Problematic substance use or problematic substance use policies?

Abstract

This special issue on substance use issues comes at a critical time for Canadian health policy makers and researchers. Most attention is currently focussed on the opioid crisis and the potential impacts of cannabis legalization. However, our most widely used and harmful substances continue to be alcohol and nicotine. Our policies to reduce harms from these substances are failing. While alcohol control policies are being gradually abandoned, opportunities to maximize the harm reduction potential of new, alternative and safer nicotine delivery devices are not being grasped. More generally, a greater focus is needed on harm reduction strategies that are informed by the experience of marginalized people with severe substance use-related problems so as to not exacerbate health inequities. In order to better inform policy responses, we recommend innovative approaches to monitoring and surveillance that maximize the use of multiple data sources, such as those used in the Canadian Substance Use Costs and Harms (CSUCH) project. Greater attention to precision in defining patterns of risky use and harms is also needed to support policies that more accurately reflect and respond to actual levels of substance use-related harm in Canadian society.

Invited Expert Opinion- Bio-informatic and Limitation Di-rectives to Help Adopt Ge-netic Addiction Risk Screening and Identify Preaddictive Reward Dysregulation: Re-quired Analytic Evidence to Induce Dopamine Homeo-statsis

“…Neurologically, MAT may induce persistent changes that compromise endorphin, dopamine, and multiple brain systems. While chronic use of agonist therapies may be necessary in the absence of other options, there is limited data on chronic vs. acute use harm reduction [ 11 , 12 ]. However, there is evidence that treatments themselves, like long-term agonist treatments for opioid use disorder (OUD), may also cause Reward Deficiency Syndrome (RDS) [ 13 ], which is a breakdown of reward neurotransmission that causes a broad range of addictive, impulsive, and compulsive behaviors.…”