Literature Collection

The majority of research and policy directives targeting opioid use and overdose prevention are based in larger urban settings and not easily adaptable to smaller Canadian settings (i.e., small- to mid-sized cities and rural areas). We identify a variety of research and policy gaps in smaller settings, including limited access to supervised consumption services, safer supply and novel opioid agonist therapy programs, as well as housing-based services and supports. Additionally, we identify the need for novel strategies to improve healthcare access and health outcomes in a more equitable way for people who use drugs, including virtual opioid agonist therapy clinics, episodic overdose prevention services, and housing-based harm reduction programs that are better suited for smaller settings. These programs should be coupled with rigorous evaluation, in order to understand the unique factors that shape overdose risk, opioid use, and service uptake in smaller Canadian settings.

The integration of a telepsychiatry application into an inner-city community mental health service was evaluated over 10 months. ISDN videoconferencing at 128 kbit/s was employed for psychiatric consultation between a primary care centre and a community mental health centre. A convenience sample of patients and referrals seen by videoconferencing was compared with a sample seen face to face. During the study period 19 patients were managed by videoconferencing and 12 face to face. There were 162 consultations, comprising 81 prearranged teleconsultations and 81 prearranged face-to-face consultations. There was no significant difference in attendance between videoconferencing and face-to-face consultations. Nine of the videoconferencing new referrals had not completed their treatment at the end of the study period, compared with only three in the face-to-face group. This implies that it takes longer to complete treatment for new referrals managed by videoconferencing.