Volume 13, Number 1

Canadian Addiction Medicine Canadien de Medicine D’Addiction March 2009

Canadian Society of Addiction Medicine / La Société Médicale Canadienne sur l’Addiction

Since the last Bulletin in November your Board of Directors has met twice via teleconference. The most pressing item on the agenda is a succession plan for office management. The Malachite group, office managers since 2006, has served notice that they will not be extending their management contract past May 2009. This decision was finalized by Malachite in October as the Board met in their face-to-face conference prior to the Vancouver Scientific gathering and AGM.
Four specific proposals have been received from parties interested in managing CSAM’s day-to-day office business. Each of these has been reviewed by the Executive Committee and consensus reached on the most appealing for our immediate requirements. The Board has decided to separate the office management duties from the annual convention organizing responsibilities. Our annual meeting this year will be held in conjunction with the International Society of Addiction Medicine (ISAM) at Calgary on September 23-25th. The actual CSAM component will take place on only one day— Saturday, September 26th. ISAM will be offering a three day scientific meeting on Wednesday thru Friday that promises to be extra special. Many highly credentialed international speakers have been confirmed by the organizing committee giving Canadian based professionals interested in addiction medicine a rare opportunity to share this expertise within our own borders. This four-day conference in Calgary will undoubtedly draw many registrants from around the world. It is hoped that CSAM members will turn out in force to meet international colleagues and provide valuable Canadian input. CSAM’s annual general meeting is to take place later on Saturday afternoon, and will be structured to encourage member discussion on important issues. Please mark your calendars now for September 23 - 26, Calgary, Alberta. One registration fee is available for both meetings or each one singly, if preferred. The Board currently has four vacancies—three geographic jurisdictions and one member-at-large. Bill Campbell’s resignation accounts for the latter. An opening for a Director from the Northern Territories has been created with Ross Wheeler’s resignation, while a similar opportunity opened for a PEI physician with my ascendency to President. The Newfoundland and Labrador position has never been filled and awaits an interested physician from our eastern most province. Any physicians with interest in these positions are asked to contact a current Board member. And a tip of the hat to Michael Varenbut, our dedicated Bulletin Editor. This communication vehicle is CSAM’s most tangible member benefit. It takes much time and energy to gather reports and organize appropriate articles. Without Michael’s interest and commitment to the Bulletin over the years CSAM would have suffered immeasurably. Thank you Michael.

Message from the President................... 1 Message from the Editor ......................... 2 Committee Reports .................................. 2 Save the Date ............................................ 4 Membership Application.......................... 5 News from Across Canada ...................... 7 Feature Articles ........................................ 8 Research Corner ....................................... 9

Dr. Michael Varenbut

AssoCiAte editor
Dr. Don Ling

An offiCiAl publiCAtion of

CSAM Head Office Suite 201, 375 West Fifth Avenue Vancouver BC V5Y 1J6 Tel: 604-484-3244 Fax: 604-874-4378 Email : admin@csam.org The CSAM/SMCA Bulletin is published by the Canadian Society of Addiction Medicine. It is a journal for the dissemination of knowledge and clinical experience related to addiction medicine. If you are a CSAM/SMCA member and would like to contribute an article or letter to the Bulletin, please send and email to the editor, Dr. Michael Varenbut at mvarenbut@toxpro.ca. Please forward your correspondence to admin@csam.org

Respectfully yours, Dr. Don Ling

Dr. Dr. Dr. as well as recommendations. which continue to enrich our publication. materials and contributions to the bulletin. Once further consultation is complete. This tool will be used in the future to assess any training programs in the field. we continue to work on our assessment of the www. Garth McIver The committee has been working on a number of projects and initiatives. and a final version of the document is made available. Mel Kahan et al. we look forward to your comments. Dr. Dr. As always. but we often fall short in documenting and reporting on these activities to our membership. using the standardized “AGREE” instrument. Brian Fern. In addition. I hope that you will find this issue of the Bulletin interesting. 2 .MESSAGE FROM THE EDITOR Dear CSAM members and Bulletin readers. It is only with your ongoing support that we will continue to improve on our publication and continue to increase its value to our members and readers. will be presented to the board as soon as possible. You will find some of their updates and reports included in this issue. which CSAM may be asked to critically appraise and endorse. Our final assessment. Suzanne Brissette. CASAM. Many of the CSAM committees have been very busy working on a multitude of projects on behalf of the membership and the board. Michael Varenbut COMMITTEE REPORTS OPIATE AGONIST COMMITTEE REPORT Michael Varenbut. We will strive to improve on this as much as possible in the future. suboxonecme. CCSAM. I would like to use this opportunity to thank all those who contributed materials. MD. FASAM Chair Committee members: Dr. The committee has also been able to provide preliminary feedback to a new set of clinical treatment guidelines for Buprenorphine prescribing. Our findings and recommendations will then be presented to the board and the authoring group. We have received unanimous CSAM board approval and support for the final version of the “Assessment Tool for training programs in Opiate Agonist Therapy”. authored by Dr. Wade Hillier.com training program. John Fraser. Wishing you all the best. There is a significant amount of work that is done “behind the scene” at CSAM. educational and informative. we will proceed with assessing the new guidelines.

