Implementation Science Program on Opioid Interventions and Services

In order to address the current opioid crisis in Canada, CRISM developed 12 project areas to facilitate and scale-up interventions across the full spectrum of care in the general population as well as particularly vulnerable groups. CRISM undertook extensive consultation to develop the 12 thematic areas which focus on service bottlenecks, evidence-based interventions, and stepped care approaches.

  1. Injectable Opioid Agonist Treatment
  • Goal: 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.
  • Examples of 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.

 

  1. Expanding Access to Nurse-Led Models of Care
  • Goal: to understand of the current state of practice by nurses for opioid addiction and develop recommendations to strengthen and expand the role of nurses in order to improve access and quality of care.
  • Examples of activities include 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.

 

  1. Engaging with People with Lived Experience of Substance Use
  • Goal: 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.
  • Examples of activities include creating a working group of people with lived experience to discuss and determine their own research priorities, conduct a survey on challenges and barriers to “peer” employment in harm reduction services, and understand experiences of opioid agonist treatment and associated discrimination and barriers.

 

  1. Indigenous Peoples
  • Goal: to establish Opioid Agonist Treatment Guidelines for First Nations governed, community-based and residential treatment-based services.
  • These activities will include 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.

 

  1. Supervised Consumption Services
  • Goal: to share knowledge and generate new evidence to support implementation of supervised consumption services in Canada.
  • These activities will include 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.

 

  1. Psychosocial and Recovery-Based Programming
  • Goal: to understanding of the current status of the treatment of opioid use disorder within the psychosocial treatment system.
  • These activities will include 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, developing an intervention plan for improving treatment using psychosocial approaches.

 

  1. Populations in Correctional Services
  • Goal: to understand opioid use related interventions used in the correctional systems in Canada.
  • Examples of activities include 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.

 

  1. Naloxone Distribution
  • Goal: to understand of naloxone availability, distribution and standards regulations across Canada.
  • Activities will include an 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.

 

  1. Detoxification and Withdrawal Management
  • Goal: address and improve practices in “detox” services.
  • Activities will include conducting an environmental scan of current institutional practices related to detoxification and withdrawal management services for opioid use disorders across Canada, review the scientific literature, and identify best practices.

 

  1. Drug Checking
  • Goal: to facilitate the implementation and delivery of drug checking programs.
  • Activities will include 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.

 

  1. Expanding Buprenorphine/Naloxone Rapid Access in Emergency Departments
  • Goal: to enhance access to opioid agonist treatment buprenorphine/naloxone in emergency departments.
  • Activities include writing a systematic literature review of the use of buprenorphine in the emergency room, conducting a survey plus interviews on physicians in the emergency room on their attitudes, beliefs, and knowledge toward this treatment, and creating a toolkit to help physicians provide this treatment in the emergency room.

 

  1. At-Risk Youth/ Newer Users
  • Goal: 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.
  • Activities include writing a literature review on the interventions and treatments for opioid use disorder in youth and young adults, describe current services available for youth, conduct youth focus groups to discuss their needs, organize a whole day youth summit in each CRISM Node.