Volume 13, Number 1
BULLETIN
Canadian Addiction Medicine
Canadien de Medicine D’Addiction
March 2009
Canadian Society of Addiction Medicine / La Société Médicale Canadienne sur l’Addiction
Contents
Message from the President.................... 1
Message from the Editor.......................... 2
Committee Reports................................... 2
Save the Date............................................. 4
Membership Application........................... 5
News from Across Canada....................... 7
Feature Articles......................................... 8
Research Corner........................................ 9
Editor-in-Chief
Dr. Michael Varenbut
Associate Editor
Dr. Don Ling
An official publication of
CSAM Head Office
Suite 201, 375 West Fifth Avenue
Vancouver BC V5Y 1J6
Tel: 604-484-3244
Fax: 604-874-4378
Email : admin@csam.org
The CSAM/SMCA Bulletin is published
by the Canadian Society of Addiction
Medicine. It is a journal for the
dissemination of knowledge and clinical
experience related to addiction medicine.
If you are a CSAM/SMCA member and
would like to contribute an article or
letter to the Bulletin, please send and
email to the editor, Dr. Michael Varenbut
at mvarenbut@toxpro.ca. Please forward
your correspondence to admin@csam.org
MESSAGE FROM THE PRESIDENT
Since the last Bulletin in November your Board of Directors has met twice
via teleconference.
The most pressing item on the agenda is a succession plan for office management.
The Malachite group, office managers since 2006, has served notice that they will not
be extending their management contract past May 2009. This decision was finalized
by Malachite in October as the Board met in their face-to-face conference prior to the
Vancouver Scientific gathering and AGM.
Four specific proposals have been received from be structured to encourage member discussion on
parties interested in managing CSAM’s day-to-day important issues. Please mark your calendars now for
office business. Each of these has been reviewed September 23 - 26, Calgary, Alberta. One registration
by the Executive Committee and consensus fee is available for both meetings or each one singly,
reached on the most appealing for our immediate if preferred.
requirements. The Board has decided to separate
The Board currently has four vacancies—three
the office management duties from the annual
geographic jurisdictions and one member-at-large.
convention organizing responsibilities.
Bill Campbell’s resignation accounts for the latter. An
Our annual meeting this year will be held in conjunction opening for a Director from the Northern Territories has
with the International Society of Addiction Medicine been created with Ross Wheeler’s resignation, while a
(ISAM) at Calgary on September 23-25th. The actual similar opportunity opened for a PEI physician with
CSAM component will take place on only one day— my ascendency to President. The Newfoundland and
Saturday, September 26th. ISAM will be offering a three Labrador position has never been filled and awaits an
day scientific meeting on Wednesday thru Friday that interested physician from our eastern most province.
promises to be extra special. Many highly credentialed Any physicians with interest in these positions are
international speakers have been confirmed by asked to contact a current Board member.
the organizing committee giving Canadian based
And a tip of the hat to Michael Varenbut, our dedicated
professionals interested in addiction medicine a
Bulletin Editor. This communication vehicle is CSAM’s
rare opportunity to share this expertise within our
most tangible member benefit. It takes much time
own borders.
and energy to gather reports and organize appropriate
This four-day conference in Calgary will undoubtedly articles. Without Michael’s interest and commitment
draw many registrants from around the world. It is to the Bulletin over the years CSAM would have
hoped that CSAM members will turn out in force to suffered immeasurably. Thank you Michael.
meet international colleagues and provide valuable
Respectfully yours,
Canadian input. CSAM’s annual general meeting is
to take place later on Saturday afternoon, and will Dr. Don Ling
 MESSAGE FROM THE EDITOR
Dear CSAM members and Bulletin readers,
I hope that you will find this issue of the Bulletin interesting, educational and informative.
Many of the CSAM committees have been very busy working on a multitude of projects on behalf
