Biomedical subjects

David C Marsh

Publications and source records attributed to David C Marsh.

9 recordsLinked to original sources

PubMed2006

Medical withdrawal management in Vancouver: service description and evaluation.

This study evaluates a medically managed inpatient detoxification service (Vancouver Detox (VD)) and investigates its clients' characteristics over a 1-year period. We present information on the daily operation at VD, and examine accessibility and efficiency of it from five perspectives: wait time, pretreatment attrition rate, treatment completion rate, length of stay (LOS), and occupancy rate (OR). In addition, we explore the impacts of seasonality and the monthly welfare check on the utilization of the service. Among 2294 referrals, 35% dropped out without engaging in treatment. Among those who were admitted to VD, 78% completed the treatment program. Shorter wait time and lower OR were found during the welfare check issuance period, and lower OR was found during summer. In addition, the patterns of utilization of VD were changed over the welfare check issuance period. Our analysis indicates that operational accessibility and efficiency at VD could be improved by specifically addressing these factors.

Adolescent↗

PubMed2005

Potential uptake and correlates of willingness to use a supervised smoking facility for noninjection illicit drug use.

Many cities are experiencing infectious disease epidemics and substantial community harms as a result of illicit drug use. Although medically supervised smoking facilities (SSFs) remain untested in North America, local health officials in Vancouver are considering to prepare a submission to Health Canada for an exemption to open Canada's first SSF for evaluation. Reluctance of health policymakers to initiate a pilot study of SSFs may be due in part to outstanding questions regarding the potential uptake and community impacts of the intervention. This study was conducted to evaluate the prevalence and correlates of willingness to use an SSF among illicit drug smokers who are enrolled in the Vancouver Injection Drug Users Study. Participants who reported actively smoking cocaine, heroin, or methamphetamine who returned for follow-up between June 2002 and December 2002 were eligible for these analyses. Those who reported willingness to use an SSF were compared with those who were unwilling to use an SSF by using logistic regression analyses. Four hundred and forty-three participants were eligible for this study. Among respondents, 124 (27.99%) expressed willingness to attend an SSF. Variables that were independently associated with willingness to attend an SSF in multivariate analyses included sex-trade work (adjusted odds ratio [AOR]=1.85), crack pipe sharing (AOR=2.24), and residing in the city's HIV epicentre (AOR =1.64). We found that participants who demonstrated a willingness to attend an SSF were more likely to be involved in the sex trade and share crack pipes. Although the impact of SSFs in North America can only be quantified by scientific evaluation, these data indicate a potential for public health and community benefits if SSFs were to become available.

Adult↗

PubMed2005

Factors predicting 2-year retention in methadone maintenance treatment for opioid dependence.

Factors predicting 2-year retention in methadone maintenance and the impact of repeat treatment episodes on retention are examined. Data (n=9555 episodes) were drawn from a population-based treatment registry and analyses were performed using episode-weighted data. We estimated a binary logistic regression model with a duration of 730 days or greater as the dependent variable. The odds of remaining in treatment for 730 days or more increase with age and vary by region and provider type, but decrease with increasing number of treatment episodes. In comparison with other studies, these analyses show much higher rates of retention in methadone treatment but suggest that repeat episodes may not be as beneficial as existing research suggests.

Adult↗

PubMed2005

Patterns of opioid and cocaine co-use: a descriptive study in a Canadian sample of untreated opioid-dependent individuals.

This study examined prevalence and patterns of co-use of opioids and cocaine in regular users of illicit opioids (N = 729) recruited from 5 Canadian cities. Fifty-seven percent (n = 417) reported having used both opioids and cocaine in the month and week preceding the interview; of these, 73% (n = 304) were able to identify a typical pattern of daily co-use. In a typical day, injectors of opioids and cocaine (n = 119) and injectors of opioids who inhaled cocaine (n = 111) showed stable opioid use but variable cocaine use, which peaked at 21 hr. Overall, 30% of the individuals used both drugs exclusively in a sequential fashion, 35% reported taking opioids and cocaine within the same hour, and 35% reported taking them together at the same time or mixing them. These findings indicate that different individuals display different patterns of opioids and cocaine co-use.

Adolescent↗

PubMed2005

Sociodemographic disparities in access to addiction treatment among a cohort of Vancouver injection drug users.

Vancouver's explosive HIV epidemic among injection drug users (IDUs) has received international attention due to the presence of a large needle exchange program. The role of addiction treatment has not been evaluated in this setting. We evaluated factors associated with use of addiction treatment among a prospective cohort of Vancouver IDUs. Addiction treatment was negatively associated with Aboriginal ethnicity and unstable housing, both of which have been associated with HIV infection in previous studies. These findings demonstrate low levels of addiction treatment among Vancouver IDUs and suggest that programs may need to be targeted towards specific populations with poor access.

Adult↗

PubMed2005

Policy changes and the methadone maintenance treatment system for opioid dependence in Ontario, 1996 to 2001.

