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Volume 13, Number 1

BULLETIN
Canadian Addiction Medicine

Canadien de Medicine D’Addiction

March 2009

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

MESSAGE FROM THE PRESIDENT


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
Contents by Malachite in October as the Board met in their face-to-face conference prior to the
Message from the President.................... 1 Vancouver Scientific gathering and AGM.
Message from the Editor.......................... 2
Committee Reports................................... 2
Four specific proposals have been received from be structured to encourage member discussion on
Save the Date............................................. 4
Membership Application........................... 5 parties interested in managing CSAM’s day-to-day important issues. Please mark your calendars now for
News from Across Canada....................... 7 office business. Each of these has been reviewed September 23 - 26, Calgary, Alberta. One registration
Feature Articles......................................... 8 by the Executive Committee and consensus fee is available for both meetings or each one singly,
Research Corner........................................ 9
reached on the most appealing for our immediate if preferred.
Editor-in-Chief requirements. The Board has decided to separate
The Board currently has four vacancies—three
Dr. Michael Varenbut the office management duties from the annual
geographic jurisdictions and one member-at-large.
convention organizing responsibilities.
Associate Editor Bill Campbell’s resignation accounts for the latter. An
Dr. Don Ling Our annual meeting this year will be held in conjunction opening for a Director from the Northern Territories has
with the International Society of Addiction Medicine been created with Ross Wheeler’s resignation, while a
An official publication of
(ISAM) at Calgary on September 23-25th. The actual similar opportunity opened for a PEI physician with
CSAM component will take place on only one day— my ascendency to President. The Newfoundland and
Saturday, September 26th. ISAM will be offering a three Labrador position has never been filled and awaits an
CSAM Head Office
Suite 201, 375 West Fifth Avenue day scientific meeting on Wednesday thru Friday that interested physician from our eastern most province.
Vancouver BC V5Y 1J6 promises to be extra special. Many highly credentialed Any physicians with interest in these positions are
Tel: 604-484-3244 international speakers have been confirmed by asked to contact a current Board member.
Fax: 604-874-4378
Email : admin@csam.org the organizing committee giving Canadian based
And a tip of the hat to Michael Varenbut, our dedicated
professionals interested in addiction medicine a
The CSAM/SMCA Bulletin is published
Bulletin Editor. This communication vehicle is CSAM’s
rare opportunity to share this expertise within our
by the Canadian Society of Addiction most tangible member benefit. It takes much time
own borders.
Medicine. It is a journal for the and energy to gather reports and organize appropriate
dissemination of knowledge and clinical This four-day conference in Calgary will undoubtedly articles. Without Michael’s interest and commitment
experience related to addiction medicine.
If you are a CSAM/SMCA member and draw many registrants from around the world. It is to the Bulletin over the years CSAM would have
would like to contribute an article or hoped that CSAM members will turn out in force to suffered immeasurably. Thank you Michael.
letter to the Bulletin, please send and meet international colleagues and provide valuable
email to the editor, Dr. Michael Varenbut Respectfully yours,
Canadian input. CSAM’s annual general meeting is
at mvarenbut@toxpro.ca. Please forward
your correspondence to admin@csam.org to take place later on Saturday afternoon, and will Dr. Don Ling
MESSAGE FROM THE EDITOR
Dear CSAM members and Bulletin readers,

I hope that you will find this issue of the Bulletin interesting, educational and informative.
Many of the CSAM committees have been very busy working on a multitude of projects on behalf
of the membership and the board. You will find some of their updates and reports included in
this issue.

