In the beginning of November, we had the wonderful opportunity to participate in a reunion of some 360 colleagues, plus 100 virtual attendants, in Saskatoon, following 2 years of enforced pandemic separation. While communications by Zoom provide new avenues for accessibility, observing the cheerful reunions in the corridors, the insights acquired from a dialogue with speakers and planning groups, and yes, even the exchange of gossip, was further evidence of our need for connectivity. Congratulations to the 2022 CSAM Conference Organizers.
This issue includes 5 articles. We introduce them in the context of the information gained from the Conference.
Spurred by the opioid crisis, the Journal receives regular submissions on opioid management, also a top topic of presentations. In this issue, 3 articles on this topic: first, a national online survey of representatives of Withdrawal Management (WM) programs. As anticipated, Rush et al1 report a relative lack of capacity in Opioid Agonist delivery as well as a need to standardize clinical guidelines. Second, the evidence for the transition from methadone to buprenorphine is so far based on case reports describing alternative methods. In the second article, Costa et al2 present the case of an individual with polysubstance use and stimulant-induced psychosis transitioning from methadone to eventually buprenorphine extended-release injection. Throughout, this focus on treatment retention is highlighted. Overall, this transition strategy based on creative case reports is in dire need of randomized control trials. The good news is that such trials are now registered in Canada3 and also in the United States. The third is a commentary by Dr Kleinman,4 who proposes additional practice guidelines to add to the developing national set.
The involuntary hospital admissions of people with severe substance use disorders (SUD) remains a subject of controversy. Di Paola et al5 report on 3 cases, with advice as to how to preserve rapport and secure positive outcomes.
Gooding et al6 compare couple therapy treatment seeking among people with SUDs versus gambling disorders from online data in a national survey. Conclusions are that treatment seeking in SUDs is mostly related to a more prominent comorbidity profile, while for gamblers, treatment seeking is more related to a greater addiction severity.
Returning back to this year’s conference, a strong feature was its emphasis on social policies. If you have not yet heard of the Overton Window7 as a yardstick of political viability and social acceptance, may I recommend you “Google” it.
This issue is to be published in March 2023. Hopefully, 2023 will turn out to be a healing and forward-looking year.
1. Rush B, Ali F, Bozinoff N, et al. Withdrawal management practices and services in Canada: a cross-sectional national survey on the management of opioid use disorder. Can J Addict 2023;14:6–14.
2. Costa T, Hannah M, Cuperfain A, et al. Maintaining evidence-based opioid agonist treatment during a methadone to buprenorphine rotation with slow-release oral morphine. Can J Addict 2023;14:15–18.
3. US National Library of Medicine. ClinicalTrials.gov. Comparing rapid micro-induction and standard induction of buprenorphine/naloxone for treatment of opioid use disorder. Accessed November 27, 2022. https://www.clinicaltrials.gov/ct2/show/NCT04234191?id=NCT04234191&draw=2&rank=1&load=cart
4. Kleinman RA. Suggestions for Canada’s opioid use disorder management guidelines. Can J Addict 2023;14:19–21.
5. Di Paola F, Franchuk S, Katz R, et al. Involuntary hospital admission in the treatment of people with severe substance use disorder. Can J Addict 2023;14:22–25.
6. Gooding NB, Williams JN, Williams RJ. The differences between gamblers and substance users who seek treatment. Can J Addict 2023;14:26–34.
7. Overton Window. Accessed September 23, 2022. In Wikipedia