Dr.MEMBERSHIP COMMITTEE REPORT Michael Varenbut. Lastly. MD. CCSAM. updates concerning the upcoming Annual Scientific Conference are expected soon. As well. Lastly. There are 127 MD members. a position paper regarding supervised injection facilities will soon be made available to the membership and public at large. CCSAM. CASAM. Brian Fern. The committee has been listening closely to the Board’s concerns and is planning on creating an area for members of the society to be listed. 82 associate members. CSAM has 232 members for 2009. Currently. 3 PHD members. David Teplin. Please contact myself if there is an interest. 4 student members and 4 retired members. CASAM. Dr. Nady El-Guebaly. CCSAM. Ron Lim. Jean Pierre Chiasson. Also. CASAM. Don Ling. FASAM Committee members: Dr. 12 honorary members. We would welcome any suggestions and ideas from our current members and appreciate any recruitment that you are able to achieve. Successful candidates will be announced at the Annual Scientific Conference. 3 . John Fraser. FASAM Chair Committee members: Dr. work is now underway to translate the site to French. The Standards Committee has been busy reviewing applications for this year’s CSAM certificants. Dr. Garth McIver The CSAM membership committee has been working on a variety of ideas to maintain and increase membership and to highlight benefits to CSAM membership as a whole. the committee seeks members who have played a pivotal role within the field or have brought a high level of expertise to their communities. STANDARDS COMMITTEE Jeff Daiter. MD. the committee is hoping to attract new members. Dr. FASAM Committee members: Dr. MD. Charles Mackay. It is with great pleasure that we welcome the following members to CSAM: Name Ferne Hand Ronda Collier Rhonda Fazzari Tara Fletcher Kim Foster Pauline Hainey Joanne Halliday Chantelle Hamm Christine MacGillivray Ashley Olesiak Melinda Rollick Paul Stewart Katharine Storkson Deana Talavera Tyler Tebbenham Sarah Telford Britta West Province SK ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON ON Member Status A A A A A A A A A A A A A A A A A Kasandra Westcott Linda Zucker Rob Keith Syed Kazmi Denise Lea Jonathan Fine Akinlolu Peluola Elena Timofeeva Richard Kretschmann ON ON BC International ON BC SK QC BC A A A MD MD MD MD PHD STU WEBSITE COMMITTEE Jeff Daiter. Dr. Dr. David Luckow CSAM’s new and improved website has been online for a number of months now. Specifically. Dr.


CSAM MEMBERSHIP FORM Membership Type  Regular Member – MD Applicant Information  Dr.  Miss  Mr.  Mrs.  Regular Member – PhD Scientists  Medical Student/ Intern/Resident  Retirees – MD or PhD  Associate Member American Society of Addiction Medicine (ASAM): International Society of Addiction Medicine (ISAM): Are you interested in Canadian Certification in Addiction Medicine? (Member – MD only) 5 . Name: (First Name) Work Address  Preferred Mailing Address Address: City: Work Phone: Address: City: Home Phone: Email Contact* Email address: Education History Undergraduate Degree(s)/University/Year Graduated: Graduate Degree(s)/University/Year Graduated: Area of Specialty: Current Employment: Area of Employment:  Private Practice  Treatment Centre  Educational Facility  Other (please specify): Appointment(s) – Hospital/University/College Including Department: Addiction Medicine Affiliations Percentage of time in research and clinical practice devoted to: Addiction: Other aspects of healthcare: Total: % % 100 % Percentage of time in research and clinical practice devoted to: Clinical Practice: Research: Teaching: Administration: Other: Total:  Member  Fellow  Member  Certificant Year of Fellowship:  Certificant  Yes Year of Certification/recertification:  No Year of Certification/recertification: % % % % % 100 % Province: Postal Code: Fax: Home Address  Preferred Mailing Address Province: Postal Code: (Middle Initial) (Last Name)  Ms.

