Canada

Subsections:

Page last updated June 9, 2020 by Doug McVay, Editor/Senior Policy Analyst.

21. Number of People in Canada Living with HIV, by Transmission Method

"HIV/AIDS remains an issue of concern for Canada. The number of people living with HIV (including AIDS) continues to rise, from an estimated 64,000 in 2008 to 71,300 in 2011 (an 11.4% increase) (Table 1, Figure 1). The increase in the number of people living with HIV is due to the fact that new infections continue at a not insignificant rate which is greater than HIV-related deaths, as new treatments have improved survival. The estimated prevalence rate in Canada in 2011 was 208.0 per 100,000 population (range: 171.0–245.1 per 100,000 population). Nearly half (46.7%) of those living with HIV were men who have sex with men (MSM). Those who acquired their infection through heterosexual contact and were not from an HIV-endemic region comprised the next largest group (17.6%), followed by those who acquired their infection through injection drug use (IDU) (16.9%) and those exposed through heterosexual contact and were also from an HIV-endemic region (14.9%)."

"Summary: Estimates of HIV Prevalence and Incidence in Canada, 2011" (Ottawa, Ontario: Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, 2012), p. 1.
http://www.phac-aspc.gc.ca/aid...
http://www.phac-aspc.gc.ca/aid...

22. Estimated Number of New HIV Infections, by Transmission Method

"Although estimates of the number of new HIV infections are uncertain, the number of new infections in 2011 was estimated at 3,175 (range between 2,250 and 4,100) which was about the same as or slightly fewer than the estimate in 2008 (3,335; range of 2,370 to 4,300) (Table 2, Figure 2). In terms of exposure category, MSM continued to comprise the greatest proportion (46.6%) of new infections in 2011, which was slightly higher than the proportion they comprised in 2008 (44.1%). In 2011, the proportion of new infections among IDU was lower than in 2008 (13.7% compared to 16.9%). The proportion of new infections attributed to the heterosexual/non-endemic and heterosexual/endemic exposure categories were about the same in 2011 compared to 2008 (20.3% vs 20.1% and 16.9% vs 16.2%, respectively) (Figure 3)."

"Summary: Estimates of HIV Prevalence and Incidence in Canada, 2011" (Ottawa, Ontario: Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, 2012), p. 2.
http://www.phac-aspc.gc.ca/aid...

23. Reported Drug Harms

"The most commonly reported drug-related harm involves physical health, reported by 30.3% of lifetime and 23.9% of past-year users of illicit drugs excluding cannabis, and 15.1% of lifetime and 10% of past-year users of any illicit drug . Following physical health, a cluster of harms, represented somewhat equally, includes harms to one’s friendships and social life (22.3% and 16.4% of users excluding cannabis, 10.7% and 6.0% of any illicit users), home and marriage (18.9% and 14.1% excluding cannabis, 8.7% and 5.1% of any illicit users), work (18.9% and 14.2% excluding cannabis, 9.2% and 5.1% of any illicit users) and financial position (19.6% and 18.9% excluding cannabis, 8.4% and 6.5% of any illicit users)."

"Canadian Addiction Survey: A National Survey of Canadians' Use of Alcohol and Other Drugs: Prevalence of Use and Related Harms," Canadian Executive Council on Addictions, Health Canada, March 2005, p. 56.
http://www.ccsa.ca/Resource%20...

24. Effectiveness of Heroin-Assisted Treatment Compared With Methadone Maintenance

"Diacetylmorphine was found to be a dominant strategy over methadone maintenance treatment in each time horizon studied (Table 2). Over a lifetime horizon, people in the methadone cohort lived 14.54 years on average following entry into the model, spending 8.79 years (60% of their remaining life) in treatment and 5.52 years in relapse. They accumulated 7.46 discounted QALYs and generated a societal cost of $1.14 million. People in the diacetylmorphine cohort lived 15.45 years on average, spending 10.41 years (67% of their remaining life) in treatment (2.34 years of which was in post-diacetylmorphine methadone treatment) and 4.05 years in relapse. They accumulated 7.92 discounted QALYs and generated a societal cost of $1.10 million. Based on these findings in the baseline model, over a lifetime horizon the provision of diacetylmorphine in the hypothetical cohort provided greater incremental health benefits and reduced the total costs to society compared with methadone maintenance treatment."

Bohdan Nosyk PhD., et al., "Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment," Canadian Medical Association Journal, April 3, 2012, 184(6):E317-E328.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

25. Effectiveness of Heroin-Assisted Treatment Compared With Methadone Maintenance

"Our results on the cost-effectiveness of diacetylmorphine are consistent with those of an economic analysis based on data from two Dutch heroin-assisted treatment trials,21 despite differences in the design of the Dutch trials and the North American Opiate Medication Initiative, and the time horizon and analytic design of the economic analyses.

"The Dutch trials compared methadone maintenance treatment with a combination of methadone and diacetylmorphine (prescribed concurrently), which changed the profiles of health utility and health resource use. Furthermore, participants in the Dutch trials were recruited from methadone maintenance programs, whereas participants in the North American Opiate Medication Initiative had to have been out of treatment for at least six months before trial entry. We considered a range of time horizons, using external parameters where necessary to extrapolate results to longer time horizons. The other economic analysis used trial data exclusively and focused only on a 12-month study period. The consistency in results between our analysis and the analysis of the Dutch trials appears to be due primarily to the advantages diacetylmorphine provides in retaining individuals in treatment.

"We believe a lifetime horizon is the most appropriate period for evaluating treatments of chronic, recurrent diseases such as opioid dependence, because treatment is available indefinitely in practice and will have a long-term impact. The key outcomes, such as progressing to a drug-free state or death, would likely not be realized within the 12-month period of the North American Opiate Medication Initiative."

