Further Insights for Our Practice–Wishes for a Kinder 2024

As I draft this year-end editorial for submission, 3 months in advance of publication, I am currently reflecting on 2023 in the context of the last 50 years. I cannot recall a time when Mother Nature has tested us so drastically. From coast to coast to coast, we have experienced extensive scarring of our forests caused by wildfires, some resulting in significant population displacements (in the Northwest Territories and Interior British Columbia), as well as a succession of floods from our rivers and hurricanes pummeling our shores (in Quebec and the Maritimes). Right now, Hurricane Lee is heading toward New Brunswick, the twelfth storm in recent memory. The impacts of global warming are no longer to be denied. Will 2024 be kinder? I am unaware of any comprehensive Canadian study following the social impacts of repeated natural disasters, including the prevalence of addiction disorders in this context. This journal eagerly invites any submission exploring this. Meanwhile, this issue offers diverse publications on a range of insights to be addressed in our practices. Faced with the rising mortality from substance overdoses and the call for additional measures, policymakers are contemplating the potential benefits of implementing involuntary treatment for individuals with substance use disorder. The Policy Committee of the Canadian Society of Addiction Medicine has conducted a systematic literature review of the effectiveness of such measures. In fact, this is the second related review article published in the CJA.1 Apart from higher retention in treatment, the literature remains equivocal as to the therapeutic benefits of this approach. The next contribution, a commentary, is an observation that while residential treatment settings are increasingly advocated by some policymakers, only a marginal minority provide opioid agonist therapy to their clients with opioid use disorder, thus depriving them of a demonstrated gold-standard approach. In a similar vein, a survey of 58 secondary schools in Ontario about the availability of youth substance use prevention programs reports that about half are not offering any such program. Of those schools that do, global programs targeting multiple substances are more common than cannabis-specific programs, a year after the legalization of cannabis in Canada. This is despite the reported relatively high rate of cannabis use among students. A comprehensive, school-level strategy is advocated. Comparing the high prevalence of publications about opioid use disorders versus the scant number of articles addressing methamphetamine/stimulant use, the next 2 epidemiological surveys are welcome. The first is a chart review of methamphetamine-related emergency department visits in 2019 in Toronto. The second analyzes a cohort of people using methamphetamine with a history of hospitalizations in London, Ontario. Not surprisingly, both groups elicit high social and clinical needs for both substance use and mental health concerns. Of additional interest, the London sample reports a high in-hospital substance use, highlighting the need to address this issue in the hospital setting. A third population-based, retrospective cohort study in Southern Ontario of initiated buprenorphine/naloxone or methadone between October 2016 and December 2018 (N=15 724) concludes that treatment retention is lower among individuals treated with buprenorphine/naloxone relative to methadone, particularly among males. The last 2 articles are about the behavioural segments of our field. A secondary analysis of an online panel of 10 199 Canadian adults who had gambled at least monthly in the previous year elicited that those with Problem Gambling (N=909) are more likely to seek help from services other than professional treatment. Friends and family may be the only ones providing help. Professional counselling and casino self-exclusion are also perceived as valued. The final study, aimed at the neglected, concerned significant others of people with problematic internet use, identifies the set of dimensions to be taken into consideration when evaluating the specific needs of partners. Very best of the Season! Nady el-Guebaly CM, MD, FRCPC Editor-in-Chief, CJA

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