Latest news with #OAT
Medscape
14-07-2025
- Health
- Medscape
Are Opioid Agonist Treatments Effective in the Fentanyl Era?
Opioid agonist treatments (OATs) such as methadone and buprenorphine-naloxone are standard therapy for opioid use disorder, but treatment duration is decreasing as fentanyl becomes more prevalent in the illicit opioid supply. Given that retention in OAT is a core measurement of treatment effectiveness, the finding underscores the urgent need for research and policy changes, according to a population-based, retrospective cohort analysis from Ontario. Illicit opioids in Canada now contain more fentanyl than before. In 2022, almost 70% of opioid samples submitted for analysis in Canada contained fentanyl or fentanyl analogs. 'Fentanyl is substantially more potent than the prescription opioids and heroin that were previously most commonly used, and the fentanyl available today often has other substances mixed in,' study author Robert Kleinman, MD, told Medscape Medical News. 'We were interested in investigating these changes because many patients report that methadone and buprenorphine-naloxone are not as effective for them as they were before the fentanyl era.' Kleinman is a scientist at the Institute for Mental Health Policy Research within the Centre for Addiction and Mental Health and an assistant professor of psychiatry at the University of Toronto, Toronto. The article was published online on July 1 in JAMA Network Open . Differences by Treatment The researchers compared the duration of methadone and buprenorphine-naloxone treatment during 2014-2016 (before fentanyl was common), 2017-2019 (as fentanyl was becoming more common), and 2020-2022 (the 'fentanyl era'). The population included 72,717 patients who were at least 15 years old and who began OAT during those periods. A total of 45,256 (62.2%) participants were men, and the population's median age was 35 years. In all, 34,538 patients (47.5%) received methadone, and 38,179 (52.5%) received buprenorphine-naloxone. Administrative data were obtained from ICES, an independent nonprofit research institute in Ontario. The data contained demographic information, as well as information about outpatient methadone and buprenorphine-naloxone dispensation, including dispensing dates and number of take-home doses supplied. The median duration for methadone use was 193 days in the 2014 to 2016 period, dropping to 86 days in 2020 to 2022. Patients who started methadone in later periods were more likely to stop treatment sooner. The risk for stopping methadone was higher among patients whose treatment was initiated in 2017-2019 (adjusted hazard ratio [aHR], 1.18; P < .001) and yet higher for those who started in 2020-2022 (aHR, 1.45; P < .001). Buprenorphine-naloxone treatment duration decreased from 51 days during 2014-2016 to 38 days during 2020-2022. Patients who initiated buprenorphine-naloxone during 2020-2022 had a higher risk for discontinuation (aHR, 1.11; P < .001). It was unclear why methadone treatment duration decreased more prominently than did buprenorphine-naloxone treatment, according to the researchers. Treatment was more likely to be discontinued early among younger individuals, particularly those aged 15-24 years. Other factors associated with early discontinuation included rurality, lower neighborhood income, and comorbidities. 'Opioid agonist treatments remain the most effective treatments for opioid use disorder, including for people using fentanyl,' Kleinman said. 'However, this study suggests that the effectiveness of the treatments may be lower than they were in the past. There are new approaches to providing these that either have been or are being developed, and research is continuing to evaluate these approaches among patients using fentanyl.' 'Compelling Data' One of the study's limitations was that its source of data does not capture OAT dispensed in hospitals, long-term care homes, or prisons. Also, since the information was obtained through ICES databases, individuals who began OAT outside Ontario were not included in the analysis. Other individuals, such as members of the Indigenous population, may receive OAT through federal benefits and would also be excluded from the analysis. Commenting on the study for Medscape Medical News , addiction medicine specialist Ryan Marino, MD, associate professor at the CWRU School of Medicine at Case Western Reserve University, Cleveland, said, 'These researchers have compelling data to show that there has been a significant decrease in the duration of time people are in treatment. I think the biggest takeaway is that we should really be wondering why. '[This] isn't something that anyone was expecting to see, at least such a dramatic difference. Hopefully this will promote more investigation.' The Centre for Addiction and Mental Health Discovery Fund, the Centre for Addiction and Mental Health Foundation, the Rangerman RAPID Lab, and the University of Toronto Department of Psychiatry Academic Scholar Award funded this study. Kleinman and Marino reported having no relevant financial relationships.