of the membership and the board. You will find some of their updates and reports included in
this issue.
There is a significant amount of work that is done “behind
the scene” at CSAM, but we often fall short in documenting
and reporting on these activities to our membership. We will
strive to improve on this as much as possible in the future.
I would like to use this opportunity to thank all those
who contributed materials, which continue to enrich
our publication.
COMMITTEE REPORTS
OPIATE AGONIST COMMITTEE
REPORT
Michael Varenbut, MD, CCSAM, CASAM, FASAM
Chair
Committee members: Dr. John Fraser, Dr. Suzanne Brissette,
Dr. Brian Fern, Dr. Wade Hillier, Dr. Garth McIver
The committee has been working on a number of projects and
initiatives. We have received unanimous CSAM board approval
and support for the final version of the “Assessment Tool for
training programs in Opiate Agonist Therapy”. This tool will be
used in the future to assess any training programs in the field,
which CSAM may be asked to critically appraise and endorse.
2
As always, we look forward to your comments, materials
and contributions to the bulletin. It is only with your
ongoing support that we will continue to improve on
our publication and continue to increase its value to our
members and readers.
Wishing you all the best,
Dr. Michael Varenbut
In addition, we continue to work on our assessment of the www.
suboxonecme.com training program. Our final assessment, as
well as recommendations, will be presented to the board as
soon as possible.
The committee has also been able to provide preliminary
feedback to a new set of clinical treatment guidelines for
Buprenorphine prescribing, authored by Dr. Mel Kahan et al.
Once further consultation is complete, and a final version
of the document is made available, we will proceed with
assessing the new guidelines, using the standardized “AGREE”
instrument. Our findings and recommendations will then be
presented to the board and the authoring group.
MEMBERSHIP COMMITTEE REPORT Kasandra Westcott ON A
Michael Varenbut, MD, CCSAM, CASAM, FASAM Linda Zucker ON A
Chair Rob Keith BC A
Committee members: Dr. John Fraser, Dr. Don Ling, Dr. Charles Syed Kazmi International MD
Mackay, Dr. David Teplin, Dr. Garth McIver Denise Lea ON MD
The CSAM membership committee has been working on a Jonathan Fine BC MD
variety of ideas to maintain and increase membership and Akinlolu Peluola SK MD
to highlight benefits to CSAM membership as a whole. We Elena Timofeeva QC PHD
would welcome any suggestions and ideas from our current Richard Kretschmann BC STU
members and appreciate any recruitment that you are able to
achieve. WEBSITE COMMITTEE
Jeff Daiter, MD, CCSAM, CASAM, FASAM
Currently, CSAM has 232 members for 2009. There are 127 MD
Committee members: Dr. Brian Fern, Dr. David Luckow
members, 82 associate members, 3 PHD members, 12 honorary
members, 4 student members and 4 retired members. CSAM’s new and improved website has been online for a
number of months now. The committee has been listening
It is with great pleasure that we welcome the following
closely to the Board’s concerns and is planning on creating an
members to CSAM:
area for members of the society to be listed. As well, updates
Name Province Member concerning the upcoming Annual Scientific Conference are
Status expected soon. Lastly, work is now underway to translate the
Ferne Hand SK A site to French.
Ronda Collier ON A
Rhonda Fazzari ON A STANDARDS COMMITTEE
Tara Fletcher ON A Jeff Daiter, MD, CCSAM, CASAM, FASAM
Kim Foster ON A Committee members: Dr. Ron Lim, Dr. Nady El-Guebaly, Dr.
Jean Pierre Chiasson.
Pauline Hainey ON A
Joanne Halliday ON A The Standards Committee has been busy reviewing applications
Chantelle Hamm ON A for this year’s CSAM certificants. Successful candidates will be
Christine MacGillivray ON A announced at the Annual Scientific Conference. Also, a position
Ashley Olesiak ON A paper regarding supervised injection facilities will soon be
Melinda Rollick ON A made available to the membership and public at large. Lastly,
Paul Stewart ON A the committee is hoping to attract new members. Specifically,
Katharine Storkson ON A the committee seeks members who have played a pivotal role
Deana Talavera ON A within the field or have brought a high level of expertise to their
Tyler Tebbenham ON A communities. Please contact myself if there is an interest.
Sarah Telford ON A
Britta West ON A