Bohdan Nosyk PhD., et al., "Cost-effectiveness of diacetylmorphine versus methadone for chronic opioid dependence refractory to treatment," Canadian Medical Association Journal, April 3, 2012, 184(6):E317-E328.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

26. Comparison of Client Satisfaction Between Those Treated With Oral Methadone Versus Injectable Heroin

"The present study determined participants’ satisfaction with received treatments in the first North American RCT [Randomized Controlled Trial] to provide injectable diacetylmorphine or hydromorphone compared to oral methadone for the treatment of long-term, treatment resistant, opioiddependency. At 3 and 12 months, participants were satisfied with the treatment received during the study period, although satisfaction was greater for those randomized to receive injectable treatments. At 3 months, participants who reported that the program met their needs were more likely to be retained at 12 months. To our knowledge this is the first study to assess treatment satisfaction among participants receiving supervised injectable diacetylmorphine or hydromorphone.

"Regardless of the outcome of the randomization, participants in the trial were highly satisfied with the treatment received. This follows previous studies which have consistently found that patients tend to report high levels of treatment satisfaction, including community health services [45], services for mental health [13], addiction [46], and opioid dependence [20]."

Marchand et al., "Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency," BMC Health Services Research, 2011, 11:174.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

27. Comparison of Client Satisfaction Between Those Treated for Opioid Dependence With Oral Methadone Versus Injectable Heroin

"Among long-term chronic opioid injectors participating in a randomized clinical trial prescribing injectable diacetylmorphine or hydromorphone and oral methadone, those receiving injectable medications were more satisfied with treatment. Independent of treatment group, treatment satisfaction was also an indicator of retention in treatment, as well as treatment response, including a reduction in substance use. As the first study in North America to provide injectable OST, these findings have valuable implications for future RCTs, which should continue to measure satisfaction in order to identify areas of improvement. These findings also provide evidence-based knowledge for good clinical practice guidelines in the treatment of chronic opioid dependence in Canada as they highlight the association between treatment satisfaction and improved treatment outcomes, particularly for those receiving more innovative treatment medications."

Marchand et al., "Client satisfaction among participants in a randomized trial comparing oral methadone and injectable diacetylmorphine for long-term opioid-dependency," BMC Health Services Research, 2011, 11:174.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

28. Participation in Methadone Maintenance in Prisons

Harm Reduction

"At the time of the survey, 7% of all inmates reported being on MMTP. An additional 9% of all inmates reported not being on the program but previously trying to get on it at CSC. The remaining 84% of inmates reported never trying to join the program (63%), never using drugs (20%), and no longer needing the program (<1%).
"Participation in MMTP was associated with drug use in penitentiaries. Of inmates who were on MMTP, 60% reported not using opiates recently in a penitentiary; however, 40% did (see Table 10). Similarly, of those who were not on CSC’s MMTP but had tried to get on the program, almost equal proportions reported no drug use in a penitentiary (45%) and recent opiate use a penitentiary (44%). Conversely, the majority of inmates who never tried to get on MMTP at CSC reported no recent opiate use in a penitentiary (87%) and a minority (12%) reported recent opiate use in a penitentiary."

Thompson, Jennie, Zakaria, Dianne, and Jarvis, Ashley, "Use of bleach and the methadone maintenance treatment program as harm reduction measures in Canadian Penitentiaries 2010," Correctional Service of Canada, Research Report R-210, August 2010.
http://www.csc-scc.gc.ca/text/...

29. Neonatal Drug Testing

"Urine, hair, and meconium samples are sensitive biological markers of substance use. Urine drug screening can detect only recent substance exposure, while neonatal hair and meconium testing can document intrauterine use because meconium and hair form in the second and third trimester, respectively.38–41 By itself, a single positive test result cannot be used to diagnose substance dependence. Although child protection agencies sometimes request hair analyses, neither hair nor meconium is appropriate for routine clinical use because of the high costs and propensity for false positive results."

Wong, Suzanne; Ordean, Alice; Kahan, Meldon, "Substance Use in Pregnancy," Society of Obstetricians and Gynaecologists of Canada (Ottawa, Ontario: April 2011), p. 370.
http://sogc.org/wp-content/upl...

30. Supervised Injection Facilities and Reductions in Overdose Mortality

"In the present analysis we found that overdose events were not uncommon at the Vancouver safer injection facility. During an 18-month period, 285 individuals accounted for 336 overdose events, yielding an overdose rate of 1.33 (95% CI: 0.0–3.6) overdoses per 1000 injections. Heroin was involved in approximately 70% of all overdoses, and opiates considered together were involved in 88%of overdoses. It is notable, however, that approximately one-third of overdoses involved stimulants. The most common indicators of overdose were depressed respiration, limp body, face turning blue, and a failure to respond to pain stimulus. The majority of overdoses were successfully managed in the SIF, with the most common overdose interventions undertaken by SIF staff involving the administration of oxygen, a call for ambulance support, and the administration of naloxone hydrochloride via injection. Among a randomly selected sample of SIF users, factors associated with time to overdose at the SIF included fewer years injecting, daily heroin use, and having a history of overdose. None of the overdose events occurring at the SIF resulted in a fatality."

Thomas Kerr, Mark W. Tyndall, Calvin Lai, Julio S.G. Montaner, Evan Wood, "Drug-related overdoses within a medically supervised safer injection facility," International Journal of Drug Policy 17 (2006) p. 440.
http://www.sciencedirect.com/s...

Pages