USA Today
24-06-2025
- USA Today
5 questions you should always ask before booking any guided tour
Booking a tour is equal parts exciting and nerve wracking. Tours aren't just a financial investment, they're also a vacation time commitment. That's why it's important to make sure you're choosing both the right trip and the right tour company before you take the plunge. As you're planning your next tour, take the time to ask yourself the following five questions, which will help you book confidently when you find your dream trip. BEST OF THE BEST: 15 best group travel companies for guided tours around the world 1. What's my idea of a perfect tour? Before you get concrete and start researching specific tours and itineraries, spend some time daydreaming about what a perfect tour would look like. The point of this exercise isn't to set your expectations up for perfection (that's never a good plan when it comes to travel), it's to give yourself a structure that will allow you to figure out what's most important to you. SOLO TRAVEL TOGETHER: 10 best tour companies for solo travel worldwide When you imagine the perfect tour, is it in a small group or large? Are you non-stop sightseeing, lingering over elaborate meals, or mixing group activities with independent time to explore on your own? Since there really are so many types of Europe tours, for example, taking the time to tap into your essential hopes about a trip is an incredibly useful way to guide your research. 2. What's my pace? This is a big one and will make or break your experience. You'll have the best time if you match your preferred pace to the right tour, since tours vary drastically in how fast-moving and physically demanding they can be. Do you want to pack as much into every waking moment as you possibly can? Are you up for long walks and activities like bike riding? Do you prefer to go on one shorter outing a day, and maybe spend more time just sitting and soaking up the scenery? TOURS FOR SENIORS: 8 best tour companies for senior travelers worldwide When you're looking at the pace of tours, you'll need to check on two aspects. Most tour companies rate the physical activity of tours; for instance, Road Scholar sorts its tours by activity level, and OAT has a detailed Physical Requirements section for each tour that outlines the general pace. The other thing to note is how many activities and how much moving around is scheduled into the days. Most tours are geared toward people who want to do and see a lot, so if you prefer a mellower pace, consider an option like a river cruise (where you can stay on the ship and relax if you want to opt out of an activity), a tour such as a Smithsonian Cultural Stay that uses a city as its home base so you're not moving from place to place, or simply a tour that is specifically less active like Road Scholar's At a Slower Pace tours. 3. What are my priorities? As the tour industry has grown over the last decade, tour companies have become increasingly creative about the tours they offer. There are still plenty of coach tours that hit the biggest sites in a country, but there are also tours that take a different approach. You can find off-the-beaten path tours (great if you've already been somewhere and want to go a little deeper), culinary tours that highlight the food and cooking of a region (and often include cooking classes along the way), and tours that focus on a particular lens such as history or nature. FOODIE FAVORITES: The best tour companies for culinary tour worldwide Before you default to traditional sightseeing, think about what you actually want out of a visit to a destination. Would it mean more to you to see a rare bird than a famous museum? If it does, you know it's time to adjust your search. 4. What are my specific needs and limitations? This ties in a lot with the questions you've already answered above, but for anyone with a medical condition, a physical challenge, or a cognitive impairment (or anyone traveling with someone with any of these), you'll need to honestly assess each option through the lens of: Will it bring me joy? And, can I actually do this? WALK IN COMFORT: How to choose the best walking shoes for travel Pushing yourself a bit is part of travel, but only to a certain extent. After a point, you move from rising to a challenge to finding yourself in potentially dangerous territory. Answering this question is something that only you (sometimes with the help of a loved one or medical professional) can answer, and it will help you find the right tour experience for you right now. 5. What tour companies do I feel confident booking with? You want to be sure you're signing up with a company you can trust with your money, your safety, and your travel experience. Inspired by questions from TourScoop readers, we regularly profile trustworthy tour companies. (This is an ongoing project for us, so if you don't see a particular tour company it doesn't mean they're not credible, simply that we haven't gotten to profiling them yet!). EASY RESEARCH: Read our reviews of the world's top tour companies Other ways of choosing a tour company you feel comfortable with include asking friends and families what tour companies they've been happy with, and looking at a tour company's rating on a site like Feefo or, if they're accredited by the BBB, their accreditation score. The 5 questions you should always ask before booking any guided tour originally appeared on More from TourScoop: The views and opinions expressed in this column are the author's and do not necessarily reflect those of USA TODAY. and are owned and operated by Vacationist Media LLC. Using the FamilyVacationist travel recommendation methodology, we review and select family vacation ideas, family vacation spots, all-inclusive family resorts, and classic family vacations for all ages. TourScoop covers guided group tours and tour operators, tour operator reviews, tour itinerary reviews and travel gear recommendations. If you buy an item through a link in our content, we may earn a commission.