There is a significant amount of work that is done “behind As always, we look forward to your comments, materials
the scene” at CSAM, but we often fall short in documenting and contributions to the bulletin. It is only with your
and reporting on these activities to our membership. We will ongoing support that we will continue to improve on
strive to improve on this as much as possible in the future. our publication and continue to increase its value to our
members and readers.
I would like to use this opportunity to thank all those
who contributed materials, which continue to enrich Wishing you all the best,
our publication. Dr. Michael Varenbut

COMMITTEE REPORTS
OPIATE AGONIST COMMITTEE In addition, we continue to work on our assessment of the www.
REPORT suboxonecme.com training program. Our final assessment, as
Michael Varenbut, MD, CCSAM, CASAM, FASAM well as recommendations, will be presented to the board as
Chair soon as possible.
Committee members: Dr. John Fraser, Dr. Suzanne Brissette,
The committee has also been able to provide preliminary
Dr. Brian Fern, Dr. Wade Hillier, Dr. Garth McIver
feedback to a new set of clinical treatment guidelines for
The committee has been working on a number of projects and Buprenorphine prescribing, authored by Dr. Mel Kahan et al.
initiatives. We have received unanimous CSAM board approval Once further consultation is complete, and a final version
and support for the final version of the “Assessment Tool for of the document is made available, we will proceed with
training programs in Opiate Agonist Therapy”. This tool will be assessing the new guidelines, using the standardized “AGREE”
used in the future to assess any training programs in the field, instrument. Our findings and recommendations will then be
which CSAM may be asked to critically appraise and endorse. presented to the board and the authoring group.

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

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CSAM MEMBERSHIP FORM
Membership Type
 Regular Member –  Medical Student/
 Regular Member – MD  Retirees – MD or PhD  Associate Member
PhD Scientists Intern/Resident
Applicant Information
 Dr.  Ms.  Mrs.  Miss  Mr.
Name:
(First Name) (Middle Initial) (Last Name)
Work Address  Preferred Mailing Address
Address:
City: Province: Postal Code:
Work Phone: Fax:
Home Address  Preferred Mailing Address
Address:
City: Province: Postal Code:
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: Percentage of time in research and clinical practice devoted to:
Addiction: % Clinical Practice: %
Other aspects of healthcare: % Research: %
Total: 100 % Teaching: %
Administration: %
Other: %
Total: 100 %

 Member  Certificant Year of Certification/recertification:


American Society of Addiction Medicine (ASAM):
 Fellow Year of Fellowship:
International Society of Addiction Medicine (ISAM):  Member  Certificant Year of Certification/recertification:
Are you interested in Canadian Certification in Addiction Medicine?
 Yes  No
(Member – MD only)

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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.
All new members require a current CSAM member to act as a referee. A supporting letter from a current CSAM member must accompany all applications for
Associate membership.
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.D.: $200.00  Student/Intern/Resident: $5.00
 Regular Member – PhD : $200.00  Retirees MD or PhD: $25.00
 Associate Member: $50.00
Multi-year membership
CSAM is pleased to offer members the opportunity to sign up for three years of membership or five years of membership. The rate for a three year membership
is $549; the rate for a five year membership is $900.
 Three-year membership $549.00  Five-year membership $900.00
Optional: International Society of Addiction Medicine (ISAM) Dues – ($90 USD, which equals $110.96 CDN, effective November 25, 2008)
NOTE: ISAM Membership not available to Associate Members
 ISAM Membership: $110.96 *TOTAL PAYMENT: $
 Cheque, Bank Draft or Money Order Payable to: The Canadian Society of Addiction Medicine or
 VISA/MC/AMEX (circle one) # Expiry Date:
Name on Card:
Signature:

We thank you for supporting the Canadian Society of Addiction Medicine.

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THE ISAM CERTIFICATION EXAM
Interested in sitting for the exam at the Anniversary Annual Meeting ISAM-CSAM in Calgary, AB Sunday Sept 27, 2009 ?
We are requesting any expression of interest from recipients of the Bulletin to be received by our ISAM office
(c/o nady.el-guebaly@albertahealthservices.ca) by June 1, 2008 for the ISAM-CSAM meeting in Calgary September 2009. The
complete documentation and dues will be required by August 15, 2009.
For further details about our exam, please peruse the ISAM website at www.isamweb.org.
Cancellations after the complete application is processed will be levied a $150 US fee from the refund.