3
 CSAM MEMBERSHIP FORM
Membership Type
 Regular Member –  Medical Student/
 Regular Member – MD  Retirees – MD or PhD  Associate Member
PhD Scientists Intern/Resident
Applicant Information
 Dr.  Ms.  Mrs.  Miss  Mr.
Name:
(First Name) (Middle Initial) (Last Name)
Work Address  Preferred Mailing Address
Address:
City: Province: Postal Code:
Work Phone: Fax:
Home Address  Preferred Mailing Address
Address:
City: Province: Postal Code:
Home Phone:
Email Contact*
Email address:

Education History
Undergraduate Degree(s)/University/Year Graduated:
Graduate Degree(s)/University/Year Graduated:
Area of Specialty:
Current Employment:
Area of Employment:  Private Practice  Treatment Centre  Educational Facility  Other (please specify):
Appointment(s) – Hospital/University/College Including Department:
Addiction Medicine Affiliations

Percentage of time in research and clinical practice devoted to: Percentage of time in research and clinical practice devoted to:
Addiction: % Clinical Practice: %
Other aspects of healthcare: % Research: %
Total: 100 % Teaching: %
Administration: %
Other: %
Total: 100 %

 Member  Certificant Year of Certification/recertification:

American Society of Addiction Medicine (ASAM):
 Fellow Year of Fellowship:
International Society of Addiction Medicine (ISAM):  Member  Certificant Year of Certification/recertification:
Are you interested in Canadian Certification in Addiction Medicine?
 Yes  No
(Member – MD only)

5
 CSAM MEMBERSHIP FORM
Topics of Special Interest in the Field of Medicine

Positions in the Society You Would Be Willing To Consider in the Future

 Board Member (Please note: Associate members are not eligible for board positions)  Committee Membership
 Standards  Website  Opioid Agonist  Education  Membership  Conference
Referee and Curriculum Vitae
Please include a recent copy of your Curriculum Vitae.
All new members require a current CSAM member to act as a referee. A supporting letter from a current CSAM member must accompany all applications for
Associate membership.
Referee’s Name:
Do you agree to have your name and office contact information included in a directory to be distributed to CSAM members only?
 Yes  No
Signature:

Payment Information
Annual Fees:
 Regular Member – M.D.: $200.00  Student/Intern/Resident: $5.00
 Regular Member – PhD : $200.00  Retirees MD or PhD: $25.00
 Associate Member: $50.00
Multi-year membership
CSAM is pleased to offer members the opportunity to sign up for three years of membership or five years of membership. The rate for a three year membership
is $549; the rate for a five year membership is $900.
 Three-year membership $549.00  Five-year membership $900.00
Optional: International Society of Addiction Medicine (ISAM) Dues – ($90 USD, which equals $110.96 CDN, effective November 25, 2008)
NOTE: ISAM Membership not available to Associate Members
 ISAM Membership: $110.96 *TOTAL PAYMENT: $
 Cheque, Bank Draft or Money Order Payable to: The Canadian Society of Addiction Medicine or
 VISA/MC/AMEX (circle one) # Expiry Date:
Name on Card:
Signature:

We thank you for supporting the Canadian Society of Addiction Medicine.

