s ongoing efforts to inform and support initiatives aimed at reducing opioid-related harms, including the 2013 release of First Do No Harm: Responding to Canada’s Prescription Drug Crisis.

The report provides pan-Canadian data on rates of hospitalizations and emergency department visits due to opioid poisonings. Opioid poisoning refers to the clinical code used in medical records when a patient is diagnosed with an acute toxicity due to opioids. Findings from the report show that:
• The rate of hospitalizations due to opioid poisoning in Canada increased over 30% between 2007–2008 and 2014–2015.
• Quebec had the lowest rates of hospitalizations due to opioid poisoning compared to all other provinces across all data years.
• Although seniors over age 65 represent only 16% of Canada’s population, they accounted for nearly one-quarter of hospitalizations due to opioid poisoning.
• The majority of opioid poisonings among seniors were accidental — likely due to the use of multiple medications and age-related changes to the body.
• Compared to other age groups, youth rates of opioid poisoning increased most rapidly and the majority of these were due to intentional self-inflicted harm.

This evidence was compiled to provide the first cross-Canada picture of who in each Canadian jurisdiction is experiencing opioid-related harms. This data can help inform and tailor prevention and treatment efforts in each jurisdiction. The data presented in the report could also be used to fuel future multi-sectoral collaborations between organizations in an effort to mitigate harms associated with opioids.

1 International Narcotics Control Board. (2013). Narcotics drugs: estimated world requirements for 2013; statistics for 2011. New York: United Nations.
2 CCENDU. (2015) CCENDU drug alert: deaths involving fentanyl in Canada, 2009-2014. Ottawa, Ont.: Canadian Centre on Substance Abuse.

An Unintended Consequences of Cannabis Legalization: Drug-Impaired Driving

Before Canada moves ahead with legalization of cannabis, there are many important things to consider and prepare for in order to minimize the unintended harms associated with cannabis use.

After cannabis was made legal in Washington and Colorado, the Canadian Centre on Substance Abuse (CCSA) met with officials to discuss their experience and published a document, Cannabis Regulation: Lessons Learned in Colorado and Washington State, that highlights many of the unintended consequences and hard lessons learned about cannabis legalization.

Among the many surprises — things that weren’t thought about or expected — was the increase in drug-impaired driving. For example, Colorado reported a 32% increase in the number of marijuana-related traffic fatalities in the year following cannabis legalization. Marijuana-related traffic fatalities can be used as an indicator that more people are driving high.

In Canada, drug-impaired driving is already a very serious issue. How serious? Well, in 2012 the Traffic Injury Research Foundation determined that about 40% of fatally injured drivers in Canada were killed in drug-related accidents. The prospect of drug-impaired driving rates going up if and when cannabis is legalized is a scary one. Although we have developed tools to help detect the presence of alcohol and gauge the level of alcohol intoxication, the same progress has not been seen for detecting cannabis levels or cannabis intoxication; this will surely need to change.

The federal government is assuring the public that it is aware of the increase in drug-impaired driving that has followed recent changes to cannabis law across the globe, and it is working hard to tackle this issue in Canada before any changes to our laws come into effect.

Prevention initiatives will be a critical component to these efforts. Prevention campaigns will be needed to educate Canadians on the risks associated with drug-impaired driving, address some common myths and very clearly explain the relationship between THC (the active ingredient cannabis) and alcohol, because when they are taken together, impairment increases.

These prevention campaigns, and the hard work and planning that goes into them, will need to happen up front — before cannabis laws change.

For more information, see Liberals warned that legal pot may mean more impaired driving.

Simultaneous Cocaine and Alcohol Use Linked to Suicide Risk

New study shows a link between using cocaine and alcohol at the same time, and risk for attempting suicide.

The link between substance use and suicide is complicated and not well understood. We know there is a link between substance use and an increase risk for suicide, but we don’t know which drugs place people at risk of suicide and the details of this relationship.

To help fill in these gaps, researchers at Brown University conducted a study to look at the relationship between substance use and suicide. It looked at 874 individuals (men and women) who ended up in an emergency department (ED) between 2010 and 2012, and who said they had recently made a suicide attempt or thought about suicide.

While they were in the ED, researchers asked questions about the patients’ substance use, and then followed up with them a full year afterward. When speaking with the researchers in the ED, patients reported use of many different substances, including marijuana, prescription painkillers, tranquilizers, stimulants, cocaine, alcohol, etc.

The study found that:
- Of the 874 people included in the study, 195 (~22%) attempted suicide at least once in the year following their ED visit.
- Of all the substances patients in the ED reported to have used, only cocaine and alcohol had a statistically significant association with suicide risk.
- Of all the patients included in this study, 41 (~5%) reported using both cocaine and alcohol at the same time. These patients were 2.4 times more likely to attempt suicide in the year following the ED visit, compared to individuals who were using just cocaine or alcohol or neither.
- Women were more likely than men to have attempted suicide, but substance use was less likely to be involved in the suicide attempts of women compared to men. What does this all mean?

The link between gender, substance use and suicide is complex.

This study cannot say that substance use causes suicide. These results simply show that there is a link between substance use (especially cocaine and alcohol when used together) and suicide or attempted suicide.

These findings are important because they can be used to help assess and identify individuals who are at high risk for suicide and ultimately help save lives. For more information, see Simultaneous cocaine, alcohol use linked to suicide risk.