Methamphetamine (“meth”; MA) use in Canada is on the rise. In the past decade, the number of deaths, hospitalizations, and emergency room visits due to MA and other stimulant use has increased across Canada. MA is highly addictive. Withdrawal symptoms include intense cravings, and long-term use can lead to psychosis (such as paranoia and hallucinations), and increased risk of HIV, Hepatitis C, and cardiovascular events (such as heart attack and stroke). Right now, there are no approved treatments for MA use disorder.

There is some early evidence that using high-dose psychostimulants as substitution therapy can be effective against MA use disorder. Studies show that psychostimulants can reduce cravings and improve mental health, and high doses are safe in this population. Contingency management, a type of treatment where a person is given an incentive for achieving certain behaviour change, has been successful in treating substance use disorders. Our stakeholder consultation showed that people with lived experience and clinicians are more receptive to using contingency management to support behavioural changes other than abstinence.

The "Addition of high dose Stimulant and engagement-focused Contingency management for the management of MEthamphetamine use disorder (ASCME): a pan-Canadian multisite randomized controlled trial" examines the effects of a high-dose stimulant lisdexamfetamine and contingency management, alone and in combination, on MA use compared with treatment as usual (which includes clinical management and behavioural therapies) in individuals with moderate to severe MA use disorder. For contingency management, we will incentivize attendance at clinic visits. We will recruit a total of 440 participants in British Columbia, Alberta, Ontario, Quebec, and New Brunswick. Our primary outcome will be self-reported MA use; we will also evaluate other key outcomes such as quality of life, craving, mental health, and adherence to treatment.

The Lead Principal Investigator for ASCME is Didier Jutras-Aswad. There is also one Site Principal Investigator at each Node with expertise in substance use research and addiction medicine responsible for the trial sites within their Node (Paxton Bach, Monty Ghosh, Bernard Le Foll, Sara Davisdson). The Trial Steering Committee consists of the Lead Investigating Principal Investigator, two individuals with Indigenous background and/or competencies, two people with lived and living experience, one CRISM nominated Principal Investigator, two independent members with relevant expertise in addiction and clinical trials, and the National Project Coordinator.

This trial will help improve our understanding of substitution therapy and contingency management in MA use disorder, which will in turn improve care and support for individuals who use MA.

Optimizing patient centered-care: A pragmatic randomized control trial comparing models of care in the management of prescription opioid misuse

The use of prescription opioid medications (e.g., oxycodone, hydromorphone) has dramatically increased in recent years in Canada, leading to a rise in opioid misuse and related harms such as hospitalization and deaths due to overdose. Thus, the prevention and treatment of opioid addiction has become an urgent public health priority which requires an evidence-based response that best reflects the needs of patients, families, and the communities they live in.

Although methadone has long been the standard of care for the treatment of opioid use disorder in Canada, there is growing consensus that the superior safety profile of buprenorphine/naloxone, as well as other comparative advantages, supports its use as a first-line therapy for opioid use disorder. The OPTIMA trial aims to evaluate these two treatment options within a Canadian practice‐based framework, generating evidence that is directly relevant to a recognized national priority in public health. The study will incorporate real-world treatment conditions, such as strict regulations for methadone dosing (i.e., dispensed daily at a pharmacy) vs. flexible take-home dosing for buprenorphine/naloxone. The effectiveness of the two treatments in reducing opioid use will be compared in a 6-month, open-label, multi-site pragmatic randomized trial involving over 250 participants recruited from all four CRISM Nodes. The evidence generated from this study will be used to inform patient care and improve overall health outcomes.

Click here for more information about OPTIMA.

The Eastside Illicit Drinkers Group for Education (EIDGE) is a peer-based support and education group affiliated with the Vancouver Area Network of Drug Users (VANDU). Non-beverage alcohol drinkers are one of the most marginalized substance using groups in Vancouver and many do not have access to care or accurate information about treatment options.

CRISM BC and EIDGE are working together to lead a community-based peer-led research project to learn about the experiences and health needs of this group. The information gathered will provide local health authorities and communities with a clearer picture of the health and safety concerns of people who drink illicit alcohol and will inform future health service planning. At the same time, the project will serve to connect the illicit drinkers community and inform them about EIDGE.

EIDGE resource - "Safer Drinking Tips: Think Before You Drink"