6
THE ISAM CERTIFICATION EXAM
Interested in sitting for the exam at the Anniversary Annual Meeting ISAM-CSAM in Calgary, AB Sunday Sept 27, 2009 ?
We are requesting any expression of interest from recipients of the Bulletin to be received by our ISAM office
(c/o nady.el-guebaly@albertahealthservices.ca) by June 1, 2008 for the ISAM-CSAM meeting in Calgary September 2009. The
complete documentation and dues will be required by August 15, 2009.
For further details about our exam, please peruse the ISAM website at www.isamweb.org.
Cancellations after the complete application is processed will be levied a $150 US fee from the refund.
Yours truly,
Nady el-Guebaly, MD
Chief Examiner, ISAM
NEWS FROM ACROSS CANADA
NEWS FROM ONTARIO
Jeff Daiter, MD, CCSAM, CASAM, FASAM
On April 23, 2009, the Annual General Meeting for the OMA
Section on Addiction Medicine will be taking place in the large
boardroom at 525 University Avenue, Suite 200, Toronto. As
new positions on the Executive will be available, all members
of the Section are encouraged to attend or participate by
teleconference (1-888-300-8196, quote conference ID
8518769). Since the Section is now focused on creating a strong
blend of executive members holding a variety of perspectives
within the field (methadone prescribers, abstinence based
practices, other addictions such as gambling or sex addiction,
etc), it is hoped that a strong showing of the membership
will be realized. From my perspective as a current executive
member, I can reassure anyone interested that the work is
both interesting and rewarding. Key policy decisions regarding
our profession are brought to light through this work. Please
feel free to contact me directly if you have any questions
regarding the above.
The CPSO is has announced a call for abstracts for their Annual
Methadone Prescribers Conference to be held in November 2009. An
application form can be found on CSAM’s website at www.csam.org.
NEWS FROM SASKATCHEWAN
Brian Fern, MD
Saskatchewan has various issues in the methadone area, as
usual. Each of our methadone centres has periodic meetings
involving most of the stakeholders (although interestingly not
the patients), at which current topics are discussed and invited
speakers give presentations.
Prescription opioids, THC, and street cocaine, of dubious quality,
are readily available all the way to the top of the province.
Questionable prescribing is not uncommon. Little heroin here,
however.
Provision of methadone to those living on reserves, many of them
many miles from our centres, remains a problem since as yet
none of them will safely store methadone for patients or transport
patients into our pharmacies for daily witnessed ingestion.
There were some suggestions that some federal prison staff
were not supportive new methadone starts for federal inmates.
Dr Lanoie, Correctional Service of Canada National Methadone
Coordinator, who resides in our province, has been working hard
and giving presentations to impress our federal prison staff on the
need for methadone maintenance therapy in our federal facilities
including new starts.
There is debate over the need for, and nature of, agreements or
contracts for methadone services. There is little consistency
here. Some doctors and pharmacists are strongly in favour, while
others see no need at all. The documents themselves also vary
greatly from severe “three strikes” for the world’s worst people
type to kindly “we want to help” for the poor struggling sufferers.
Fascinating range of attitudes. We would be interested in knowing
how others see this issue, in particular why would such therapy
need such a document and what should be in it to satisfy current
thinking on all the stakeholders’ positions, presumably including
the patients.
Signing off with these few thoughts from the Prairies.
7
News from Across Canada, cont Page 9
 ADDICTION HISTORY TAKING
TECHNIQUES
Dr. Frank Evans, Past CSAM President
Part 1
Nowhere else in medicine, will you find a patient more
resistant, noncompliant, minimizing, and sometimes
dishonest when presenting their addiction history than in
addiction medicine. Most feel that this is a natural response
of the disease process in order to maintain its viability. One
must understand that it is NOT the patient but the natural
process of the disease of addiction.
Without an accurate and detailed addiction history, you
are prone to being manipulated by the addiction and