the rate for a five year membership is $900. 2008) NOTE: ISAM Membership not available to Associate Members  ISAM Membership:  VISA/MC/AMEX (circle one) # Name on Card: Signature: $110.00  Five-year membership $900.00  Student/Intern/Resident: $200.00 $5. which equals $110. 6 . The rate for a three year membership is $549. A supporting letter from a current CSAM member must accompany all applications for Associate membership. All new members require a current CSAM member to act as a referee.00 $25.96 *TOTAL PAYMENT: $ Expiry Date:  Cheque.00 Optional: International Society of Addiction Medicine (ISAM) Dues – ($90 USD. Bank Draft or Money Order Payable to: The Canadian Society of Addiction Medicine or We thank you for supporting the Canadian Society of Addiction Medicine.:  Regular Member – PhD :  Associate Member: $200.00 Multi-year membership CSAM is pleased to offer members the opportunity to sign up for three years of membership or five years of membership.D. Referee’s Name: Do you agree to have your name and office contact information included in a directory to be distributed to CSAM members only?  Yes  No Signature: Payment Information Annual Fees:  Regular Member – M.CSAM MEMBERSHIP FORM Topics of Special Interest in the Field of Medicine Positions in the Society You Would Be Willing To Consider in the Future  Board Member (Please note: Associate members are not eligible for board positions)  Committee Membership  Standards  Website  Opioid Agonist  Education  Membership  Conference Referee and Curriculum Vitae Please include a recent copy of your Curriculum Vitae.96 CDN.  Three-year membership $549. effective November 25.00  Retirees MD or PhD: $50.

of dubious quality. 2009 ? We are requesting any expression of interest from recipients of the Bulletin to be received by our ISAM office (c/o nady. cont Page 9 7 NEWS FROM SASKATCHEWAN Brian Fern. AB Sunday Sept 27. remains a problem since as yet none of them will safely store methadone for patients or transport patients into our pharmacies for daily witnessed ingestion. ISAM NEWS FROM ACROSS CANADA NEWS FROM ONTARIO Jeff Daiter. the Annual General Meeting for the OMA Section on Addiction Medicine will be taking place in the large boardroom at 525 University Avenue. while others see no need at all. as usual. Yours truly.el-guebaly@albertahealthservices. and street cocaine. Little heroin here. Each of our methadone centres has periodic meetings involving most of the stakeholders (although interestingly not the patients). agreements or contracts for methadone services. News from Across Canada. There is debate over the need for.ca) by June 1. MD. MD Chief Examiner. The complete documentation and dues will be required by August 15. has been working hard and giving presentations to impress our federal prison staff on the need for methadone maintenance therapy in our federal facilities including new starts. The documents themselves also vary greatly from severe “three strikes” for the world’s worst people type to kindly “we want to help” for the poor struggling sufferers. are readily available all the way to the top of the province. Suite 200. Correctional Service of Canada National Methadone Coordinator. Provision of methadone to those living on reserves. MD Saskatchewan has various issues in the methadone area. Key policy decisions regarding our profession are brought to light through this work. CASAM.org. Prescription opioids. in particular why would such therapy need such a document and what should be in it to satisfy current thinking on all the stakeholders’ positions. Signing off with these few thoughts from the Prairies.csam. Nady el-Guebaly. 2009. abstinence based practices. There were some suggestions that some federal prison staff were not supportive new methadone starts for federal inmates. From my perspective as a current executive member. Some doctors and pharmacists are strongly in favour. etc).org. FASAM On April 23. who resides in our province. Toronto. Fascinating range of attitudes. please peruse the ISAM website at www. We would be interested in knowing how others see this issue. many of them many miles from our centres. CCSAM. For further details about our exam. 2009. all members of the Section are encouraged to attend or participate by teleconference (1-888-300-8196. I can reassure anyone interested that the work is both interesting and rewarding. The CPSO is has announced a call for abstracts for their Annual Methadone Prescribers Conference to be held in November 2009. presumably including the patients. quote conference ID 8518769). and nature of. Questionable prescribing is not uncommon. speakers give presentations. There is little consistency here.THE ISAM CERTIFICATION EXAM Interested in sitting for the exam at the Anniversary Annual Meeting ISAM-CSAM in Calgary. Dr Lanoie. Cancellations after the complete application is processed will be levied a $150 US fee from the refund. Please feel free to contact me directly if you have any questions regarding the above. at which current topics are discussed and invited .isamweb. 2008 for the ISAM-CSAM meeting in Calgary September 2009. THC. An application form can be found on CSAM’s website at www. it is hoped that a strong showing of the membership will be realized. Since the Section is now focused on creating a strong blend of executive members holding a variety of perspectives within the field (methadone prescribers. however. As new positions on the Executive will be available. other addictions such as gambling or sex addiction.

