Abstract
BackgroundWhile patient-reported treatment dissatisfaction is considered an important factor in determining the success of substance use disorder treatment, the levels of dissatisfaction with opioid agonist therapies (OAT) and its relationship with the risk of fentanyl exposure have not been characterized in the context of the ongoing opioid overdose crisis in the US and Canada. Our primary hypothesis was that OAT dissatisfaction was associated with an increased odds of fentanyl exposure.MethodsOur objective was to examine self-reported treatment satisfaction among OAT patients in Vancouver, Canada and the association with fentanyl exposure. Longitudinal data were derived from 804 participants on OAT enrolled in two community-recruited harmonized prospective cohort studies of people who use drugs in Vancouver between 2016 and 2018 via semi-annual interviews and urine drug screens (UDS). We employed multivariable generalized estimating equations to examine the relationship between OAT dissatisfaction and fentanyl exposure.ResultsOut of 804 participants (57.0% male), 222 (27.6%) reported being dissatisfied with OAT at baseline and 1070 out of 1930 observations (55.4%) had fentanyl exposure. The distribution of OAT reported in the sample was methadone (n = 692, 77.7%), buprenorphine-naloxone (n = 82, 9.2%), injectable OAT (i.e., diacetylmorphine or hydromorphone; (n = 65, 7.3%), slow-release oral morphine (n = 44, 4.9%) and other/study medication (n = 8, 1.0%). In the multivariable analysis, OAT dissatisfaction was positively associated with fentanyl exposure (AOR = 1.34; 95% CI: 1.08–1.66).ConclusionsA substantial proportion of OAT patients in our sample reported dissatisfaction with their OAT, and more than half were exposed to fentanyl. We also found that those who were dissatisfied with their OAT were more likely to be exposed to fentanyl. These findings demonstrate the importance of optimizing OAT satisfaction in the context of the ongoing opioid overdose crisis.
Highlights
The United States and Canada are facing an overdose crisis that is being driven in large part by the introduction of illicitly-manufactured fentanyl and its analogues into the illicit drug supply [1]
In the context of the ongoing opioid overdose crisis, we are unaware of any study that has examined the role of treatment satisfaction and overdose risk among opioid agonist therapies (OAT) patients
Across the 804 particiapnts included in the study at baseline, 131 (16.3%) felt very satisfied, 311 (38.7%) felt satisfied, 140 (17.4%) were neutral, 120 (14.9%) felt unsatisfied and 102 (12.7%) felt very unsatisfied with OAT
Summary
The United States and Canada are facing an overdose crisis that is being driven in large part by the introduction of illicitly-manufactured fentanyl and its analogues into the illicit drug supply [1]. Satisfaction with OAT has been associated with significantly higher treatment retention rates, reduced drug use at one year follow up and perceived improvement in social, physical and emotional well-being [13,14,15,16]. In the context of the ongoing opioid overdose crisis, we are unaware of any study that has examined the role of treatment satisfaction and overdose risk among OAT patients. While patient-reported treatment dissatisfaction is considered an important factor in determining the success of substance use disorder treatment, the levels of dissatisfaction with opioid agonist therapies (OAT) and its relationship with the risk of fentanyl exposure have not been characterized in the context of the ongoing opioid overdose crisis in the US and Canada. Our primary hypothesis was that OAT dissatisfaction was associated with an increased odds of fentanyl exposure
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