handicapped in attempting to compose an accurate and
thorough differential diagnosis. Of course, if your differential
diagnosis is not fully correct, then your proposed plan of
treatment will also not be correct and can cause harm,
serious setbacks or limited to no success in stabilizing
the disease process. This can really undermine a patient’s
hope and confidence that a solution is possible with their
addictive disorder.
The addiction history will also be the most powerful
tool to help you circumvent denial, rationalization, and
minimization about a patient’s addiction problem without
having to confront the patient directly. Confrontation
between the physician and the patient, who is suffering
from the addictive disorder, can only stress and damage the
doctor-patient relationship with the risk of subsequent loss
of patient contact.
A detailed and accurate addiction history, from the patient’s
own words, is what one can use as the confrontational “bad
cop” component when discussed appropriately. This will
hopefully allow you, the addiction specialist, to maintain an
8
empathetic, “good cop” role.
For example, “Mr. Johnston, I can see and understand your
point of view. I really do.” “However, can you help me with
this. Mr. Johnston, did you not say in your own history,
that your wife said she left you because of your excessive
drinking?” “Again, I can see and understand your point of
view, but is this what you said in your history?”
In conclusion, the patient’s own addiction history will serve
as probably the most useful therapeutic tool in helping
a patient deal with their addictive disorder. The addiction
history can be used to take the confrontational role,
allowing the addiction specialist to stay in a nonjudgmental,
empathetic role, and hopefully maintain the doctor-patient
relationship. Remember, if one gets too confrontational
and judgmental, the patient is more likely to not return
for further appointments. Once lost, one cannot work with
patient thereafter. Let the patient’s own history, do the
confrontational work for you.
Now, how does one obtain this history?
Part 2 – In the next
edition of the Bulletin:
How to obtain an
accurate and detailed
history, regardless of
obstruction by the
patient’s disease.
News from Across Canada, continued
NEWS FROM PRINCE
EDWARD ISLAND
The PEI Provincial Methadone Maintenance Treatment Program is
now in its fifth year of operation. The patients in treatment now
number 92 with about 35 added in the past year.
The program consists of inpatient induction (5-8 days) at our
Provincial Detox Unit in Mt. Herbert, weekly group sessions
for three months and regular counseling sessions along with
scheduled physician visits. Patients work through a four-Phase
level system with carry doses restricted to Phase III and IV only.
Phase III is possible only after 12 weeks with completion of
groups and counseling plus clean urine screens for at least 6
weeks.
A summer social work student was able to compile some
statistical data for the 75 clients then in treatment. Male patients
predominated at 59%, and overall average age was 32.5 years.
Age range was 19 - 57, with the average time of substance use
for the group being14 years (range 4-49). Only 31% of the clients
were living in married or common law situations while 75% have
children. 44% were receiving a form of income assistance.
Prior to induction about 41% of patients gave history of some
type of work recently, although usually sparse and irregular.
Those clients successful in reaching Phase IV reported a 71%
employment record, often times self supporting.
A great emphasis is put on both addiction counseling and
attending a 3-4 week rehab program. 53% of the group in
treatment last July reported having completed at least one
rehab course.
As with most MMT programs today the demand for treatment
outweighs the available resource. In response to the PEI
predicament a new position was authorized by government last
year.
In April 2009 Nicole Peters, BN will assume the position of Team
Lead for the MMT Program. She joins Barbara Lacey, MSW, the
previous coordinator who now moves to a newly created Social
Work position with the program. Additional resource is provided
by the two Out Patient Detox Nurses, Nicole’s previous position,
and an admin assistant who provides physician support. While
I remain the sole physician piece of the team we are hopeful
of a second physician joining the Provincial Addictions Facility