Mr. I really do.ADDICTION HISTORY TAKING TECHNIQUES Dr. one cannot work with patient thereafter. Johnston. who is suffering from the addictive disorder. Johnston. how does one obtain this history? Part 1 Nowhere else in medicine. the addiction specialist. Let the patient’s own history. but is this what you said in your history?” In conclusion. from the patient’s own words. Most feel that this is a natural response of the disease process in order to maintain its viability. that your wife said she left you because of your excessive drinking?” “Again. did you not say in your own history. The addiction history can be used to take the confrontational role. 8 . to maintain an Part 2 – In the next edition of the Bulletin: How to obtain an accurate and detailed history. One must understand that it is NOT the patient but the natural process of the disease of addiction. and hopefully maintain the doctor-patient relationship. Past CSAM President empathetic. Remember. Of course. This will hopefully allow you. can you help me with this. noncompliant. and minimization about a patient’s addiction problem without having to confront the patient directly. This can really undermine a patient’s hope and confidence that a solution is possible with their addictive disorder. regardless of obstruction by the patient’s disease. will you find a patient more resistant. For example. empathetic role. the patient’s own addiction history will serve as probably the most useful therapeutic tool in helping a patient deal with their addictive disorder. serious setbacks or limited to no success in stabilizing the disease process. “good cop” role. the patient is more likely to not return for further appointments. can only stress and damage the doctor-patient relationship with the risk of subsequent loss of patient contact. rationalization. Without an accurate and detailed addiction history. Once lost. minimizing. do the confrontational work for you. and sometimes dishonest when presenting their addiction history than in addiction medicine. The addiction history will also be the most powerful tool to help you circumvent denial. then your proposed plan of treatment will also not be correct and can cause harm. if your differential diagnosis is not fully correct.” “However. Confrontation between the physician and the patient. Frank Evans. is what one can use as the confrontational “bad cop” component when discussed appropriately. allowing the addiction specialist to stay in a nonjudgmental. if one gets too confrontational and judgmental. I can see and understand your point of view. A detailed and accurate addiction history. “Mr. I can see and understand your point of view. you are prone to being manipulated by the addiction and handicapped in attempting to compose an accurate and thorough differential diagnosis. Now.