Yours truly,

Nady el-Guebaly, MD
Chief Examiner, ISAM

NEWS FROM ACROSS CANADA


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

Part 1 For example, “Mr. Johnston, I can see and understand your
point of view. I really do.” “However, can you help me with
this. Mr. Johnston, did you not say in your own history,
Nowhere else in medicine, will you find a patient more that your wife said she left you because of your excessive
resistant, noncompliant, minimizing, and sometimes drinking?” “Again, I can see and understand your point of
dishonest when presenting their addiction history than in view, but is this what you said in your history?”
addiction medicine. Most feel that this is a natural response
of the disease process in order to maintain its viability. One In conclusion, the patient’s own addiction history will serve
must understand that it is NOT the patient but the natural as probably the most useful therapeutic tool in helping
process of the disease of addiction. a patient deal with their addictive disorder. The addiction
history can be used to take the confrontational role,
Without an accurate and detailed addiction history, you allowing the addiction specialist to stay in a nonjudgmental,
are prone to being manipulated by the addiction and empathetic role, and hopefully maintain the doctor-patient
handicapped in attempting to compose an accurate and relationship. Remember, if one gets too confrontational
thorough differential diagnosis. Of course, if your differential and judgmental, the patient is more likely to not return
diagnosis is not fully correct, then your proposed plan of for further appointments. Once lost, one cannot work with
treatment will also not be correct and can cause harm, patient thereafter. Let the patient’s own history, do the
serious setbacks or limited to no success in stabilizing confrontational work for you.
the disease process. This can really undermine a patient’s
hope and confidence that a solution is possible with their Now, how does one obtain this history?
addictive disorder.

The addiction history will also be the most powerful


Part 2 – In the next
tool to help you circumvent denial, rationalization, and edition of the Bulletin:
minimization about a patient’s addiction problem without
having to confront the patient directly. Confrontation
How to obtain an
between the physician and the patient, who is suffering accurate and detailed
from the addictive disorder, can only stress and damage the
doctor-patient relationship with the risk of subsequent loss history, regardless of
of patient contact. obstruction by the
A detailed and accurate addiction history, from the patient’s
own words, is what one can use as the confrontational “bad
patient’s disease.
cop” component when discussed appropriately. This will
hopefully allow you, the addiction specialist, to maintain an

8
News from Across Canada, continued

NEWS FROM PRINCE workforce this summer. This would prove a welcome addition to
EDWARD ISLAND the Methadone Program as well as to the Detox Unit and Rehab
Programs with the facility.
The PEI Provincial Methadone Maintenance Treatment Program is
now in its fifth year of operation. The patients in treatment now T. Donald Ling, M.D.
number 92 with about 35 added in the past year. Medical Consultant