workforce this summer. This would prove a welcome addition to
the Methadone Program as well as to the Detox Unit and Rehab
Programs with the facility.
T. Donald Ling, M.D.
Medical Consultant
RESEARCH CORNER
By Dr. David Teplin, Psy.D, C.Psych. Private Practice
A double-blind, placebo-
controlled trial of
modafinil (200 mg/day) for
methamphetamine dependence.
Addiction, 104, 224–233. Shearer, J. Darke, S., Rodgers, C.,
Slade, T., van Beek, L., Lewis, J., Brady, D., McKetin, R., Mattick,
R. & Wodak, A. (2009).
The aim of this study was to examine the safety and efficacy of
modafinil (200 mg/day) compared to placebo in the treatment
of methamphetamine dependence and to examine predictors of
post-treatment outcome. Eighty methamphetamine-dependent
subjects in Sydney, Australia were allocated randomly to
modafinil (200 mg/day)
(n = 38) or placebo (n = 42) under double-blind conditions for
10 weeks with a further 12 weeks post- treatment follow-up.
Comprehensive drug use data (urine specimens and self-report)
and other health and psychosocial data were collected weekly during
treatment and research interviews at baseline, week 10 and week
22. Treatment retention and medication adherence were equivalent
between groups. There were no differences in methamphetamine
abstinence, craving or severity of dependence. Medication-
compliant subjects tended to provide more methamphetamine-
negative urine samples over the 10-week treatment period (P =
0.07). Outcomes were better for methamphetamine-dependent
subjects with no other substance dependence and those who
accessed counseling. There were statistically significant reductions
in systolic blood pressure (P = 0.03) and weight gain (P = 0.05) in
modafinil-compliant subjects compared to placebo. There were no
medication-related serious adverse events. Adverse events were
generally mild and consistent with known pharmacological effects.
Modafinil demonstrated promise in reducing methamphetamine
9
 use in selected methamphetamine-dependent patients. The study
findings support definitive trials of modafinil in larger multi-site
trials.
Buprenorphine tapering schedule
and illicit opioid use.
Addiction, 104, 256–265. Ling, W., Hillhouse, M., Domier, C.,
Doraimani, G., Hunter, J., Thomas, C., Jenkins, J., Hasson, A.,
Annon, J., Saxon, A., Selzer, J., Boverman, J., Bilangi, R. (2009).
The aim of this study was to compare the effects of a short
or long taper schedule after buprenorphine stabilization on
participant outcomes as measured by opioid-free urine tests at
the end of each taper period. This multi-site study, sponsored
by Clinical Trials Network (CTN, a branch of the US National
Institute on Drug Abuse) was conducted from 2003 to 2005
to compare taper conditions at 7 and 28 days. Data were
collected at weekly clinic visits to the end of the taper periods,
and at 1-month and 3-month post-taper follow-up visits. Eleven
out-patient treatment programs in 10 US cities. Non-blinded
dosing with Suboxone® during the 1-month stabilization phase
included 3 weeks of flexible dosing as determined appropriate
by the study physicians. A fixed dose was required for the final
week before beginning the taper phase. At the end of the taper,
44% of the 7-day taper group (n = 255) provided opioid-free
urine specimens compared to 30% of the 28-day taper group (n
= 261; P = 0.0007). There were no differences at the 1-month
and 3-month follow-ups (7-day = 18% and 12%; 28-day = 18%
and 13%, 1 month and 3 months, respectively). For individuals
terminating buprenorphine pharmacotherapy for opioid
dependence, there appears to be no advantage in prolonging
the duration of taper.
Correlates of alcohol use
among methadone-maintained
adults.
Drug and Alcohol Dependence, 101: 124–127. Nyamathia, A.,
Cohenb, A., Marfiseec, M., Shoptawd, S., Greengolde, B., de Castroe,
V., Georgef, D., & Leakeg, B. (2009).
This prospective study (n = 190) examined correlates of
alcohol use from baseline data of a longitudinal trial conducted
among moderate and heavy alcohol users receiving methadone
maintenance therapy (MMT). The sample included MMT clients
who were 18–55 years of age, and were receiving MMT from five
large methadone maintenance clinics in the Los Angeles area.
Half of the sample was heavy drinkers and nearly half (46%)
reported heroin use. Using a structured questionnaire, correlates
10
of heavy alcohol use included White and Hispanic ethnicity,
