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

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

Download Full-text

A Retrospective Cohort Study Comparing In-Person and Telemedicine-Based Opioid Agonist Treatment in Ontario, Canada, Using Administrative Health Data

European Addiction Research ◽

10.1159/000513471 ◽

2021 ◽

pp. 1-9

Author(s):

Kristen A. Morin ◽

Matthiew D. Parrotta ◽

Joseph K. Eibl ◽

David C. Marsh

Keyword(s):

Mental Health ◽

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort ◽

Health Data ◽

Emergency Department Visits ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

Administrative Health Data ◽

Health Related

Background: This study evaluated how telemedicine as a modality for opioid agonist treatment compares to in-person care. Methods: We conducted a retrospective cohort study of patients enrolled in opioid agonist treatment between January 1, 2011, and December 31, 2015, in Ontario, Canada. We compared patients who received opioid agonist treatment predominantly in person, mixed, and predominantly by telemedicine. We used a logistic regression model to evaluate mortality, a Cox proportional hazard model to assess retention, and a negative binomial regression model to evaluate emergency department visits and hospitalizations. The study was performed using administrative health data with physician billing data from the Ontario Health Insurance Plan and prescription data from the Ontario Drug Benefit databases. Results: A total of 55,924 individuals were included in the study. Receiving opioid agonist treatment by predominantly telemedicine was not associated with all-cause mortality (OR = 0.9, 95% CI: 0.8–1.0), 1-year treatment retention (OR = 1.0, 95% CI: 0.9–1.1), or opioid-related emergency department visits and hospitalizations when compared to in-person care. The rate of emergency department visits (IRR = 1.4), the rate of mental health-related emergency department visits (IRR = 1.5), and the rate of mental health-related hospitalizations per year (IRR = 1.2) was higher for patients who received opioid agonist treatment predominantly by telemedicine compared to in person. Conclusion: Our findings support the conclusion that telemedicine is equal to in-person care regarding mortality opioid-related emergency department visits and retention, and is a viable option for those seeking opioid agonist treatment.

Download Full-text

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

10.21203/rs.3.rs-27508/v1 ◽

2020 ◽

Author(s):

Kristen Morin ◽

Joseph K Eibl ◽

Graham Gauthier ◽

Brian Rush ◽

Christopher Mushquash ◽

...

Keyword(s):

Mental Disorders ◽

Opioid Use Disorder ◽

Emergency Department Visits ◽

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, frequent emergency department visits (OR 3.69; 95% CI 3.7-4.1) and hospitalizations (OR 2.6; 95%CI 2.5-2.7). However,there was no association between having a diagnosis of a mental disorderand one-year treatment retention in OAT OR 1.0; 95%CI 0.9-1.1). Conclusion: Our findings highlight the consequences of the high prevalence of mental disorders for individuals with opioid use disorder in Ontario, Canada

Download Full-text

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

10.21203/rs.3.rs-27508/v2 ◽

2020 ◽

Author(s):

Kristen 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 who had been diagnosed with mental disorders, the number of ED visits per year 2.25 times higher, and the number of hospitalizations per year was 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 Hazzard 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

Download Full-text

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

10.21203/rs.3.rs-19301/v1 ◽

2020 ◽

Author(s):

Kristen A. Morin ◽

Joseph K. Eibl ◽

Graham Gauthier ◽

Brian Rush ◽

Christopher Mushquash ◽

...

Keyword(s):

Mental Disorders ◽

Opioid Use Disorder ◽

Emergency Department Visits ◽

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 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, 2016. 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 across databases. Results: We identified 55,924 individuals enrolled in opioid agonist treatment, 87% had a concurrent mental disorder diagnosis during this time period. We observed that having a mental disorder was predictive of all-cause mortality (Odds Ratio (OR) 1.4; 95% Confidence Interval (CI) 1.2-1.5, frequent emergency department visits (OR 3.69; 95% CI 3.7-4.1) and hospitalizations (OR 2.6; 95% CI 2.5-2.7). However it was not predictive for one-year treatment retention in OAT OR 1.0; 95% CI 0.9-1.1). Conclusion: Our findings highlight consequences of the high prevalence of mental disorders for individuals with opioid use disorder in Ontario, Canada.

Download Full-text

Incidence and prevalence of dementia in linked administrative health data in Saskatchewan, Canada: a retrospective cohort study

BMC Geriatrics ◽

10.1186/s12877-015-0075-3 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 14

Author(s):

Julie G. Kosteniuk ◽

Debra G. Morgan ◽

Megan E. O’Connell ◽

Andrew Kirk ◽

Margaret Crossley ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Health Data ◽

Administrative Health Data ◽

Linked Administrative Health Data ◽

Prevalence Of Dementia

Download Full-text

Self-harm and suicide during and after opioid agonist treatment among primary care patients in England: a cohort study

The Lancet Psychiatry ◽

10.1016/s2215-0366(21)00392-8 ◽

2021 ◽

Cited By ~ 1

Author(s):

Prianka Padmanathan ◽

Harriet Forbes ◽

Maria Theresa Redaniel ◽

David Gunnell ◽

Dan Lewer ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

Primary Care Patients ◽

Self Harm

Download Full-text

Using routinely collected data to understand and predict adverse outcomes in opioid agonist treatment: Protocol for the Opioid Agonist Treatment Safety (OATS) Study

BMJ Open ◽

10.1136/bmjopen-2018-025204 ◽

2018 ◽

Vol 8 (8) ◽

pp. e025204 ◽

Cited By ~ 8

Author(s):

Sarah Larney ◽

Matthew Hickman ◽

David A Fiellin ◽

Timothy Dobbins ◽

Suzanne Nielsen ◽

...

Keyword(s):

Emergency Department ◽

Treatment Protocol ◽

Health Data ◽

Adverse Outcomes ◽

Learning Approaches ◽

Emergency Department Presentation ◽

Opioid Use ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

Routinely Collected Health Data

IntroductionNorth America is amid an opioid use epidemic. Opioid agonist treatment (OAT) effectively reduces extramedical opioid use and related harms. As with all pharmacological treatments, there are risks associated with OAT, including fatal overdose. There is a need to better understand risk for adverse outcomes during and after OAT, and for innovative approaches to identifying people at greatest risk of adverse outcomes. The Opioid Agonist Treatment and Safety study aims to address these questions so as to inform the expansion of OAT in the USA.Methods and analysisThis is a retrospective cohort study using linked, routinely collected health data for all people seeking OAT in New South Wales, Australia, between 2001 and 2017. Linked data include hospitalisation, emergency department presentation, mental health diagnoses, incarceration and mortality. We will use standard regression techniques to model the magnitude and risk factors for adverse outcomes (eg, mortality, unplanned hospitalisation and emergency department presentation, and unplanned treatment cessation) during and after OAT, and machine learning approaches to develop a risk-prediction model.Ethics and disseminationThis study has been approved by the Population and Health Services Research Ethics Committee (2018HRE0205). Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely-collected health Data statement.

Download Full-text