Opioid Agonist Treatment In Ontario Research Articles

M106 - Reduction in Substance Use-Related Harms Among a Cohort of People Receiving Injectable Opioid Agonist Treatment in Ontario, Canada

M106 - Reduction in Substance Use-Related Harms Among a Cohort of People Receiving Injectable Opioid Agonist Treatment in Ontario, Canada

Evaluating the association between urine drug screening frequency and retention in opioid agonist treatment in Ontario, Canada: a retrospective cohort study

ObjectiveThe objective of this study was to evaluate how urine drug screening (UDS) frequency is associated with retention in opioid agonist treatment (OAT).MethodsData for this retrospective cohort study of 55...

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

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.

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

BackgroundDue 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.MethodsWe 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 Database, and continuous retention in treatment, defined as 1 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.ResultsWe 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 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 1-year treatment retention in OAT-adjusted hazard ratio (HR) = 1.0; 95% CI 0.9 to 1.1.ConclusionOur findings highlight the consequences of the high prevalence of mental disorders for individuals with opioid use disorder in Ontario, Canada.

A retrospective cohort study evaluating correlates of deep tissue infections among patients enrolled in opioid agonist treatment using administrative data in Ontario, Canada.

The objective of this study was to evaluate the relationship between individual characteristics and deep tissue infections in patients enrolled in opioid agonist treatment in Ontario, Canada. A retrospective cohort study was conducted on patients in opioid agonist treatment between January 1, 2011, and December 31, 2015 in Ontario, Canada. Patients were identified using data from the Ontario Health Insurance Plan Database, and the Ontario Drug Benefit Plan Database. We identified other study variables including all-cause mortality using data from the Registered Persons Database. Encrypted patient identifiers were used to link across databases. Logistic regression models were used to measure potential correlates of deep tissue infections. An increase in the incidence of deep tissue infections was observed between 2011 and 2016 for patients on opioid agonist treatment. Additionally, age, sex, positive HIV diagnosis, and all-cause mortality was correlated with deep tissue infection in our study population. The study indicates factors that are associated with deep tissue infections in the opioid use disorder population and can be used to identify opportunities to reduce the incidence of new infections.

Concurrent psychiatry for patients enrolled in opioid agonist treatment: a propensity score matched cohort study in Ontario Canada

ObjectiveThe objective was to characterize the relationship between geography, concurrent psychiatric services, all-cause mortality, and acute health care use for individuals enrolled in Opioid Agonist Treatment, in Ontario, Canada.MethodsWe conducted a propensity score matching study of patients enrolled in Opioid Agonist Treatment in Ontario for the first time between January 1, 2011, and December 31, 2015. We first compared outcomes between patients who were actively engaged and patients who were not actively engaged in Opioid Agonist Treatment. We created treatment and a control groups on the basis of an individual’s access to psychiatric care within an episode of Opioid Agonist Treatment. Relative risk and number needed to treat were calculated to determine the correlation between psychiatric care and health outcomes among patients enrolled in Opioid Agonist Treatment at two time points within an episode of care and for two geographic regions in Ontario (north and south).ResultsDuring the first year of Opioid Agonist Treatment, concurrent psychiatric care was associated with a reduction in all-cause mortality in southern Ontario (RR 0.80, 95% CI, 0.73–0.87), a reduction in emergency department visits in both northern and southern Ontario (north: RR = 0.76, 95% CI, 0.72–0.81; south: RR = 0.87, 95% CI, 0.86–0.88), and a reduction in hospitalizations (north: RR = 0.88, 95% CI. 0.82–0.94, south: RR = 0.92, 95% CI, 0.91–0.93).ConclusionOur findings have significant clinical and political implications for health system planning highlighting the need for integrated mental health and addiction services for individuals with Opioid Use Disorder.