and fair or poor physical health combined with older age (≥50
years).We also found that MMT clients who were younger than
50 years, regardless of health status, were more likely to be
heavy drinkers. Compared with moderate alcohol consumers, a
greater number of heavy alcohol users also experienced recent
victimization. To optimize MMT, alcohol screening should be part
of routine assessment and alcohol treatment should be made
available within MMT programs. Moreover, special consideration
should be provided to the most vulnerable clients, such as the
younger user, those with a long-term and current history of
heavy drug use, and those victimized and reporting fair or poor
health. In addition, promoting attention to general physical and
mental health problems within MMT programs may be beneficial
in enhancing health outcomes of this population.
Neighborhood smoking norms
modify the relation between
collective efficacy and
smoking behavior.
Drug and Alcohol Dependence, 100: 138–145. Ahern, J., Galea,
S., Hubbard, A., & Syme, SL. (2009).
Using data from the 2005 New York Social Environment Study
(n = 4000), the authors examined the separate and combined
associations of neighborhood collective efficacy and anti-
smoking norms with individual smoking. The outcome was
current smoking, assessed using the World Mental Health
Comprehensive International Diagnostic Interview (WMH-CIDI)
tobacco module. Exposures of interest were neighborhood
collective efficacy, measured as the average neighborhood
response on a well established scale, and neighborhood anti-
smoking norms, measured as the proportion of residents
who believed regular smoking was unacceptable. All analyses
adjusted for demographic and socioeconomic characteristics,
as well as history of smoking prior to residence in the current
neighborhood, individual perception of smoking level in the
neighborhood, individual perception of collective efficacy, and
individual smoking norms. In separate generalized estimating
equation logistic regression models, neighborhood collective
efficacy was not associated with smoking (OR 1.06, 95% CI
0.84–1.34) but permissive neighborhood smoking norms were
associated with more smoking (OR 1.34, 95% CI 1.03–1.74),
particularly among residents with no prior history of smoking
(OR 2.88, 95% CI 1.92–4.30). When considered in combination,
where smoking norms were permissive, higher collective
efficacy was associated with more smoking; in contrast, where
norms were strongly anti-smoking, higher collective efficacy
was associated with less smoking. The authors concluded that
features of the neighborhood social environment may need
to be considered in combinations to understand their role in
shaping health and health behavior.
Caffeinated energy drinks—A
growing problem.
Drug and Alcohol Dependence, 99: 1–10. Reissig, CJ., Strain, EC.,
& Griffiths, RR. (2009).
Since the introduction of Red Bull in Austria in 1987 and in
the United States in 1997, the energy drink market has grown
exponentially. Hundreds of different brands are now marketed,
with caffeine content ranging from a modest 50 mg to an
alarming 505 mg per can or bottle. Regulation of energy drinks,
including content labeling and health warnings differs across
countries, with some of the most lax regulatory requirements
in the U.S. The absence of regulatory oversight has resulted in
aggressive marketing of energy drinks, targeted primarily toward
young males, for psychoactive, performance-enhancing and
stimulant drug effects. There are increasing reports of caffeine
intoxication from energy drinks, and it seems likely that problems
with caffeine dependence and withdrawal will also increase. In
children and adolescents who are not habitual caffeine users,
vulnerability to caffeine intoxication may be markedly increased
due to an absence of pharmacological tolerance. Genetic factors
may also contribute to an individual’s vulnerability to caffeine-
related disorders including caffeine intoxication, dependence,
and withdrawal. The combined use of caffeine and alcohol is
increasing sharply, and studies suggest that such combined use
may increase the rate of alcohol-related injury. Several studies
suggest that energy drinks may serve as a gateway to other
forms of drug dependence. Regulatory implications concerning
labeling and advertising, and the clinical implications for children
and adolescents are discussed.
Correlates of extramedical