The program consists of inpatient induction (5-8 days) at our


Provincial Detox Unit in Mt. Herbert, weekly group sessions
for three months and regular counseling sessions along with
scheduled physician visits. Patients work through a four-Phase
RESEARCH CORNER
By Dr. David Teplin, Psy.D, C.Psych. Private Practice
level system with carry doses restricted to Phase III and IV only.
Phase III is possible only after 12 weeks with completion of
groups and counseling plus clean urine screens for at least 6 A double-blind, placebo-
weeks. controlled trial of
modafinil (200 mg/day) for
A summer social work student was able to compile some
statistical data for the 75 clients then in treatment. Male patients
methamphetamine dependence.
Addiction, 104, 224–233. Shearer, J. Darke, S., Rodgers, C.,
predominated at 59%, and overall average age was 32.5 years.
Slade, T., van Beek, L., Lewis, J., Brady, D., McKetin, R., Mattick,
Age range was 19 - 57, with the average time of substance use R. & Wodak, A. (2009).
for the group being14 years (range 4-49). Only 31% of the clients
were living in married or common law situations while 75% have The aim of this study was to examine the safety and efficacy of
children. 44% were receiving a form of income assistance. modafinil (200 mg/day) compared to placebo in the treatment
of methamphetamine dependence and to examine predictors of
Prior to induction about 41% of patients gave history of some post-treatment outcome. Eighty methamphetamine-dependent
type of work recently, although usually sparse and irregular. subjects in Sydney, Australia were allocated randomly to
Those clients successful in reaching Phase IV reported a 71% modafinil (200 mg/day)
employment record, often times self supporting.
(n = 38) or placebo (n = 42) under double-blind conditions for
A great emphasis is put on both addiction counseling and 10 weeks with a further 12 weeks post- treatment follow-up.
attending a 3-4 week rehab program. 53% of the group in Comprehensive drug use data (urine specimens and self-report)
treatment last July reported having completed at least one and other health and psychosocial data were collected weekly during
rehab course. treatment and research interviews at baseline, week 10 and week
22. Treatment retention and medication adherence were equivalent
As with most MMT programs today the demand for treatment
between groups. There were no differences in methamphetamine
outweighs the available resource. In response to the PEI abstinence, craving or severity of dependence. Medication-
predicament a new position was authorized by government last compliant subjects tended to provide more methamphetamine-
year. negative urine samples over the 10-week treatment period (P =
In April 2009 Nicole Peters, BN will assume the position of Team 0.07). Outcomes were better for methamphetamine-dependent
Lead for the MMT Program. She joins Barbara Lacey, MSW, the subjects with no other substance dependence and those who
previous coordinator who now moves to a newly created Social accessed counseling. There were statistically significant reductions
in systolic blood pressure (P = 0.03) and weight gain (P = 0.05) in
Work position with the program. Additional resource is provided
modafinil-compliant subjects compared to placebo. There were no
by the two Out Patient Detox Nurses, Nicole’s previous position,
medication-related serious adverse events. Adverse events were
and an admin assistant who provides physician support. While
generally mild and consistent with known pharmacological effects.
I remain the sole physician piece of the team we are hopeful
Modafinil demonstrated promise in reducing methamphetamine
of a second physician joining the Provincial Addictions Facility
9
use in selected methamphetamine-dependent patients. The study of heavy alcohol use included White and Hispanic ethnicity,
findings support definitive trials of modafinil in larger multi-site and fair or poor physical health combined with older age (≥50
trials. years).We also found that MMT clients who were younger than
50 years, regardless of health status, were more likely to be
Buprenorphine tapering schedule heavy drinkers. Compared with moderate alcohol consumers, a
and illicit opioid use. greater number of heavy alcohol users also experienced recent
Addiction, 104, 256–265. Ling, W., Hillhouse, M., Domier, C., victimization. To optimize MMT, alcohol screening should be part
Doraimani, G., Hunter, J., Thomas, C., Jenkins, J., Hasson, A., of routine assessment and alcohol treatment should be made
Annon, J., Saxon, A., Selzer, J., Boverman, J., Bilangi, R. (2009). available within MMT programs. Moreover, special consideration
The aim of this study was to compare the effects of a short should be provided to the most vulnerable clients, such as the
or long taper schedule after buprenorphine stabilization on younger user, those with a long-term and current history of
participant outcomes as measured by opioid-free urine tests at heavy drug use, and those victimized and reporting fair or poor