Time Out
05-06-2025
- Entertainment
- Time Out
101 Dalmatians
This review is from 101 Dalmatians' original 2022 run at the Open Air Theatre. It returns to the Hammersmith Apollo for a summer 2025 run starring Sydnie Christmas as Cruella de Vil. Adapted direct from Dodie Smith's 1956 kids' book – ie, absolute not a Disney production – '101 Dalmatians' is a scrappy affair. It's the first ever original musical from the Regent's Park Open Air Theatre, and it boasts charming puppetry, big-name writers and a scream of a turn from Kate Fleetwood as the evil Cruella de Vil. But by the towering standards of the OAT – known for its revelatory musical revivals – it's pretty uneven. If you just view it as a fun kids' show, you'd be more forgiving. In fact, I was pretty forgiving: I skipped press night and took my children the following afternoon. However, I wouldn't say it's really been pushed as a show for youngsters: historically the OAT's musicals are aimed at an adult audience, the evening finish is certainly too late for my children, and the foregrounding of Fleetwood's villainous Cruella de Vil in the publicity recalls Disney's more adult-orientated spin-off film of last year ('Cruella'). Anyway: my kids had fun at Timothy Sheader's production. I mean, it starts with a protracted bottom-sniffing scene, for crying out loud, as grown-up dalmatians Pongo (Danny Collins and Ben Thompson) and Perdi (Emma Lucia and Yana Penrose) meet for the first time, give each other a good honk up the backside, fall in love and nudge their bookish, introverted human owners Dominic (Eric Stroud) and Danielle (Karen Fishwick) into starting a relationship. Skip forward a bit and humans and hounds have moved in together, and the latter have produced 15 babies. Uber puppet designer and director Toby Olié's spotty pooches are proper showstoppers: Pongo and Perdi have large, mobile forebodies operated by a puppeteer and hind legs shared with the human actor who speaks their lines: Emma Lucia is particularly charming as a compassionate, north-eastern Perdi. The innumerable puppies are generally just represented by their heads… and they're jolly sweet, too. In Johnny McKnight's stage adaptation of Zinnie Harris's contemporary update, the canine idyll is punctured by the arrival of Fleetwood's De Vil, a psychopathic influencer who is, by and large, extremely funny as she self-pityingly inveigles her way into our heroes' lives, then persuades herself she absolutely must have – and deserves – a dalmatian-puppy-skin coat. With a succession of increasingly frightening fright wigs, her forever remarkable cheekbones, and some full-on panto-villain vibes, Fleetwood is an absolute joy. She's also the focal point of the most visually imaginative moments of Sheader's production: a spirited, cartoon-style attempt to use puppetry to look like her hair and arms have popped out after she swallows a dodgy potion; and most impressively, a tableau at the end of the first half where the dancers line up in formation behind her to form the giant puppyskin coat of her fantasies (there's deliciously lurid costume design from Katrina Lindsay). Lots of positives, then, but as a whole, it feels pretty all over the shop. Much as Harris has updated the story, neither she nor McKnight have solved its problems: the abrupt second-half switch of focus to a group of child actors playing a quartet of escaped puppies is tonally disorientating and lays an awful lot of pressure on some very young performers. Even taking that on the chin as a necessity of the story, there were too many moments when I struggled to work out exactly what was going on (Cruella's initial capture of Pongo and Perdi, for instance, was baffling – she seemingly only managed to abduct them from their home because a scene change happened around them). There's also simply a dearth of memorable characters beyond Cruella: Perdi is lovely, but her aside it's hard to feel especially invested in the bland good guys (beyond the obvious fact that skinning puppies is bad). And while stage legend Douglas Hodge's wordy, string-and-brass-heavy songs are pleasant and good at keeping the story ticking along, there's a lack of killer tunes that might have compensated for other shortcomings – although the joyous finale 'One Hundred and One' is a keeper. My kids didn't care about any of this: they enjoyed two hours of a lighthearted good vs evil yarn with some cool puppets and a boo-hissable villain. They didn't worry about the merits of '101 Dalmatians' as a musical for the ages. And if you can take the same attitude, you'll have a blast, or at least you'll have a blast in the good bits. But ultimately the Open Air Theatre is one of the best musical theatre venues in London, and by its own extremely lofty standards, '101 Dalmatians' is a bit of a dog's dinner.
