Implementation Science Program

Implementation
Science Program

Following an international review, CIHR has approved a proposal submitted by the CRISM network for a 5-year directed grant addressing the opioid emergency. The submission to CIHR was to develop and execute an implementation science program in four thematic areas that have high potential for reducing the individual and population burden of opioid use.

The research themes were developed as priority areas for the research program by the CRISM NPIs, following consultation with CIHR and CRISM members. Because of the very short timeline set by CIHR for response to the RFA, and with their approval, the proposal merely provides a rationale for each theme as well as key implementation research priorities. Still, it does not provide detailed descriptions of specific projects or study protocols. CRISM intends to use the process of identifying and developing protocols for specific projects within the approved research themes as an opportunity to engage CRISM members. The registration form that was circulated to CRISM members was designed to allow CRISM members from across the country to declare their interest in leading and/or collaborating within these research themes. Our goal in soliciting member interest was to assemble regional and national teams of interested researchers, practitioners, and decision-makers to develop specific projects within these thematic areas.

Twelve projects were identified, and each of the five CRISM Nodes will be responsible for coordinating three of them. Projects were allocated to ensure that each Node coordinates projects of roughly equal size and scope.

BC Node Facilitation

Expanding Access to Nurse-Led Models of Care

Goals: to understand the current state of practice by nurses for opioid addiction and develop recommendations to strengthen and expand the role of nurses to improve access and quality of care.
Example activities: a national scan of regulations, policies, and practices that identify the role of nurses in opioid addiction care, developing recommendations to expand the role of nurses and working towards implementing those recommendations, promoting nursing education, and piloting a clinic where a nurse care manager plays the central role in patient care.

Injectable Opioid Agonist Treatment

Goals: to facilitate and support the successful delivery of injectable opioid agonist treatment (iOAT) in Canada through educational resources, development of best practices and recommendations, and monitoring and evaluation.
Example activities: include developing guidelines for health providers and policy makers, a national scan of current iOAT services, developing a community of practice, and national research to evaluate the success of iOAT services.

Engaging with People with Lived/Living Expertise of Substance Use

Goals: to facilitate the engagement of people who use drugs throughout Canada by enhancing national peer networks. Peers will engage in implementation science projects and identify advocacy priorities to converge on a national set of actions to address the opioid crisis.
Example activities: creating a working group of people with lived experience to discuss and determine their own research priorities, conducting a survey on challenges and barriers to “peer” employment in harm reduction services, and understanding experiences of opioid agonist treatment and associated discrimination and barriers.

Prairies Node Facilitation

Treatment of Opioids in Psychosocial and Recovery-based Programs (TOPP)

Goals: to understand the current status of the treatment of opioid use disorder within the psychosocial treatment system.
Example activities: surveying the range of current approaches to the treatment of individuals with opioid use disorder within psychosocial addiction treatment programs across Canada that do not include pharmacological agonist treatment, developing “good practice” descriptions, and developing an intervention plan for improving treatment using psychosocial approaches.

Supervised Consumption Services in Canada (SCS)

Goals: to share knowledge and generate new evidence to support the implementation of supervised consumption services in Canada.
Example activities: developing a national evidence-based guidance document and online resource repository, creating plain language resources explaining supervised consumption services, and a national scan of existing service models.

Opioid-Agonist Therapy (OAT) And Crystal Meth Guidelines For Community-Based And Residential Treatment Centres Who Serve First Nations Clients

Goals: to establish Opioid Agonist Treatment Guidelines for First Nations governed, community-based and residential treatment-based services.
Example activities: engagement with First Nations governed community-based and residential treatment services providers, a literature review, a scan of community and treatment centres across Canada, and development of treatment guidelines.

Ontario Node Facilitation

Detoxification and Withdrawal Management

Goals: address and improve practices in “detox” services.
Example activities: conducting an environmental scan of current institutional practices related to detoxification and withdrawal management services for opioid use disorders across Canada, reviewing the scientific literature, and identifying best practices.

Populations in Correctional Services

Goals: to understand opioid use-related interventions used in the correctional systems in Canada.
Example activities: writing a review of interventions for preventing harms or treating opioid addiction in corrections systems, evaluate the strategies currently in place in Ontario provincial prisons, study the transition from corrections back to the community, raise awareness about the opioid situation in prisons and its potential harms, and identify policies to reduce harm and create a safer environment.

Naloxone Distribution

Goals: to understand naloxone availability, distribution and standards regulations across Canada.
Example activities: environmental scan of naloxone distribution across Canada, development of a naloxone ‘Best Practice’ guideline, creation of a central database of Canadian data outcomes on naloxone distribution, and supporting further research on naloxone distribution.

Quebec and Atlantic Nodes Facilitation

Drug Checking

Goals: to facilitate the implementation and delivery of drug checking programs.
Example activities: scanning drug checking services already or soon to be implemented in Canada and develop a web forum for knowledge transfer and dissemination, identify and synthesize the existing literature on drug checking services, and conduct surveys to determine locations in Canada where there is interest and willingness from people who use drugs to use these services and from providers to implement them.

Expanding Access to OAT Initiation: Buprenorphine/Naloxone Rapid Access in Emergency Departments

Goals: to share knowledge and generate new evidence to support the implementation of supervised consumption services in Canada.
Example activities: developing a national evidence-based guidance document and online resource repository, creating plain language resources explaining supervised consumption services, and a national scan of existing service models.

At-risk Youth and Newer Users

Goals: to provide additional evidence and develop guidance for the treatment of opioid use disorder among youth and young adults, and help scale-up interventions specifically for youth and young adults.
Example activities: writing a literature review on the interventions and treatments for opioid use disorder in youth and young adults, describing current services available for youth, conducting youth focus groups to discuss their needs, organizing a whole-day youth summit in each CRISM Node.