scholarly journals Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study

BMJ ◽  
2020 ◽  
pp. m772 ◽  
Author(s):  
Lindsay A Pearce ◽  
Jeong Eun Min ◽  
Micah Piske ◽  
Haoxuan Zhou ◽  
Fahmida Homayra ◽  
...  
Keyword(s):  
Relative Risk ◽  
Illicit Drug ◽  
Population Based ◽  
Opioid Use Disorder ◽  
Drug Supply ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Risk Of Mortality ◽  
Stopping Treatment

Abstract Objective To compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply. Design Population based retrospective cohort study. Setting Individual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada. Participants 55 347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018. Main outcome measures All cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply. Results 7030 (12.7%) of 55 347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk). Conclusions Retention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.

scholarly journals Opioid Agonist Treatment and Risk of Mortality During an Opioid Overdose Public Health Emergency: A Population-Based Retrospective Cohort Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Lindsay A Pearce ◽  
Jeong Eun Min ◽  
Micah Piske ◽  
Haoxuan Zhou ◽  
Fahmida Homayra ◽  
...  
Keyword(s):  
Relative Risk ◽  
Illicit Drug ◽  
Opioid Overdose ◽  
Drug Supply ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Risk Of Death ◽  
Synthetic Opioids ◽  
Risk Of Mortality ◽  
Stopping Treatment

IntroductionOpioid agonist treatment (OAT) is a safe and effective treatment for opioid use disorder (OUD). However, people commonly stop and start OAT and their risk of death is high immediately after stopping. The prevalence of illicitly manufactured fentanyl and other highly potent synthetic opioids have increased in the illicit drug supply globally. Yet, there is limited evidence examining the relationship between OAT and mortality when these contaminants are widely available in the illicit drug supply. Objectives and ApproachWe aimed to compare the risk of mortality on and off OAT in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply. We linked five health administrative datasets in British Columbia, Canada, creating a cohort of 55,347 people with OUD who received OAT during a 23-year period (1996 to 2018). We compared the risk of mortality on and off treatment over time, and according to time since starting or stopping treatment and by medication type. Results7,030 of 55,347 (12.7%) OAT recipients died during follow-up. All-cause SMR was substantially lower on OAT (4.6 [4.4 to 4.8]) compared to off OAT (9.7 [9.5 to 10.0]). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 [1.8 to 2.4] times higher than on OAT prior to the introduction of fentanyl, and increased to 3.4 [2.8 to 4.3] at the end of the study period (65% increase in relative risk). Conclusion / ImplicationsThe protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, while the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.

Multi-site intervention to improve emergency department care for patients who live with opioid use disorder: A quantitative evaluation

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 784-792 ◽  
Author(s):  
Patrick McLane ◽  
Ken Scott ◽  
Zainab Suleman ◽  
Karen Yee ◽  
Brian R. Holroyd ◽  
...  
Keyword(s):  
Emergency Department ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Emergency Department Care ◽  
Improvement Project ◽  
Health Crisis ◽  
Opioid Agonist Treatment ◽  
Before And After ◽  
Disorder Treatment

ABSTRACTBackgroundOpioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.MethodsThe intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.ResultsThe intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.ConclusionsEmergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.

scholarly journals Opioid agonist treatment and fatal overdose risk in a state‐wide US population receiving opioid use disorder services

Addiction ◽  
2020 ◽  
Vol 115 (9) ◽  
pp. 1683-1694 ◽  
Author(s):  
Noa Krawczyk ◽  
Ramin Mojtabai ◽  
Elizabeth A. Stuart ◽  
Michael Fingerhood ◽  
Deborah Agus ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Fatal Overdose

scholarly journals A Cohort Study Evaluating the Association Between Concurrent Mental Disorders, Mortality, Morbidity, and Continuous Treatment Retention for Patients in Opioid Agonist Treatment (OAT) Across Ontario, Canada Using Administrative Health Data

2020 ◽  
Author(s):  
Kristen A Morin ◽  
Joseph K Eibl ◽  
Graham Gauthier ◽  
Brian Rush ◽  
Christopher Mushquash ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Opioid Use Disorder ◽  
Treatment Retention ◽  
Continuous Treatment ◽  
Drug Benefit ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Opioid Agonist Treatment ◽  
Using Data

Abstract Background: Due to the high prevalence of mental disorders among people with opioid use disorder, the objective of this study was to determine the association between concurrent mental disorders, mortality, morbidity and continuous treatment retention for patients in opioid agonist treatment in Ontario, Canada. Methods: We conducted a retrospective cohort study of patients enrolled in opioid agonist treatment between January 1, 2011, and December 31, 2015. Patients were stratified into two groups: those diagnosed with concurrent mental disorders and opioid use disorder and those with opioid use disorder only, using data from the Ontario Health Insurance Plan Database, Ontario Drug Benefit Plan Database. The primary outcome studied was all-cause mortality using data from the Registered Persons Database. Emergency Department visits from the National Ambulatory Care Database, hospitalizations Discharge Abstract Database, and continuous retention in treatment, defined as one year of uninterrupted opioid agonist treatment using data from the Ontario Drug Benefit Plan Database, were measured as secondary outcomes. Encrypted patient identifiers were used to link information across databases.Results: We identified 55,924 individuals enrolled in opioid agonist treatment, and 87% had a concurrent mental disorder diagnosis during this period. We observed that having a mental disorder was associated with an increased likelihood of all-cause mortality (Odds Ratio (OR) 1.4; 95% Confidence Interval (CI) 1.2-1.5. For patients diagnosed with mental disorders the estimated rate of ED visits per year was 2.25 times higher and estimated rate of hospitalization per year 1.67 times higher than for patients with no mental disorders. However, there was no association between having a diagnosis of a mental disorder and one-year treatment retention in OAT adjusted Hazard Ratio (HR) = 1.0; 95%CI 0.9 to 1.1).Conclusion: Our findings highlight the consequences of the high prevalence of mental disorders for individuals with opioid use disorder in Ontario, Canada

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