.. A. In April 2009 Nicole Peters.. & Wodak. J. Medicationcompliant subjects tended to provide more methamphetaminenegative urine samples over the 10-week treatment period (P = 0. van Beek. Eighty methamphetamine-dependent subjects in Sydney. Herbert.. MSW. Lewis. The aim of this study was to examine the safety and efficacy of modafinil (200 mg/day) compared to placebo in the treatment of methamphetamine dependence and to examine predictors of post-treatment outcome. Those clients successful in reaching Phase IV reported a 71% employment record.. Treatment retention and medication adherence were equivalent between groups. T.News from Across Canada. Comprehensive drug use data (urine specimens and self-report) and other health and psychosocial data were collected weekly during treatment and research interviews at baseline. continued NEWS FROM PRINCE EDWARD ISLAND The PEI Provincial Methadone Maintenance Treatment Program is now in its fifth year of operation. and an admin assistant who provides physician support. The program consists of inpatient induction (5-8 days) at our Provincial Detox Unit in Mt. week 10 and week 22. Prior to induction about 41% of patients gave history of some type of work recently. Australia were allocated randomly to modafinil (200 mg/day) (n = 38) or placebo (n = 42) under double-blind conditions for 10 weeks with a further 12 weeks post. BN will assume the position of Team Lead for the MMT Program. craving or severity of dependence. C. Adverse events were generally mild and consistent with known pharmacological effects.. Outcomes were better for methamphetamine-dependent subjects with no other substance dependence and those who accessed counseling. 44% were receiving a form of income assistance. with the average time of substance use for the group being14 years (range 4-49).57. Medical Consultant RESEARCH CORNER By Dr. A great emphasis is put on both addiction counseling and attending a 3-4 week rehab program. Brady. Only 31% of the clients were living in married or common law situations while 75% have children. Nicole’s previous position. Male patients predominated at 59%.03) and weight gain (P = 0.05) in modafinil-compliant subjects compared to placebo. In response to the PEI predicament a new position was authorized by government last year. Private Practice A double-blind. Rodgers. J. 53% of the group in treatment last July reported having completed at least one rehab course. plAcebocontrolled triAl of modAfinil (200 mg/dAy) for methAmphetAmine dependence. This would prove a welcome addition to the Methadone Program as well as to the Detox Unit and Rehab Programs with the facility. There were no medication-related serious adverse events. although usually sparse and irregular. Patients work through a four-Phase level system with carry doses restricted to Phase III and IV only. The patients in treatment now number 92 with about 35 added in the past year. A summer social work student was able to compile some statistical data for the 75 clients then in treatment. There were statistically significant reductions in systolic blood pressure (P = 0. R. While I remain the sole physician piece of the team we are hopeful of a second physician joining the Provincial Addictions Facility workforce this summer. (2009). M. There were no differences in methamphetamine abstinence. McKetin. R. David Teplin. Darke.07). S.D. Donald Ling. C. the previous coordinator who now moves to a newly created Social Work position with the program. 104. often times self supporting. Age range was 19 . She joins Barbara Lacey.5 years. Addiction.treatment follow-up. Psy. Modafinil demonstrated promise in reducing methamphetamine 9 .Psych.. As with most MMT programs today the demand for treatment outweighs the available resource.D. and overall average age was 32. 224–233. Mattick. Phase III is possible only after 12 weeks with completion of groups and counseling plus clean urine screens for at least 6 weeks. Slade. L. T. Additional resource is provided by the two Out Patient Detox Nurses. weekly group sessions for three months and regular counseling sessions along with scheduled physician visits. D. Shearer.