use of OxyContin® versus
other analgesic opioids among
the US general population.
Drug and Alcohol Dependence, 99: 58–67. Silvia S. Martins, SS.,
Storr, CL., Zhuc, H., & Chilcoat, HD. (2009).
The authors examined the differences in socio-demographic and
psychiatric characteristics associated with past-year extra-medical
OxyContin® use (n = 1144) versus extra-medical other opioid
analgesics use (n = 7074). Data on opioid sources was compared
among past-month users. They also compared extra-medical
opioid users (n = 8218) versus other drug users (n = 16,214), and
individuals with an analgesic disorder who had past-year extra-
medical OxyContin® use (n = 339) versus those with other opioid
use (n = 820). Past-year opioid users were more likely than users of
other illegal drugs to be more educated and have a past-year major
depressive episode. Past-year OxyContin® users were more likely
than other opioid users to be 18–25 years old (OR = 1.9[1.1,3.2]),
and have mental health and deviant behavior problems. Those with
past-year analgesic disorder who used OxyContin® were more
likely to be younger, sell illegal drugs (OR = 2.5[1.5,4.2]), and
use illegal drugs than those who used other opioids. Past-month
OxyContin® users were more likely than past-month other opioid
users to buy analgesics from drug dealers/other strangers and
obtain opioid analgesics from multiple sources. Such findings point
out differences between OxyContin® and other opioid users that
might help prevention specialists and assist efforts to curb opioid
analgesics diversion.
The prevalence of childhood
trauma among those seeking
buprenorphine treatment.
Journal of Addictive Diseases, 28:64–67. Sansone, RA., Whitecar,
P., & Wiederman, MW. (2009).
In this study, the authors examined the prevalence of five
types of childhood trauma among a sample of adult patients
who were addicted to opioids and seeking treatment with
buprenorphine. Using a survey methodology, the authors
examined a consecutive sample of 113 participants and found
that 20.4% reported having experienced sexual abuse, 39.8%
reported having experienced physical abuse, 60.2% reported
having experienced emotional abuse, 23.0% reported having
experienced physical neglect, and 65.5% reported having
witnessed violence. Only 19.5% of the sample denied having
experienced any of the five forms of childhood trauma. Most
respondents (60.2%) reported having experienced one, or
two, or three different forms of childhood trauma. A minority
reported having experienced four (13.3%) or all five (7.1%)
forms of childhood trauma. These data indicate that among
individuals with opioid dependence who are seeking treatment
with buprenorphine, the prevalence rates of various types of
childhood trauma are quite high.
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 CSAM BOARD OF DIRECTORS
President, Dr. Don Ling
Past-President, Dr. Frank Evans
Secretary/Treasurer, Dr. David Marsh
BC Regional Director, Dr. Garth McIver
Alberta Regional Director, Dr. Ron Lim
Saskatchewan Regional Director, Dr. Brian Fern
Manitoba Regional Director, Dr. Hannah Hulsbosch
Nova Scotia Regional Director, Dr. John Fraser
Ontario Regional Director, Dr. Jeff Daiter
Ontario Regional Director, Dr. Sharon Cirone
Quebec Regional Director, Dr. Charles Mackay
Quebec Regional Director, Dr. David Luckow
New Brunswick Regional Director, Dr. Linda Hudson
Member-at-Large, Dr. Michael Varenbut

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CONTINUING EDUCATIONAL OPPORTUNITIES

1. The joint CSAM/ISAM meeting will be held in Calgary, September 23 to 27, 2009. For additional information, please visit: www.csam.org or
www.isamweb.org. The deadline for Abstracts is May 15, 2009. For the call for abstracts, visit www.csam.org.

2. The College of Physicians and Surgeons of Ontario will host its Annual Methadone Prescribers Conference in Toronto on November 6, 2009.
This event is aimed at physicians who currently hold an exemption to prescribe methadone for the treatment of opioid dependence and who are
currently providing methadone maintenance treatments to patients.

The deadline to submit an abstract is June 1, 2009. For the call for abstracts, visit www.csam.org. For additional questions regarding the conference,
call 416-967-2600, ext 307 or email kbrown@cpso.on.ca. Registration details and materials will be made available at a later point.

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