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IN REMEMBRANCE OF ALEXANDRA DE KIEWIT
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Along with hundreds of community members, we are heartbroken to hear of the sudden passing of Alexandra de Kiewit. Alexandra was central to harm reduction and drug user advocacy not only in Quebec, but across Turtle Island and internationally.
Alexandra, a co-founder and Board of Directors member of the Canadian Association of People Who Use Drugs, was an active member of the National Safer Supply Community of Practice. We benefited from her voice on multiple committees and working groups including "Action for Safer Supply," a working group composed exclusively of people who use drugs whose goal is to make safer supply a reality for all drug users across the country.
Along with her keen expertise and deep knowledge, Alexandra poured her inspiring personality and unstoppable activism into everything she did. She taught many people many things.
She saw deeply rooted intersections between criminalized communities and worked ceaselessly to promote the liberation of all people – sex workers, people who use drugs, people living with HIV and/or Hepatitis C, people living with disabilities, and other marginalized people. For her, the decriminalization of sex work and drugs – as well as the establishment of an accessible regulated drug supply – was crucial to liberation and the realization of fundamental human rights for everyone.
Alexandra taught us compassion, community organizing, group facilitation, radical drug user advocacy, collective solidarity, movement building, and conflict resolution. Most of all, she taught us about love and what it means to love all people – in all their raw, beautiful, human, and very powerful forms.
We are certainly not alone in this grief. Alexandra's impact will be felt far and wide for decades to come. We will continue our collective work in her honour and memory. Our sincere condolences to her family, friends, loved ones, and extended community. We stand together in grief and in solidarity with all those affected by this immense loss. May she rest in power.
In love and in rage,
Alexandra Holtom, for the National Safer Supply Community of Practice
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NSS-CoP Resource Library: Did you know we have a resource library with OVER 700 resources on safer supply? You can access it for FREE anytime. It features academic journal articles, grey literature, knowledge translation materials, clinical practice guidelines, and more!
Victoria SAFER Initiative: Safe Supply Protocols: The Victoria SAFER Initiative is a flexible, community-based, safer supply program with health care provider oversight. Its goal is to affirm the lives of people who use drugs by providing safer, pharmaceutical alternatives to the currently toxic supply created by criminalization. Updates may have been made to these protocols since you received them. Please check back with the Victoria SAFER Initiative (vicsaferproject@gmail.com) at AVI Health & Community Services should updated versions be required.
Fentanyl Patch: Prescribed Safer Supply Protocols - PHS Community Services, British Columbia Centre on Substance Use, and Government of British Columbia: In July 2021, the Ministry of Mental Health and Addictions, Ministry of Health, and Office of the Provincial Health Officer released Access to Prescribed Safer Supply in British Columbia: Policy Direction, which enables individuals to access a range of medications through prescription to reduce the risk of drug toxicity death due to accessing the illicit drug supply. The first phase of implementation of this policy allows for the prescribing of certain opioids through regional health authority-run programs and federally funded programs (e.g., SAFER). Prescribed pharmaceutical alternatives is not intended for treatment of substance use disorders but is primarily a harm reduction approach as one strategy for reducing the risks of illicit drug toxicity events and deaths. The new prescribed safer supply protocols are being developed and released in a phased approach to support the implementation of emerging approaches for prescribed safer supply in BC, beginning with fentanyl patches with resources for sufentanil and Fentora to follow. These protocols will be updated as evidence is collected and practices are evaluated.
Scan of Evidence and Jurisdictional Approaches to Safer Supply - Public Health Ontario: The objective of this environmental scan is to summarize evidence on the health and social impacts of safer supply programs. This scan will also describe local, provincial/state, national or international examples of safer supply models.
Xylazine: A frank scope of "tranq-dope" - Vancouver Island Drug Checking Project: There has been increasing interest in the media recently about xylazine, a sedative that sometimes shows up in down/opioid samples. This post answers some common questions we’ve heard about xylazine by drawing on research, the wisdom of lived experience, and our own data.
Impact of the COVID-19 Controlled Drugs and Substances Act exemption on pharmacist prescribing of opioids, benzodiazepines, and stimulants in Ontario - Ontario Drug Policy Research Network: The lockdowns and restrictions resulting from the COVID-19 pandemic led to worsening continuity of care in patients receiving any chronic treatment. Health Canada issued an exemption to the Controlled Drugs and Substances Act (CDSA) in March 2020 allowing pharmacists to act as prescribers of controlled substances to support continuity of care during the COVID-19 pandemic. This study investigated the utilization of Ontario pharmacist prescribing of opioids, benzodiazepines, and stimulants from January 2019 to December 2021.