higher collective correlAtes of Alcohol use Among methAdone-mAintAined Adults. Greengolde. & Leakeg.. 101: 124–127. a branch of the US National Institute on Drug Abuse) was conducted from 2003 to 2005 to compare taper conditions at 7 and 28 days.use in selected methamphetamine-dependent patients. Exposures of interest were neighborhood collective efficacy.03–1. Cohenb.. The sample included MMT clients who were 18–55 years of age. Non-blinded dosing with Suboxone® during the 1-month stabilization phase included 3 weeks of flexible dosing as determined appropriate by the study physicians. individual perception of collective efficacy. a greater number of heavy alcohol users also experienced recent victimization. there appears to be no advantage in prolonging the duration of taper... Shoptawd. To optimize MMT. Drug and Alcohol Dependence.0007).. M. Bilangi... A. Hubbard. alcohol screening should be part of routine assessment and alcohol treatment should be made available within MMT programs.. A fixed dose was required for the final week before beginning the taper phase. G. and neighborhood antismoking norms.84–1.34) but permissive neighborhood smoking norms were associated with more smoking (OR 1. J. J. Hunter. All analyses adjusted for demographic and socioeconomic characteristics. de Castroe.34. J... Domier. Doraimani.We also found that MMT clients who were younger than 50 years. 95% CI 1. R.88. (2009). Using data from the 2005 New York Social Environment Study (n = 4000). the authors examined the separate and combined associations of neighborhood collective efficacy and antismoking norms with individual smoking. W... were more likely to be heavy drinkers. 100: 138–145. Marfiseec. A. For individuals terminating buprenorphine pharmacotherapy for opioid dependence. and those victimized and reporting fair or poor health.. Eleven out-patient treatment programs in 10 US cities. correlates 10 .. Annon.. When considered in combination. S. In separate generalized estimating equation logistic regression models. as well as history of smoking prior to residence in the current neighborhood. M. Jenkins. A. and individual smoking norms. Drug and Alcohol Dependence. J.. Moreover. The aim of this study was to compare the effects of a short or long taper schedule after buprenorphine stabilization on participant outcomes as measured by opioid-free urine tests at the end of each taper period. B. P = 0. Nyamathia. A. B. regardless of health status. J. Ling.. Data were collected at weekly clinic visits to the end of the taper periods. Galea. The study findings support definitive trials of modafinil in larger multi-site trials. respectively). At the end of the taper. Half of the sample was heavy drinkers and nearly half (46%) reported heroin use. In addition. This prospective study (n = 190) examined correlates of alcohol use from baseline data of a longitudinal trial conducted among moderate and heavy alcohol users receiving methadone maintenance therapy (MMT).. neighborhood collective efficacy was not associated with smoking (OR 1. SL. of heavy alcohol use included White and Hispanic ethnicity... BUPRENORPHINE TAPERING SCHEDULE AND ILLICIT OPIOID USE. S. V.92–4. and fair or poor physical health combined with older age (≥50 years). Compared with moderate alcohol consumers. A. D. special consideration should be provided to the most vulnerable clients. Using a structured questionnaire.74). There were no differences at the 1-month and 3-month follow-ups (7-day = 18% and 12%.30). NEIGHBORHOOD SMOKING NORMS MODIFY THE RELATION BETWEEN COLLECTIvE EFFICACY AND SMOKING BEHAvIOR. 1 month and 3 months. Thomas. where smoking norms were permissive. such as the younger user. Ahern. Hillhouse. This multi-site study. 28-day = 18% and 13%. 95% CI 0. J. (2009). assessed using the World Mental Health Comprehensive International Diagnostic Interview (WMH-CIDI) tobacco module. Boverman. and at 1-month and 3-month post-taper follow-up visits. Hasson. measured as the average neighborhood response on a well established scale. Addiction. C. Georgef. The outcome was current smoking. 44% of the 7-day taper group (n = 255) provided opioid-free urine specimens compared to 30% of the 28-day taper group (n = 261. sponsored by Clinical Trials Network (CTN.. 104. 95% CI 1. 256–265. & Syme.06. particularly among residents with no prior history of smoking (OR 2. promoting attention to general physical and mental health problems within MMT programs may be beneficial in enhancing health outcomes of this population. Saxon.. those with a long-term and current history of heavy drug use. measured as the proportion of residents who believed regular smoking was unacceptable. individual perception of smoking level in the neighborhood. C. and were receiving MMT from five large methadone maintenance clinics in the Los Angeles area. Selzer. (2009).