CBC
04-06-2025
- Health
- CBC
Sask. auditor's latest report urges action on opioid crisis, transitional housing
The latest report from Saskatchewan's provincial auditor outlines concerns around the growing opioid crisis, transitional housing for victims in interpersonal violence and oversight of school divisions. Tara Clemett spoke about her findings at a news conference Tuesday. Clemett pointed to the rise in drug toxicity deaths across the province due to the prevalent use of substances like fentanyl. She said people trying to get into outpatient treatment programs including Opioid Agonist Therapy (OAT) and Rapid Access to Addictions Medicine (RAAM) — directly operated by the Saskatchewan Health Authority (SHA) — are having to wait. According to a release from the Clemett's office, patients seeking treatment waited an average of four days in Kamsack, nearly five days in Saskatoon and just over a day in Regina. Good practice recommends clients wait no more than three days, the release added. "When we did our own testing, we did find Saskatoon and Kamsack are not necessarily hitting good practice in terms of someone coming to seek help from a prescriber and seeing them within three days," Clemett said. "The authority needs that information so it can make decisions and know where there might be gaps." Clemett also found Lloydminster and Estevan, which don't have OAT programs, saw local increases in drug toxicity deaths from 2022 to 2024 over previous periods. Clemett recommended that the SHA implement a centralized IT system and centralized standards to work toward more accessible treatment services. "Ultimately, you would hope that would have a positive impact when it does come to them being able to live," she said. School division safeguards Clemett also found financial discrepancies within the education system. She said 19 of 27 school divisions should have more financial safeguards in place, especially when it comes to journal entries and electronic fund transfers. Many schools across the province allow one person to oversee all financial records, increasing the chance for error or hidden information, Clemett said. "We would always want those to be independently reviewed and approved," she said. The report also pointed out that 14 independent religious schools in Saskatchewan do not require certified teachers. She questioned if students enrolled in these independent schools are getting an effective education. "From our perspective, in the event that the ministry is going to allow these schools to have teachers that aren't necessarily certified, they should be doing a better job of monitoring overall student achievement," Clemett said. Transitional housing Transitional housing for interpersonal violence victims was also top of mind for Clemett on Tuesday. Saskatchewan has one of the highest rates of intimate partner violence in the country, her report says. While there is transitional housing across the province, the funding varies from one house to the next. Clemett said the government has no substantial reasoning as to why one transition house may receive more funding than another. She referred to Regina and Swift Current, which each have funded transition houses with equal bed numbers, but funding differed by more than $200,000 in 2024–25. "There is a limited pot of money here in terms of what can go around, to some degree, to transition space," Clemett said. "So you just want to make sure that you're probably providing the money to the right facilities that really need the help, so that they can serve the people that are looking for safe shelter." The province's Opposition NDP also made its concerns about the auditor's findings known Tuesday. Meara Conway, NDP deputy House Leader and critic for rural and remote health, and ethics and democracy, reiterated the issues around interpersonal violence and lack of access to services in the midst of the province's opioid crisis. She said there is a lack of access to methadone, which increases the likelihood of opioid relapse and deters people from treatment. There is also a lack of information for the vulnerable when it comes to accessing treatment and shelters, Conway said. "We'll continue to see the drug crisis get worse because we have a government that has continuously politicized this crisis instead of roll up their sleeves, meet people where they're at and, you know, provide a range of services where and when people need them."
