Dataset Information

Assessing the determinants of completing OAT induction and long-term retention: A population-based study in British Columbia, Canada.

ABSTRACT:

Background

Pharmacological treatments for opioid use disorder are essential, life-saving medications, yet successful induction of them and long-term retention on them is limited in many settings. Induction into opioid agonist treatment (OAT) features the highest risk of mortality throughout the treatment course, and greatest risk of discontinuation. We aimed to identify determinants of completing OAT induction and, among those completing induction, time to OAT discontinuation in British Columbia (BC), Canada.

Methods

We conducted a retrospective study using linked population-level health administrative databases to capture all individuals in BC receiving at least one OAT dispensation from January 1, 2008, to September 30, 2018. We constructed covariates capturing client demographics, clinical history, and characteristics of the treatment episode and the primary prescribing physician. We estimated a two-part model to identify determinants of the probability of completing induction using a generalized linear mixed model with logit link and the time to OAT discontinuation among those completing induction using a Cox proportional hazards frailty model.

Results

We observed 220,474 OAT episodes (73.9% initiated with methadone, 24.7% with buprenorphine, and 1.4% with slow-release oral morphine) among 45,608 individuals over the study period. Less than 60% of all OAT episodes completed induction (59.0% for methadone episodes, 56.7% for buprenorphine/naloxone, 41.0% for slow-release oral morphine) and half of all episodes that completed induction reached the minimum effective dosage (51.0% for methadone episodes [60 mg/day], 48.2% for buprenorphine/naloxone [12 mg/day], 59.4% for slow-release oral morphine [240 mg/day]). In multiple regression analysis, the adjusted odds of completing induction with buprenorphine improved over time, exceeding that of methadone in 2018: 1.46 (1.40, 1.51). For those who completed induction, buprenorphine use was associated with shorter times to discontinuation throughout the study period, but the estimated rate of discontinuation decreased over time (adjusted hazard ratio, vs. methadone in 2008: 2.50 (2.35, 2.66); in 2018: 1.79 (1.74, 1.85)).

Conclusion

We found low rates of completing OAT induction and, for those who did complete it, low rates of reaching the minimum effective dose.

SUBMITTER: Kurz M

PROVIDER: S-EPMC9833672 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Publications

Assessing the determinants of completing OAT induction and long-term retention: A population-based study in British Columbia, Canada.

Kurz Megan M Min Jeong Eun JE Dale Laura M LM Nosyk Bohdan B

Journal of substance abuse treatment 20211026

<h4>Background</h4>Pharmacological treatments for opioid use disorder are essential, life-saving medications, yet successful induction of them and long-term retention on them is limited in many settings. Induction into opioid agonist treatment (OAT) features the highest risk of mortality throughout the treatment course, and greatest risk of discontinuation. We aimed to identify determinants of completing OAT induction and, among those completing induction, time to OAT discontinuation in British ...[more]

PMID: 34740484

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Dataset Information

Assessing the determinants of completing OAT induction and long-term retention: A population-based study in British Columbia, Canada.

Background

Methods

Results

Conclusion

Publications

Assessing the determinants of completing OAT induction and long-term retention: A population-based study in British Columbia, Canada.

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