These data indicate that among individuals with opioid dependence who are seeking treatment with buprenorphine. H.. targeted primarily toward young males. Since the introduction of Red Bull in Austria in 1987 and in the United States in 1997. Several studies suggest that energy drinks may serve as a gateway to other forms of drug dependence. The authors concluded that features of the neighborhood social environment may need to be considered in combinations to understand their role in shaping health and health behavior. with some of the most lax regulatory requirements in the U. and have mental health and deviant behavior problems. Most respondents (60.1. EC. and the clinical implications for children and adolescents are discussed. (2009). and withdrawal. Storr.. Past-year OxyContin® users were more likely than other opioid users to be 18–25 years old (OR = 1. Sansone.0% reported having experienced physical neglect. and studies suggest that such combined use may increase the rate of alcohol-related injury. Hundreds of different brands are now marketed. RA. & Wiederman. Martins. SS. Those with past-year analgesic disorder who used OxyContin® were more likely to be younger. dependence. HD. There are increasing reports of caffeine intoxication from energy drinks. Drug and Alcohol Dependence. and 65. 28:64–67. sell illegal drugs (OR = 2.5[1. the energy drink market has grown exponentially. (2009). Journal of Addictive Diseases. RR. MW.2% reported having experienced emotional abuse. A minority reported having experienced four (13. or three different forms of childhood trauma. higher collective efficacy was associated with less smoking. Only 19. Reissig.5% of the sample denied having experienced any of the five forms of childhood trauma. Zhuc. where norms were strongly anti-smoking.5. or two.S. Past-year opioid users were more likely than users of other illegal drugs to be more educated and have a past-year major depressive episode.214). the prevalence rates of various types of childhood trauma are quite high. 99: 1–10. In children and adolescents who are not habitual caffeine users. Silvia S. & Griffiths. Past-month OxyContin® users were more likely than past-month other opioid users to buy analgesics from drug dealers/other strangers and obtain opioid analgesics from multiple sources.9[1. Data on opioid sources was compared among past-month users.2%) reported having experienced one. and use illegal drugs than those who used other opioids. 39. & Chilcoat. 99: 58–67.3. and it seems likely that problems with caffeine dependence and withdrawal will also increase. psychiatric characteristics associated with past-year extra-medical OxyContin® use (n = 1144) versus extra-medical other opioid analgesics use (n = 7074). 23. vulnerability to caffeine intoxication may be markedly increased due to an absence of pharmacological tolerance. the authors examined a consecutive sample of 113 participants and found that 20. The combined use of caffeine and alcohol is increasing sharply. performance-enhancing and stimulant drug effects. and individuals with an analgesic disorder who had past-year extramedical OxyContin® use (n = 339) versus those with other opioid use (n = 820). THE PREvALENCE OF CHILDHOOD TRAUMA AMONG THOSE SEEKING BUPRENORPHINE TREATMENT..3%) or all five (7..5% reported having witnessed violence. for psychoactive.4% reported having experienced sexual abuse.. They also compared extra-medical opioid users (n = 8218) versus other drug users (n = 16. in contrast. CL.2]). with caffeine content ranging from a modest 50 mg to an alarming 505 mg per can or bottle. Strain..8% reported having experienced physical abuse.2]). (2009). The authors examined the differences in socio-demographic and . Using a survey methodology. including content labeling and health warnings differs across countries. Regulatory implications concerning labeling and advertising. The absence of regulatory oversight has resulted in aggressive marketing of energy drinks. Such findings point out differences between OxyContin® and other opioid users that might help prevention specialists and assist efforts to curb opioid analgesics diversion. 60. the authors examined the prevalence of five types of childhood trauma among a sample of adult patients who were addicted to opioids and seeking treatment with buprenorphine. 11 correlAtes of extrAmedicAl use of oxycontin® versus other AnAlgesic opioids Among the us generAl populAtion. Drug and Alcohol Dependence. P.4. In this study.1%) forms of childhood trauma. Regulation of energy drinks. Genetic factors may also contribute to an individual’s vulnerability to caffeinerelated disorders including caffeine intoxication.efficacy was associated with more smoking. CJ. CAFFEINATED ENERGY DRINKS—A GROWING PROBLEM. Whitecar..

org. 2009. This event is aimed at physicians who currently hold an exemption to prescribe methadone for the treatment of opioid dependence and who are currently providing methadone maintenance treatments to patients. Michael Varenbut CORPORATE SPONSORS CSAM would like to thank all of our corporate sponsors for their generous support towards the production. For the call for abstracts.ca. Registration details and materials will be made available at a later point. Dr. 2. via unrestricted educational grants. For additional information.CSAM BOARD OF DIRECTORS President.org.isamweb. Ron Lim Saskatchewan Regional Director. Garth McIver Alberta Regional Director. Dr.csam. John Fraser Ontario Regional Director. Dr. The deadline to submit an abstract is June 1. Brian Fern Manitoba Regional Director. Dr. Dr. Dr. Dr. Frank Evans Secretary/Treasurer. The deadline for Abstracts is May 15. 2009. please visit: www.org.on. For additional questions regarding the conference. The joint CSAM/ISAM meeting will be held in Calgary. September 23 to 27. ext 307 or email kbrown@cpso.csam. Gold Sponsor: Silver Sponsor: Bronze Sponsors: CONTINUING EDUCATIONAL OPPORTUNITIES 1. Dr. 2009. Charles Mackay Quebec Regional Director. For the call for abstracts. 2009. Dr. Don Ling Past-President. Dr. Dr. David Marsh BC Regional Director.csam. Dr. Sharon Cirone Quebec Regional Director. 12 . The College of Physicians and Surgeons of Ontario will host its Annual Methadone Prescribers Conference in Toronto on November 6. Dr.org or www. David Luckow New Brunswick Regional Director. visit www. Hannah Hulsbosch Nova Scotia Regional Director. Dr. visit www. Linda Hudson Member-at-Large. Jeff Daiter Ontario Regional Director. printing and distribution of the Bulletin. call 416-967-2600.

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