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Objectives: Stimulants are a class of drugs approved for the treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy. However, they are also often used “off-label” as adjunct therapies for the treatment of obesity and depression. The objective of this study is to summarize how stimulant use is globally measured in the literature and to explore rates of stimulant use in Alberta, Canada. Methods: A traditional narrative literature review was conducted to summarize global methods of stimulant assessment. Then using definitions guided by the literature and current regulatory bodies in Alberta, we conducted a series of descriptive analyses to assess how frequent stimulant use was in Alberta patients from 2019 to 2021: 1) number of dispenses by year; 2) average days of drug supply; 3) proportion of days covered (PDC); and 4) defined daily dose (DDDs). Results: In the literature review, the most frequently used measures of stimulant drug use were trends over time (prevalence), types of drug use, and dispensations of prescriptions. In all, there is a global trend of increased use of stimulants among both adults and children. In Alberta, 173,789 patients were prescribed stimulant medication in 2019–2021, representing approximately 4 % of the entire Alberta population. Overall, 61.1 % were between the ages of 10–34 and 46.8 % were female. The number of dispensations rose from 713,896 in 2019 to 973,930 in 2021 – with up to 43 % being lisdexamfetamine stimulant dispenses. Conclusions: Although stimulant use in AB was measured using similar trend estimates as the literature, there is a lack of research to support whether these measures are accurate and effective at the population-level. Future steps to standardize both medical and nonmedical use of prescription stimulants are warranted in efforts to fully quantify both benefits and risks associated with stimulant use.

Abstract Background Benzodiazepines are a class of medications that are being frequently prescribed in Canada but carry significant risk of harm. There has been increasing clinical interest on the potential “sparing effects” of medical cannabis as one strategy to reduce benzodiazepine use. The objective of this study as to examine the association of medical cannabis authorization with benzodiazepine usage between 2013 and 2021 in Alberta, Canada. Methods A propensity score matched cohort study with patients on regular benzodiazepine treatment authorized to use medical cannabis compared to controls who do not have authorization for medical cannabis. A total of 9690 medically authorized cannabis patients were matched to controls. To assess the effect of medical cannabis use on daily average diazepam equivalence (DDE), interrupted time series (ITS) analysis was used to assess the change in the trend of DDE in the 12 months before and 12 months after the authorization of medical cannabis. Results Over the follow-up period after medical cannabis authorization, there was no overall change in the DDE use in authorized medical cannabis patients compared to matched controls (− 0.08 DDE, 95% CI: − 0.41 to 0.24). Likewise, the sensitivity analysis showed that, among patients consuming ≤5 mg baseline DDE, there was no change immediately after medical cannabis authorization compared to controls (level change, − 0.04 DDE, 95% CI: − 0.12 to 0.03) per patient as well as in the month-to-month trend change (0.002 DDE, 95% CI: − 0.009 to 0.12) per patient was noted. Conclusions This short-term study found that medical cannabis authorization had minimal effects on benzodiazepine use. Our findings may contribute ongoing evidence for clinicians regarding the potential impact of medical cannabis to reduce benzodiazepine use. Highlights • Medical cannabis authorization had little to no effect on benzodiazepine usage among patients prescribed regular benzodiazepine treatment in Alberta, Canada. • Further clinical research is needed to investigate the potential impact of medical cannabis as an alternative to benzodiazepine medication.

Abstract Objective: To describe utilization of at-home coronavirus disease 2019 (COVID-19) testing among healthcare workers (HCW). Design: Serial cross-sectional study. Setting and participants: HCWs in the Chicago area. Methods: Serial surveys were conducted from the Northwestern Medicine (NM HCW SARS-CoV-2) Serology Cohort Study. In April 2022, participants reflected on the past 30 days to complete an online survey regarding COVID-19 home testing. Surveys were repeated in June and November 2022. The percentage of completed home tests and ever-positive tests were reported. Multivariable Poisson regression was used to calculate prevalence rate ratios (PRR) and univariate analysis was used for association between participant characteristics with home testing and positivity. Results: Overall, 2,226 (62.4%) of 3,569 responded to the survey in April. Home testing was reported by 26.6% of respondents and 5.9% reported having at least one positive home test. Testing was highest among those 30–39 years old (35.9%) and nurses (28.3%). A positive test was associated (P < .001) with exposure to people, other than patients with known or suspected COVID-19. Home testing increased in June to 36.4% (positivity 19.9%) and decreased to 25% (positivity 13.5%) by November. Conclusion: Our cohort findings show the overall increase in both home testing and ever positivity from April to November – a period where changes in variants of concern of SARS-CoV-2 were reported nationwide. Having an exposure to people, other than patients with known or suspected COVID-19 was significantly associated with both, higher home testing frequency and ever-test positivity.