Department of Psychology, 192287University of Calgary, Calgary, Alberta.
Addictions and Mental Health Ontario, Toronto, Ontario.
Can J Psychiatry. 2022 Aug;67(8):638-647. doi: 10.1177/07067437221082858. Epub 2022 Mar 8.
To describe current approaches in treatment of opioid use disorder (OUD) within Canadian psychosocial outpatient, day, and residential addiction treatment programs, with an emphasis on the use of opioid agonist therapy (OAT).
An online census survey was conducted in English and French of Canadian psychosocial addiction treatment programs ( = 214).
Programs estimated that 25% of their clients have OUD. A slight majority of programs provide some type of specialized services to clients with OUD (58%), most frequently providing or facilitating access to OAT but also specialized counselling, case management, education, and harm reduction services.Most programs reported that they admitted clients on OAT (88%) and only a minority expected or encouraged clients to taper (14%) or discontinue (6%). Programs focusing on client abstinence as the treatment goal were more likely to expect or encourage tapering or discontinuation than programs that focus on helping clients achieve personal consumption goals. Of programs that did not currently facilitate OAT, 44% indicated that they would provide OAT, but lacked the necessary accreditation, physician support, or other resources. No philosophical objections to OAT were noted.OAT initiation was provided by 30% of programs, 23% referred to another service within their organization, and 29% referred to a service outside their organization. The remaining 18% did not facilitate OAT initiation at all, ranging from 0% in Quebec to 23% in the Prairies. Overdose response kits were provided by 86% of programs. The majority not providing kits indicated willingness if policy support and resources were provided (67%).
Overall, the results demonstrate that psychosocial programs provide some specialized services for OUD but desire further support specifically to provide OAT, including training, knowledge, and the expertise of individuals qualified to prescribe and dispense OAT. Many psychosocial treatment programs expressed a need for staff and resources for this purpose.
描述加拿大心理社会门诊、日间和住院成瘾治疗项目中治疗阿片类药物使用障碍（OUD）的当前方法，重点介绍阿片类激动剂治疗（OAT）的使用。
用英语和法语对加拿大心理社会成瘾治疗项目进行了在线普查（ = 214）。
项目组估计，25%的患者患有 OUD。大多数项目为 OUD 患者提供某种类型的专门服务（58%），最常提供或协助获得 OAT，但也提供专门的咨询、病例管理、教育和减少伤害服务。大多数项目报告说，他们收治了正在接受 OAT 的患者（88%），只有少数项目期望或鼓励患者减少（14%）或停止（6%）。以客户戒断为治疗目标的项目更有可能期望或鼓励减少或停止，而不是以帮助客户实现个人消费目标为重点的项目。在目前不提供 OAT 的项目中，44%表示他们将提供 OAT，但缺乏必要的认证、医生支持或其他资源。没有注意到对 OAT 的任何哲学反对。30%的项目提供 OAT 启动，23%的项目将患者转介到组织内的另一个服务，29%的项目将患者转介到组织外的服务。其余 18%的项目根本不提供 OAT 启动服务，魁北克省为 0%，草原地区为 23%。86%的项目提供了过量反应包。大多数未提供试剂盒的项目表示，如果提供政策支持和资源，他们愿意提供（67%）。
总的来说，结果表明，心理社会项目为 OUD 提供了一些专门的服务，但特别需要进一步的支持，以提供 OAT，包括培训、知识和有资格开处和分发 OAT 的个人的专业知识。许多心理社会治疗项目表示需要为此目的提供人员和资源。