the end of each taper period. This multi-site study, sponsored health. In addition, promoting attention to general physical and
by Clinical Trials Network (CTN, a branch of the US National mental health problems within MMT programs may be beneficial
Institute on Drug Abuse) was conducted from 2003 to 2005 in enhancing health outcomes of this population.
to compare taper conditions at 7 and 28 days. Data were
collected at weekly clinic visits to the end of the taper periods, Neighborhood smoking norms
and at 1-month and 3-month post-taper follow-up visits. Eleven modify the relation between
out-patient treatment programs in 10 US cities. Non-blinded
collective efficacy and
dosing with Suboxone® during the 1-month stabilization phase
included 3 weeks of flexible dosing as determined appropriate
smoking behavior.
by the study physicians. A fixed dose was required for the final Drug and Alcohol Dependence, 100: 138–145. Ahern, J., Galea,
week before beginning the taper phase. At the end of the taper, S., Hubbard, A., & Syme, SL. (2009).
44% of the 7-day taper group (n = 255) provided opioid-free
Using data from the 2005 New York Social Environment Study
urine specimens compared to 30% of the 28-day taper group (n
(n = 4000), the authors examined the separate and combined
= 261; P = 0.0007). There were no differences at the 1-month
associations of neighborhood collective efficacy and anti-
and 3-month follow-ups (7-day = 18% and 12%; 28-day = 18%
smoking norms with individual smoking. The outcome was
and 13%, 1 month and 3 months, respectively). For individuals
current smoking, assessed using the World Mental Health
terminating buprenorphine pharmacotherapy for opioid
Comprehensive International Diagnostic Interview (WMH-CIDI)
dependence, there appears to be no advantage in prolonging
tobacco module. Exposures of interest were neighborhood
the duration of taper.
collective efficacy, measured as the average neighborhood
response on a well established scale, and neighborhood anti-
Correlates of alcohol use smoking norms, measured as the proportion of residents
among methadone-maintained who believed regular smoking was unacceptable. All analyses
adults. adjusted for demographic and socioeconomic characteristics,
Drug and Alcohol Dependence, 101: 124–127. Nyamathia, A., as well as history of smoking prior to residence in the current
Cohenb, A., Marfiseec, M., Shoptawd, S., Greengolde, B., de Castroe,
neighborhood, individual perception of smoking level in the
V., Georgef, D., & Leakeg, B. (2009).
neighborhood, individual perception of collective efficacy, and
This prospective study (n = 190) examined correlates of individual smoking norms. In separate generalized estimating
alcohol use from baseline data of a longitudinal trial conducted equation logistic regression models, neighborhood collective
among moderate and heavy alcohol users receiving methadone efficacy was not associated with smoking (OR 1.06, 95% CI
maintenance therapy (MMT). The sample included MMT clients 0.84–1.34) but permissive neighborhood smoking norms were
who were 18–55 years of age, and were receiving MMT from five associated with more smoking (OR 1.34, 95% CI 1.03–1.74),
large methadone maintenance clinics in the Los Angeles area. particularly among residents with no prior history of smoking
Half of the sample was heavy drinkers and nearly half (46%) (OR 2.88, 95% CI 1.92–4.30). When considered in combination,
reported heroin use. Using a structured questionnaire, correlates where smoking norms were permissive, higher collective
10
efficacy was associated with more smoking; in contrast, where psychiatric characteristics associated with past-year extra-medical
norms were strongly anti-smoking, higher collective efficacy OxyContin® use (n = 1144) versus extra-medical other opioid
was associated with less smoking. The authors concluded that analgesics use (n = 7074). Data on opioid sources was compared
features of the neighborhood social environment may need among past-month users. They also compared extra-medical
to be considered in combinations to understand their role in opioid users (n = 8218) versus other drug users (n = 16,214), and
shaping health and health behavior. individuals with an analgesic disorder who had past-year extra-
medical OxyContin® use (n = 339) versus those with other opioid
Caffeinated energy drinks—A use (n = 820). Past-year opioid users were more likely than users of
growing problem. other illegal drugs to be more educated and have a past-year major
Drug and Alcohol Dependence, 99: 1–10. Reissig, CJ., Strain, EC., depressive episode. Past-year OxyContin® users were more likely
than other opioid users to be 18–25 years old (OR = 1.9[1.1,3.2]),
& Griffiths, RR. (2009).
and have mental health and deviant behavior problems. Those with
Since the introduction of Red Bull in Austria in 1987 and in past-year analgesic disorder who used OxyContin® were more
the United States in 1997, the energy drink market has grown likely to be younger, sell illegal drugs (OR = 2.5[1.5,4.2]), and