Grief Basics - AIDS Bereavement and Resiliency Program of Ontario: This is an opportunity to learn more about your own grief and the bereavement experiences of your staff, coworkers, clients, and community members. ABRPO's hope is that this course can contribute to a shared language about our grief and care across the sector.
The Safer Bathroom Toolkit - Canadian Institute for Substance Use Research: Bathrooms can provide private, seemingly safe spaces for people to use substances, especially when they are unable to access supervised consumption or overdose prevention sites. Even when these designated services are available, some people will continue to use substances in bathrooms. There are several reasons for this, such as privacy, stigma, and fear of others knowing they use substances. However, there can be serious risks to using substances in bathrooms, including overdosing alone and potentially not receiving lifesaving help in time. Restricting access to bathrooms or implementing measures to discourage substance use in bathrooms does not work. Rather, doing so increases risks for people who use substances, staff, and other people at risk of injury due to unsafe bathroom lighting, layout, and so forth. There are ways of making bathrooms safer for people who use substances. This toolkit will help you to do that.
Saving Our Own Lives - A Liberatory Practice of Harm Reduction: This is a conversation about liberatory harm reduction with Shira Hassan and other organizers about her new book, Saving Our Own Lives. This is a recording from Haymarket Books, recorded on October 5th, 2022.
Provider-Assisted Injection in Ontario's Supervised Consumption Services Frequently Asked Questions - HIV Legal Network: This resource answers some frequently asked questions about legal liability to help SCS providers in Ontario make informed decisions about their practices related to assisted injection.
ED Toolkit for Opioid Use Disorder - META:PHI: The goal of the META:PHI ED Toolkit for Opioid Use Disorder is to provide the resources necessary for a prescriber in any emergency department in Ontario to initiate buprenorphine when appropriate, along with additional materials to support all ED staff in providing evidence-based care for patients with opioid use disorder.
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RESEARCH PAPER OF THE MONTH
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Pauly, B., McCall, J., Cameron, F., Stuart, H., Hobbs, H., Sullivan, G., Ranger, C., & Urbanoski, K. (2022). A concept mapping study of service user design of safer supply as an alternative to the illicit drug market | International Journal of Drug Policy
Highlights:
- Methods: Within a community based participatory approach to research, we conducted a concept mapping study to foreground the perspectives of drug users and develop a conceptual model of effective safer supply. Our team was composed of researchers from a local drug user organization, a local harm reduction organization, and academic researchers. The focused prompt developed by the team was: “Safe supply would work well if…” Sixty-three drug users participated in three rounds of focus groups as part of the concept mapping process, involving brainstorming, sorting, rating and naming of themes.
- Results: The concept mapping process resulted in six clusters of statements: 1) Right dose and right drugs for me; 2) Safe, positive and welcoming spaces; 3) Safer supply and other services are accessible to me; 4) I am treated with respect; 5) I can easily get my safer supply; and 6) Helps me function and improves my quality of life (as defined by me). The statements within each cluster describe key components central to an effective model of safer supply as defined by drug users.
- Conclusion: The results of this study provide insights into key components of effective safer supply to inform planning and evaluation of future safer supply programs informed by drug user perspectives.
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We encourage NSS-CoP members to email info@nss-aps.ca with submissions to include in our newsletter. Content examples include but are not limited to community-led projects, peer-reviewed articles, grey literature, government publications, etc.