BACKGROUND: Until recently, the availability of methadone treatment in Ontario, Canada was limited. In 1996, policy changes were introduced to increase the availability of treatment. The 5-year impact of these policy changes is assessed. METHODS: For these census data, descriptive statistics were used to examine changes in the patient and provider populations over time using data from the College of Physicians and Surgeons of Ontario Methadone Maintenance Registry of Patients and the Registry of Methadone Prescribing Physicians. RESULTS: Between 1996 and 2001, the total number of clients in treatment increased substantially from: 1595 to 7787. Over this time period, the number of physicians prescribing methadone increased from 60 to 161. INTERPRETATION: Policy changes resulted in substantial increases in the patient and provider populations across Ontario. However, the estimated low proportion of opiate users in treatment indicates that more efforts are needed to address the potential demand for treatment.

Adult↗

PubMed2004

Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users.

Many Canadian cities are experiencing ongoing infectious disease and overdose epidemics among injection drug users (IDUs). In particular, Human Immunodeficiency Virus (HIV) and hepatitis C Virus (HCV) have become endemic in many settings and bacterial and viral infections, such as endocarditis and cellulitis, have become extremely common among this population. In an effort to reduce these public health concerns and the public order problems associated with public injection drug use, in September 2003, Vancouver, Canada opened a pilot medically supervised safer injecting facility (SIF), where IDUs can inject pre-obtained illicit drugs under the supervision of medical staff. The SIF was granted a legal exemption to operate on the condition that its impacts be rigorously evaluated. In order to ensure that the evaluation is appropriately open to scrutiny among the public health community, the present article was prepared to outline the methodology for evaluating the SIF and report on some preliminary observations. The evaluation is primarily structured around a prospective cohort of SIF users, that will examine risk behavior, blood-borne infection transmission, overdose, and health service use. These analyses will be augmented with process data from within the SIF, as well as survey's of local residents and qualitative interviews with users, staff, and key stakeholders, and standardised evaluations of public order changes. Preliminary observations suggest that the site has been successful in attracting IDUs into its programs and in turn helped to reduce public drug use. However, each of the indicators described above is the subject of a rigorous scientific evaluation that is attempting to quantify the overall impacts of the site and identify both benefits and potentially harmful consequences and it will take several years before the SIF's impacts can be appropriately examined.

Journal Article↗

PubMed2004

Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users.

BACKGROUND: North America's first medically supervised safer injecting facility for illicit injection drug users was opened in Vancouver on Sept. 22, 2003. Although similar facilities exist in a number of European cities and in Sydney, Australia, no standardized evaluations of their impact have been presented in the scientific literature. METHODS: Using a standardized prospective data collection protocol, we measured injection-related public order problems during the 6 weeks before and the 12 weeks after the opening of the safer injecting facility in Vancouver. We measured changes in the number of drug users injecting in public, publicly discarded syringes and injection-related litter. We used Poisson log-linear regression models to evaluate changes in these public order indicators while considering potential confounding variables such as police presence and rainfall. RESULTS: In stratified linear regression models, the 12-week period after the facility's opening was independently associated with reductions in the number of drug users injecting in public (p < 0.001), publicly discarded syringes (p < 0.001) and injection-related litter (p < 0.001). The predicted mean daily number of drug users injecting in public was 4.3 (95% confidence interval [CI] 3.5-5.4) during the period before the facility's opening and 2.4 (95% CI 1.9-3.0) after the opening; the corresponding predicted mean daily numbers of publicly discarded syringes were 11.5 (95% CI 10.0-13.2) and 5.4 (95% CI 4.7-6.2). Externally compiled statistics from the city of Vancouver on the number of syringes discarded in outdoor safe disposal boxes were consistent with our findings. INTERPRETATION: The opening of the safer injecting facility was independently associated with improvements in several measures of public order, including reduced public injection drug use and public syringe disposal.

British Columbia↗

PubMedDate not supplied

Rationale to evaluate medically supervised safer smoking facilities for non-injection illicit drug users.

Many cities are experiencing ongoing infectious disease epidemics and substantial community harm as a result of illicit drug use. In an effort to reduce these public order and public health concerns, consideration has been given to the opening in Vancouver of a safer smoking facility (SSF). The present review was conducted to examine if there is a rationale to support the evaluation of a SSF in the Canadian context. Available evidence suggests that conventional drug control strategies are insufficient to address the health and community harms of non-injection drug use, and that the public order benefits of supervised injection facilities may be relevant to SSFs. In addition, there is persuasive evidence to suggest there is potential for blood-borne disease transmission through the sharing of smoking paraphernalia, and the potential for SSFs to address this concern is a pressing public health question. Also relevant to this topic are interventions to prevent transition into injection drug use, and SSFs may also be evaluated as a potential strategy to address this concern.

Amphetamine-Related Disorders↗