exponentially. Hundreds of different brands are now marketed, use illegal drugs than those who used other opioids. Past-month
with caffeine content ranging from a modest 50 mg to an OxyContin® users were more likely than past-month other opioid
alarming 505 mg per can or bottle. Regulation of energy drinks, users to buy analgesics from drug dealers/other strangers and
including content labeling and health warnings differs across obtain opioid analgesics from multiple sources. Such findings point
countries, with some of the most lax regulatory requirements out differences between OxyContin® and other opioid users that
in the U.S. The absence of regulatory oversight has resulted in might help prevention specialists and assist efforts to curb opioid
aggressive marketing of energy drinks, targeted primarily toward analgesics diversion.
young males, for psychoactive, performance-enhancing and
stimulant drug effects. There are increasing reports of caffeine The prevalence of childhood
intoxication from energy drinks, and it seems likely that problems trauma among those seeking
with caffeine dependence and withdrawal will also increase. In
buprenorphine treatment.
children and adolescents who are not habitual caffeine users,
Journal of Addictive Diseases, 28:64–67. Sansone, RA., Whitecar,
vulnerability to caffeine intoxication may be markedly increased
P., & Wiederman, MW. (2009).
due to an absence of pharmacological tolerance. Genetic factors
may also contribute to an individual’s vulnerability to caffeine- In this study, the authors examined the prevalence of five
related disorders including caffeine intoxication, dependence, types of childhood trauma among a sample of adult patients
and withdrawal. The combined use of caffeine and alcohol is who were addicted to opioids and seeking treatment with
increasing sharply, and studies suggest that such combined use buprenorphine. Using a survey methodology, the authors
may increase the rate of alcohol-related injury. Several studies examined a consecutive sample of 113 participants and found
suggest that energy drinks may serve as a gateway to other that 20.4% reported having experienced sexual abuse, 39.8%
forms of drug dependence. Regulatory implications concerning reported having experienced physical abuse, 60.2% reported
labeling and advertising, and the clinical implications for children having experienced emotional abuse, 23.0% reported having
and adolescents are discussed. experienced physical neglect, and 65.5% reported having
witnessed violence. Only 19.5% of the sample denied having
Correlates of extramedical experienced any of the five forms of childhood trauma. Most
use of OxyContin® versus respondents (60.2%) reported having experienced one, or
other analgesic opioids among two, or three different forms of childhood trauma. A minority
reported having experienced four (13.3%) or all five (7.1%)
the US general population.
forms of childhood trauma. These data indicate that among
Drug and Alcohol Dependence, 99: 58–67. Silvia S. Martins, SS.,
individuals with opioid dependence who are seeking treatment
Storr, CL., Zhuc, H., & Chilcoat, HD. (2009).
with buprenorphine, the prevalence rates of various types of
The authors examined the differences in socio-demographic and childhood trauma are quite high.
11
CSAM BOARD OF DIRECTORS
President, Dr. Don Ling Saskatchewan Regional Director, Dr. Brian Fern Quebec Regional Director, Dr. Charles Mackay
Past-President, Dr. Frank Evans Manitoba Regional Director, Dr. Hannah Hulsbosch Quebec Regional Director, Dr. David Luckow
Secretary/Treasurer, Dr. David Marsh Nova Scotia Regional Director, Dr. John Fraser New Brunswick Regional Director, Dr. Linda Hudson
BC Regional Director, Dr. Garth McIver Ontario Regional Director, Dr. Jeff Daiter Member-at-Large, Dr. Michael Varenbut
Alberta Regional Director, Dr. Ron Lim Ontario Regional Director, Dr. Sharon Cirone

CORPORATE SPONSORS
CSAM would like to thank all of our corporate sponsors for their generous support
towards the production, printing and distribution of the Bulletin, via unrestricted
educational grants.

Gold Sponsor: Silver Sponsor:

Bronze Sponsors:

CONTINUING EDUCATIONAL OPPORTUNITIES


1. The joint CSAM/ISAM meeting will be held in Calgary, September 23 to 27, 2009. For additional information, please visit: www.csam.org or
www.isamweb.org. The deadline for Abstracts is May 15, 2009. For the call for abstracts, visit www.csam.org.

2. The College of Physicians and Surgeons of Ontario will host its Annual Methadone Prescribers Conference in Toronto on November 6, 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.

The deadline to submit an abstract is June 1, 2009. For the call for abstracts, visit www.csam.org. For additional questions regarding the conference,
call 416-967-2600, ext 307 or email kbrown@cpso.on.ca. Registration details and materials will be made available at a later point.

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