Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy

Objective: The objective of this study was to evaluate epidemiological trends of co-use patterns of amphetamine-type stimulants and opioids and the impact of co-use patterns on Opioid Agonist Treatment (OAT) retention in Ontario, Canada. The secondary objective was to assess geographical variation in amphetamine-type stimulant use in Northern Rural, Northern Urban, Southern Rural and Southern Urban Areas of Ontario.Methods: A retrospective cohort study on 32,674 adults receiving OAT from ~70 clinics was conducted between January 1, 2014, and December 31, 2020, in Ontario, Canada. Patients were divided into four groups base on the proportion of positive urine drug screening results for amphetamine-type stimulants during treatment: group 1 (0–25%), group 2 (25–50%), group 3 (50–75%), and groups 4 (75–100%). A Fractional logistic regression model was used to evaluate differences over time in amphetamine-type stimulant use with urine drug screening results. A Cox Proportional Hazard Ratio model was used to calculate the impact of amphetamine-type stimulant use on retention in OAT and adjusted for sociodemographic characteristics, drug use and clinical factors. Lastly, a logistic regression model was used on a subgroup of patients to assess the impact of geography on amphetamine-type stimulant use in Northern Rural, Northern Urban, Southern Rural and Southern Urban Areas of Ontario.Results: There were significant differences in amphetamine-type stimulant positive urine drug screening results year-over-year from 2015 to 2020. Significant differences were observed between amphetamine-type stimulant groups with regards to sociodemographic, clinical and drug use factors. Compared to those with no amphetamine-type stimulant use, the number of days retained in OAT treatment for amphetamine-type stimulant users was reduced (hazard ratio 1.19; 95% confidence interval = 1.07–1.17; p < 0.001). Lastly, an adjusted logistic regression model showed a significant increase in the likelihood of amphetamine-type stimulant use in Northern Rural regions compared to Southern Urban areas.Conclusion: There was a significant increase in amphetamine-type stimulant use among individuals in OAT from 2014 to 2020, associated with decreased OAT retention. Research is required to determine if tailored strategies specific to individuals in OAT who use amphetamine-type stimulants can improve OAT outcomes.

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Measuring Treatment Attrition at Various Stages of Engagement in Opioid Agonist Treatment in Ontario Canada Using a Cascade of Care Framework

10.21203/rs.3.rs-1170954/v1 ◽

2022 ◽

Author(s):

Farah Tahsin ◽

Kristen A. Morin ◽

Frank Vojtesek ◽

David C. Marsh

Keyword(s):

Drug Screening ◽

Urban Areas ◽

Primary Objective ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

Rural And Urban Areas ◽

Urine Drug ◽

Cascade Of Care ◽

The Impact ◽

Urine Drug Screening

Abstract Background The cascade of care framework is an effective way to measure attrition at various stages of engagement in Opioid Agonist Treatment (OAT). The primary objective of the study was to describe the cascade of care for individuals who have accessed OAT from a network of specialized addiction clinics in Ontario, Canada. The secondary objectives were to evaluate correlates associated with retention in OAT at various stages and the impact of patients' location of the residence on retention in OAT. Design: A multi-clinic retrospective cohort study was conducted using electronic medical record (EMR) data from the largest network of OAT clinics in Canada (70 clinics) from 2014-2020. Study participants included all individuals who received OAT from the network of clinics during the study period. Measurements: In this study, four stages of the cascade of care framework were operationalized to identify treatment engagement patterns, including patients retained within 90 days, 90 to 365 days, one to two years, and more than two years. Correlates associated with OAT retention for 90 days, 90 to 365 days, one to two years, and more than two years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 individuals were included in the study. Compared to individuals who were retained in OAT for 90 days, individuals who were retained for 90 to 365 days, one to two years, or more than two years were more likely to have a higher number of treatment attempts, a higher number of average monthly urine drug screening and a lower proportion of positive urine drug screening results for other drug use. Conclusion Distinct sociodemographic and clinical factors are likely to influence treatment retention at various stages of engagement along the OAT continuum. Research is required to determine if tailored strategies specific to people at different stages of engagement have the potential to improve outcomes of OAT.

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Large Variation in Provincial Guidelines for Urine Drug Screening During Opioid Agonist Treatment in Canada

The Canadian Journal of Addiction ◽

10.1097/cxa.0000000000000015 ◽

2018 ◽

Vol 9 (2) ◽

pp. 6-9 ◽

Cited By ~ 1

Author(s):

Eloise Moss ◽

Jasmine McEachern ◽

Lauren Adye-White ◽

Kelsey C. Priest ◽

Lauren Gorfinkel ◽

...

Keyword(s):

Drug Screening ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

Urine Drug ◽

Urine Drug Screening

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Opioid agonist therapy uptake among people who inject drugs: The findings of two consecutive bio-behavioral surveillance surveys in Iran

10.21203/rs.3.rs-24098/v2 ◽

2020 ◽

Author(s):

Mehran Nakhaeizadeh ◽

Zahra Abdolahiniya ◽

Hamid Sharifi ◽

Ali Mirzazadeh ◽

Mostafa Shokoohi ◽

...

Keyword(s):

Health Outcomes ◽

Harm Reduction ◽

People Who Inject Drugs ◽

World Health ◽

Agonist Therapy ◽

Opioid Agonist ◽

Behavioral Surveillance ◽

Opioid Agonist Therapy ◽

Opioid Drugs ◽

History Of

Abstract Background Opioid agonist therapy (OAT) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OAT uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran.Methods Data were obtained from two national bio-behavioral surveillance surveys (N2010 = 1,783 and N2014 = 2,166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression models were built to determine the correlates of OAT uptake for the 2014 survey and adjusted odds ratios (AORs) and 95% confidence intervals (CI) were reported.Results The prevalence of OAT uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P-value = 0.033). OAT uptake varied across the studied cities ranging from 0.0%-69.3% in the 2010 survey and 3.2%-75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI: 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI: 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI: 1.08, 2.5) were associated with OAT uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI: 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI: 0. 0.51, 0.86) were less likely to uptake OAT. Conclusions Although OAT uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remains significant disparities across urban settings in Iran. Importantly, the OAT services appear to be serving high-risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes of OAT across Iran.

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