Objective We sought to compare unintentional opioid and other drug poisoning (OODP) and suicide deaths regarding clinical and service use profiles. Method We undertook a retrospective, administrative data-based study to identify these deaths in Quebec from 2003 to 2018. Descriptive variables were chosen among those available in the Quebec Integrated Chronic Disease Surveillance System, classified according to Anderson's model of health services as determinants of health outcomes. We also used multivariable logistic regression to compare OODP and suicide deaths. Results We identified 2,002 OODP deaths and 16,555 suicides. In both groups, a considerable proportion were male, aged 30–64 years, and pertained to materially and socially deprived areas, and most presented with at least one mental health or substance-related disorder (SRD) and used primary and specialist healthcare services in the last year before death. When comparing the two groups, some factors predominantly characterized OODP deaths (e.g., living in the Montreal area, several past-year physical comorbidities, SRDs) or suicide deaths (e.g., male sex, depression and bipolar disorder, psychiatrist visit). Similarities also emerged, including several psychiatric comorbidities (anxiety disorder, cluster B personality disorder, schizophrenia and other psychotic disorder), most past-year physical comorbidities and several factors regarding service use in the last year before death (e.g., hospitalizations and general practitioner visits/psychotherapy visits). Conclusions While some distinctions in individual clinical and service use emerged between OODP and suicide deaths, several similarities also arose, including the generally high burden of mental disorders for both populations. Suicide prevention recommendations of better detection, engagement and management of individuals with depression or SRDs at the primary care and general hospital levels, with support from coordinated mental health and addiction services, might also represent a potentially effective strategy alongside existing overdose prevention efforts and key involvement of peer-led and community-based resources to decrease OODP deaths.
Introduction Adolescence represents a period of heightened vulnerability for the initiation of psychoactive substance use, such as cannabis. A growing body of research suggests a marked co-occurrence between attention-deficit/hyperactivity disorder (ADHD) symptoms and early or problematic cannabis use. However, most of these studies are cross-sectional, raising questions about the nature and directionality of this association. Understanding the underlying dynamics of this relationship is of particular importance for both prevention and intervention among at-risk adolescents. Method Data were drawn from CoVenture , a longitudinal study of 3,756 secondary school students from the Greater Montreal area. Each year from Grade 7 to Grade 11, participants self-reported their frequency of alcohol and cannabis use, as well as ADHD symptoms. A Random Intercept Cross-Lagged Panel Model was used to assess within-person associations over time, controlling for alcohol use and demographic covariates. Results At a between-person level, cannabis use and ADHD symptoms were significantly associated, even after controlling for alcohol use. At a within-person level, findings suggest a bidirectional relationship, starting in Grade 8. Greater ADHD symptom severity significantly predicted subsequent year increases in cannabis use. The reverse pathway—from greater cannabis use to subsequent year increases in ADHD symptoms—was also significant. Further analysis showed that higher cannabis use in Grade 9 increased the risk of reaching a clinically relevant level of ADHD symptoms in Grade 10. Conclusion The findings suggest that ADHD and cannabis use are related through a common vulnerability mutually exacerbating relationship where (a) ADHD symptoms present a risk factor for cannabis use onset, and (b) once cannabis use has begun, cannabis use and ADHD symptoms appear to mutually predict each other, suggesting a potential “spiral effect” that warrants attention.
Background Depression in children and adolescents is a leading cause of disability worldwide, with rising prevalence and limited efficacy of conventional pharmacotherapies. Omega-3 polyunsaturated fatty acids (PUFAs) have emerged as a potential adjunctive or alternative treatment due to their anti-inflammatory and neuroprotective properties. However, evidence in paediatric populations remains inconclusive. This updated meta-analysis aims to evaluate the efficacy and safety of omega-3 PUFA supplementation versus placebo or standard care for depressive symptoms in children and adolescents. Methods We conducted a systematic search for randomized controlled trials (RCTs) comparing omega-3 PUFA supplementation in children and adolescents with depressive disorders or clinically significant depressive symptoms. For the meta-analysis, we used R software (version 4.5.0) with the meta and metasens packages. Using a random-effects model, we evaluated continuous outcomes using standardized mean differences (SMDs) and dichotomous outcomes using risk ratios (RRs), each with 95 per cent confidence intervals (95% CIs). Trial sequential analysis (TSA) was performed to assess the robustness of findings and calculate required information sizes (RISs). Results We included nine RCTs with a total of 848 participants. There were no statistically significant differences between omega-3 and control groups in change in depression symptom severity at any follow-up duration: 3–4 weeks, 6–8 weeks, 10–12 weeks, 16 weeks, or 24–26 weeks. Heterogeneity was significant across most subgroups, with I 2 ranging between 67.1 per cent and 91.8 per cent. Similarly, no significant effects were observed for response rate or remission rate at any time point, or all-cause dropouts. TSA indicated that the cumulative evidence did not reach the RIS. Conclusion Omega-3 did not significantly improve depressive symptoms or remission in children and adolescents. However, TSA showed that the evidence remains underpowered, so a potential benefit cannot be excluded. Significant clinical heterogeneity and insufficient information size underscore the need for large-scale RCTs with standardized outcome measures.
Objective In Ontario, substance use disorders are the top reason for mental health and addictions-related hospitalizations, many of which are related to substance withdrawal. Our objective was to identify briefer withdrawal-related hospitalizations that are potentially manageable in medically supported community-based settings, assess the degree of intra-provincial variation for these types of admissions, and examine the health care utilization of these patients. Methods We conducted a population-based, cross-sectional study using linked health administrative data for Ontario residents hospitalized with alcohol- or opioid-use withdrawal between January 1, 2019 to December 31, 2021. Brief withdrawal admissions (BWAs) were defined as hospitalizations with a stay of 0–4 days and without intensive care. We calculated BWA rates per 100,000 person-years (PY), overall and for health regions within the province. Log-binomial regression models were used to examine differences in health care utilization in the year following a BWA compared with the year prior to admission. Results There were 12,544 BWAs in Ontario during our study period (28.6 admissions per 100,000 PY) with a greater than 7-fold difference ( p < 0.001) between the provincial health regions with the highest (North West region, 149.5 per 100,000 PY) and lowest (Central region, 20.8 per 100,000 PY) rate. In the year following a BWA, 30% of patients required hospital admission and 50% had an emergency department visit for substance use, which represented a significant increase of 63% (Relative Rate (RR) = 1.63; 95% Confidence Interval (95% CI) 1.55–1.71, P -value <0.001) and 11% (RR = 1.11; 95% CI 1.08–1.14, P -value <0.001), compared with the year prior to admission, respectively. Conclusions Understanding the variation in BWAs, and the significant health care use following such events, is vital in supporting provincial efforts to improve withdrawal management. Future research should examine if providing more resources to community-based withdrawal services to manage BWAs results in improved patient outcomes and reduced acute care capacity/costs.
