S2 Ep5: Treatment considerations for co-occurring substance use disorders

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Summary

Evidence-based treatments often focus on a specific type of substance, like opioids or stimulants. However, many people have more than one substance that they use frequently.

In this episode, Dr. Lindsay Mackay, David Ball and their guests talk about co-occurring substance use and its implications in clinical care. In particular, they discuss co-occurring substance use as it relates to gender and to stigma in the clinic.
 

Lineup

In this episode, you’ll hear:

• 1:48 – Dr. Lorraine Greaves – Clinical Professor, UBC School of Population and Public Health, and Senior Investigator, Centre of Excellence for Women’s Health
• 15:50 – Shawn Wood – Outreach Worker and Harm Reduction Advocate

 
Pearls

Here’s what listeners can take away from this episode:

1. It’s important to get a full history of all substances being used and provide education on how to use safely and prevent overdose. Being aware of drug testing facilities and safe consumption sites in your community is an essential part of providing education and promoting safety for the people we care for.
2. Be aware of the trauma and mistrust experienced by people in the medical system. Take time and listen with sensitivity to some of these experiences in order to understand where people are coming from and how you can best provide support and improve trust.
3. For patients with more than one substance use disorder, these should be treated concurrently when possible. Equitable treatment should be offered for all substance use. Fostering, a trusting relationship with your patients and having an honest non-judgemental conversation about substance use and patient goals is key for an effective treating relationship.
4. Bear in mind the interaction between substance use and sex and gender. Be aware of differences in stigma and the impact on our patients. Using the principles of motivational interviewing, non-judgmentally engaged with your patients about sources of substances, coercion, and context of use.
5. A patient centred-approach is essential. Whichever treatment option works best for that person should be chosen along with the appropriate education. The elicit toxic drug supply will put somebody at far greater risk of harm, and it’s our responsibility as care providers to help people reduce the risk of harm and death.

 
Resources

Online learning

• Addiction Care and Treatment Online Course (Online, self-paced, free) — See Module 8, Co-occurring substance use disorders
• Provincial Opioid Addiction Treatment Support Program (Online, self-paced, free) — See Module 18, Polysubstance use while on OAT

Guidance:

• BC Centre on Substance Use. At a Glance: Managing co-occurring opioid and alcohol use disorders. [Internet]. 2019.

Articles

• Argento E, Socias ME, Hayashi K, Choi J, Mackay L, Christie D, Milloy MJ, DeBeck K. Psychedelic use is associated with reduced daily opioid use among people who use illicit drugs in a Canadian setting. Int J Drug Policy. 2022 Feb;100:103518. doi: 10.1016/
• Bhalla IP, Stefanovics EA, Rosenheck RA. Clinical Epidemiology of Single Versus Multiple Substance Use Disorders: Polysubstance Use Disorder.Med Care. 2017;55 Suppl 9 Suppl 2:S24-s32.
• Greaves, L. Missing in Action: Sex and Gender in Substance Use Research. Int. J. Environ. Res. Public Health 2020, 17, 2352. https://doi.org/10.3390/ijerph17072352

Additional resources

• Centre of Excellence for Women’s Health. Fact Sheets on Sex and Gender Related Factors for Five Substances (online):
  • Sex, Gender and Alcohol
  • Sex, Gender and Opioids
  • Sex, Gender and Cannabis
  • Sex, Gender, Nicotine and Tobacco
  • Sex, Gender and Methamphetamines

   

  Photo by DarkoStojanovic on pixabay