Time Out
02-05-2025
- Entertainment
- Time Out
The best open air theatre shows to see in London this summer
I'm Andrzej, the theatre editor at Time Out, and as I type this we're having a balmy early May and nothing on the planet seems as wonderful as the London open air theatre season, which has just begun. Obviously it's not going to last, but open air season is – as much as anything else – an annual act of defiance of the English weather, and there's nothing wrong with that. Here's my pick of the most exciting open air shows to see this season, which starts now and runs on until basically the end of October Funniest show: Shucked Timothy Sheader was one of London's longest-serving artistic directors, having run the Regent's Park Open Air Theatre – on the whole, brilliantly – for 18 years until he surprisingly went off to the Donmar last year. As far as it's possible to tell from a single summer season, Drew McOnie has not tinkered heavily with the OAT's musicals-heavy formula, but he has got one hell of a musical to open his season. Shucked is a heavyweight Broadway smash that one would have probably expected to go into the West End (and it might still do so). But instead it opens McOnie's tenure at the OAT. Apparently it is very, very funny, a story of corn-loving hillbillies who venture into the big city for the first time after their corn harvest fails. Open Air Theatre, May 10-Jun 14. Book tickets here. Heaviest show: The Crucible The Shakespeare's Globe outdoor season is always pretty damn reliable and while there are a couple of more outre choices for 2025 – Troilus and Cressida, anyone? – you can take my word for it that the whole thing looks like a safe bet. The big point of interest this summer is Ola Ince's revival of Arthur Miller's all time American classic The Crucible – I believe I'm right in saying that there has never been either an American play or a twentieth century play staged there. But with its epic scope, shadings of the magical and close-to-Shakespeare's-day setting, The Crucible feels like a fit so perfect it's incredible it hasn't been done before. Shakespeare in the Squares feels like the sort of concept that should be a decades-old London tradition, but in fact the company has only been around since 2016. The concept is pretty simple: each year the company tours a Shakespeare play around London's most charming garden squares (plus a few other outside spaces so it's not purely a tour of west London, although if you've ever wanted to hit up a posh west London square, this is your chance). And the Shakespeare is decent: none of the big names of the Globe or RSC and the productions are usually somewhat truncated, but thoughtful takes nonetheless. Which should stand them in good stead for this summer's pop hit-drenched take on The Taming of the Shrew, a deeply problematic play that can nonetheless be a lot of fun if approached smartly. Various locations, Jun 4-Jul 12. Most fabulous: West End Live There is nothing else in the UK quite like this enormous free festival of musical theatre, which takes over Trafalgar Square for a weekend every June. The deal is pretty simple: for two days the casts of a load of musicals sing a handful of their greatest hits, and while it's clearly not the same thing as getting a full show, it's a hell of a lot of incredible songs. A word to the wise: a lot of the biggest shows pile their West End Live slots in before their 2.30pm Saturday matinees and the crowd area can hit capacity very quickly at this time. Trafalgar Square, Jun 21 and 22. Best for families: Theatre on Kew Kew Gardens has a longstanding theatrical partnership with the Australian Shakespeare Company, which is a bit odd when you're first presented with it but kind of makes sense insofar as the ASC has a repertoire of all-ages open-air shows ready to go and appears to be happy to decamp to west London during the notoriously harsh Australian winters. It's one of the best spots in London to go for family open-air theatre, not least because your ticket to the show gets you general entry to Kew. This year's kids shows are The Dream Fairies (for little ones) and Alice in Wonderland (for bigger ones), or for an ultra atmospheric bit of more adult theatre there's Macbeth, which should be pretty amazing as darkness falls. Kew Gardens, Jul 18-Aug 31. Sadly not happening: River Stage A bit of a PSA here – the National Theatre has 'paused' its outdoor River Stage weekenders. This is a big shame, although the NT has a new leader (Indhu Rubasingham) who has only just got her feet under the table, but hopefully she'll come up with something next summer. Most spectacular: Greenwich + Docklands International Festival From simulations of the Northern Lights to a bus journey musing on the life of Stephen Lawrence, GDIF has been hugely on form in recent years as the largely free festival of street theatre – which has increasingly embraced spectacular installations post-pandemic – has drifted into a late summer slot. So late, in fact, that we don't have a line up or official dates yet. But expect it to be late August into early September, and also bloody spectacular.