- Foreman-Mackey, A., et al. (2022). Moving towards a continuum of safer supply options for people who use drugs: A qualitative study exploring national perspectives on safer supply among professional stakeholders in Canada | Substance Abuse Treatment, Prevention, and Policy
- Urbanoski, K., et al. (2022). The North American opioid crisis: evidence and nuance on prescribed safer supply | The Lancet
- Michaud, L., et al. (2022). Between Care and Control: Examining Surveillance Practices in Harm Reduction | Contemporary Drug Problems
- Brothers, T. D., et al. (2022). Social and structural determinants of injection drug use-associated bacterial and fungal infections: a qualitative systematic review and thematic synthesis | medRxiv Preprint
- Schlosser, A. V., & Hoffer, L. D. (2022). “I don’t go to funerals anymore”: how people who use opioids grieve drug-related death in the US overdose epidemic | Harm Reduction Journal
- Meyerson, B. E., et al. (2022). Nothing really changed: Arizona patient experience of methadone and buprenorphine access during COVID | PLOS One
- Zolopa, C., et al. (2022). Changes in supervised consumption site use and emergency interventions in Montréal, Canada in the first twelve months of the COVID-19 pandemic: An interrupted time series study | International Journal of Drug Policy
- Cui, Z., et al. (2022). Opioid agonist therapy engagement and crystal methamphetamine use: The impact of unregulated opioid use in Vancouver, Canada | International Journal of Drug Policy
- Lexchin, J., et al. (2022). Information about confirmatory studies required for new drugs conditionally approved by Health Canada: A cross-sectional study | PLOS One
- Lépine, B., et al. (2022). Prescribing buprenorphine for opioid use disorder in primary care: A survey of French general practitioners in the Sentinelles network | Journal of Substance Abuse Treatment
- Husain, J. M., et al. (2022). A qualitative analysis of barriers to opioid agonist treatment for racial/ethnic minoritized populations | Journal of Substance Abuse Treatment
- Tassey, T., et al. (2022). OUD MEETS: A novel program to increase initiation of medications for opioid use disorder and improve outcomes for hospitalized patients being discharged to skilled nursing facilities | Journal of Substance Abuse Treatment
- Filteau, M., et al. (2022). ‘It’s the same thing as giving them CPR training’: rural first responders’ perspectives on naloxone | Harm Reduction Journal
- Aldabergenov, D., et al. (2022). Methadone and buprenorphine-related deaths among people prescribed and not prescribed Opioid Agonist Therapy during the COVID-19 pandemic in England | International Journal of Drug Policy
- Hallgren, K. A., et al. (2022). Acceptability, feasibility, and outcomes of a clinical pilot program for video observation of methadone take-home dosing during the COVID-19 pandemic | Journal of Substance Abuse Treatment
- Bozinoff, N., et al. (2022). Patterns of use and adverse events reported among persons who regularly inject buprenorphine: a systematic review | Harm Reduction Journal
- Adams, K. K., et al. (2022). Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis | Addiction Science & Clinical Practice
- Loyal, J. P., et al. (2022). Trends in Involuntary Psychiatric Hospitalization in British Columbia: Descriptive Analysis of Population-Based Linked Administrative Data from 2008 to 2018 | Canadian Journal of Psychiatry
- King, L., et al. (2022). Prevalence and correlates of stocking up on drugs during the COVID-19 pandemic: Data from the C3PNO Consortium | Drug and Alcohol Dependence
- Sugarman, A., et al. (2022). Opioid Use Disorder Treatments: An Evidence Map | Drug and Alcohol Dependence
- Gibbons, J. B., et al. (2022). Association Between Buprenorphine Treatment Gaps, Opioid Overdose, and Health Care Spending in US Medicare Beneficiaries With Opioid Use Disorder | JAMA Psychiatry
- Landis, R. K., et al. (2022). Buprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policies | Drug and Alcohol Dependence
- Getty, C-A., et al. (2022). A qualitative exploration of patients' experience of mobile telephone-delivered contingency management to promote adherence to supervised methadone | Drug and Alcohol Review
- Cole, E. S., et al. (2022). Outpatient Follow-Up and Use of Medications for Opioid Use Disorder after Residential Treatment among Medicaid Enrollees in 10 States | Drug and Alcohol Dependence
- Hibbard, P. F. (2022). From there to here: A journey through substance use disorder, prison, and recovery | Journal of Substance Abuse Treatment
- Dertadian, G. C., et al. (2022). “Overdose Has Many Faces”: The Politics of Care in Responding to Overdose at Sydney’s Medically Supervised Injecting Centre | Contemporary Drug Problems
- Hallowell, B. D., et al. (2022). Sociodemographic and prescribing characteristics that impact long-term retention in buprenorphine treatment for opioid use disorder among a statewide population | Drug and Alcohol Dependence
- Holland, A., et al. (2022). Analysis of the UK Government’s 10-Year Drugs Strategy—a resource for practitioners and policymakers | Journal of Public Health
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COMMUNITY UPDATES & EVENTS
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The Substance User Network of the Atlantic Region (SUNAR) is hosting their third webinar titled "Harm Reduction & Social Justice in Carceral Settings" on Friday, November 4th from 12pm to 1:30pm ADT. Join them to learn about social justice and the need for equitable access to health care and harm reduction for incarcerated people who use substances. Register now here!
Primary Care of Ontario Research and Learning (POPLAR): Attention primary care clinicians working in Fee-for-Service (FFS) models in Ontario! The Primary Care of Ontario Research and Learning (POPLAR) network is looking for guidance as we expand our outreach to FFS practitioners. We know it’s especially challenging for busy clinicians, especially those working without the support of an interprofessional team, to find time for networking, research, and knowledge-sharing. We also know that some feel reluctant to share their practice-based data with larger networks. We’d love to hear from you about what barriers you or your colleagues may be experiencing and what value you would need to get from a learning and research network in order to make participation worthwhile. Read more about POPLAR here. For more information or to share your ideas, please contact Catherine.Macdonald@AllianceON.org or info@poplarnetwork.ca.
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National and General News:
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