Evaluating the effectiveness of concurrent opioid agonist treatment and physician-based mental health services for patients with mental disorders in Ontario, Canada.

Kristen A Morin,Joseph K Eibl,David C Marsh,Joseph M Caswell,Nancy E Lightfoot,Brian Rush,Christopher Mushquash,Sungwoo Lim

doi:10.1371/journal.pone.0243317

Abstract

The objective of this study was to evaluate the relationship between concurrent physician-based mental health services, all-cause mortality, and acute health service use for individuals enrolled in Opioid Agonist Treatment in Ontario, Canada. A cohort study of patients enrolled in opioid agonist treatment in Ontario was conducted between January 1, 2011, and December 31, 2015, in Ontario with an inverse probability of treatment weights using the propensity score to estimate the effect of physician-based mental health services. Treatment groups were created based on opioid agonist treatment patients' utilization of physician-based mental health services. Propensity score weighted odds ratios were calculated to assess the relationship between the treatment groups and the outcomes of interest. The outcomes included all-cause mortality using data from the Registered Persons Database, Emergency Department visits from the National Ambulatory Care Database, and hospitalizations using data from the Discharge Abstract Database. Encrypted patient identifiers were used to link across databases. A total of 48,679 individuals in OAT with mental disorders. Opioid agonist treatment alone was associated with reduced odds of all-cause mortality (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3-0.4). Patients who received mental health services from a psychiatrist and primary care physician while engaged in OAT, the estimated rate of ED visits per year was higher (OR = 1.3, 95% CI 1.2-1.4) and the rate of hospitalizations (OR = 0.5, 95% CI 0.4-0.6) than in the control group. Our findings support the view that opioid agonist treatment and concurrent mental health services can improve clinical outcomes for complex patients, and is associated with enhanced use of acute care services.

Highlights

The opioid crisis continues to have detrimental impacts on communities in Canada despite the increased programming and policies recently put in place to mitigate these effects [1,2,3,4]
Opioid agonist treatment alone was associated with reduced odds of all-cause mortality (odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3–0.4)
Patients who received mental health services from a psychiatrist and primary care physician while engaged in opioid agonist treatment (OAT), the estimated rate of emergency departments (ED) visits per year was higher (OR = 1.3, 95% confidence intervals (CI) 1.2–1.4) and the rate of hospitalizations (OR = 0.5, 95% CI 0.4–0.6) than in the control group

Summary

Introduction

The opioid crisis continues to have detrimental impacts on communities in Canada despite the increased programming and policies recently put in place to mitigate these effects [1,2,3,4]. In the Province of Ontario, the death rate continues to rise from 5.2 deaths per 100,000 population in 2016 to 7.9 in 2017 [6]. In Ontario, opioid-related ED visits increased from an average of 9.42 per 100,000 population in 2003 to 19.55 per 100,000 population in 2015 [7,8,9]. It is estimated that 50–90% of those who develop OUD are diagnosed with a concurrent mental disorder [10]. The most prevalent mental disorders reported in this population are anxiety and mood disorders, including major depression and bipolar disorder [11, 12]. Bogdanowicz et al demonstrated that the risk of death is almost four times greater in patients with OUD and concurrent mental disorders [17]

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Results

Conclusion