Background

Opioid Agonist Treatment (OAT) is the most effective intervention for opioid use disorder (OUD), but retention has decreased due to increasingly potent drugs like fentanyl. This cohort can be used retrospectively to observe trends in service utilization, healthcare integration, healthcare costs and patient outcomes. It also facilitates the design of observational studies to mimic a prospective design.

Methods

This study used linked administrative data from ICES to create a cohort of 137,035 individuals who received at least one prescription of methadone or buprenorphine/naloxone between 2014 and 2022. Data were linked using de-identified personal health numbers. Variables included age, sex, rurality, income, homelessness, and mental health conditions. Regional differences in OAT use, retention, and mortality were analyzed.

Results

Of the cohort, 56.1% began OAT after 2014. Southern Ontario participants more often started on methadone (53.2%), while Northern Ontario patients favored buprenorphine/naloxone (62.7%). Northern patients were younger, more likely to be female, live in rural areas, and face homelessness. The death rate was higher in Southern Ontario (22.1%) than in Northern Ontario (13.2%). Retention declined over time, with 73.4% of patients remaining in treatment at the study's end.

Conclusions

The findings highlight regional disparities in OAT delivery and emphasize the need for region-specific strategies, particularly in rural areas, to improve retention and reduce mortality.

中文翻译：

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队列概况：加拿大安大略省省级阿片类激动剂治疗队列

 背景

阿片类激动剂治疗 （OAT） 是治疗阿片类药物使用障碍 （OUD） 的最有效干预措施，但由于芬太尼等药物的效力越来越强，保留率有所下降。该队列可以回顾性地用于观察服务利用、医疗保健整合、医疗保健成本和患者结果的趋势。它还有助于设计观察性研究以模拟前瞻性设计。

 方法

这项研究使用来自 ICES 的关联管理数据创建了一个由 137,035 人组成的队列，这些人在 2014 年至 2022 年期间至少接受了一次美沙酮或丁丙诺啡/纳洛酮处方。数据使用去标识化的个人健康号码进行链接。变量包括年龄、性别、农村、收入、无家可归和心理健康状况。分析了 OAT 使用、保留和死亡率的地区差异。

 结果

在该队列中，56.1% 的人在 2014 年之后开始接受 OAT。安大略省南部的参与者更经常从美沙酮开始 （53.2%），而安大略省北部患者更喜欢丁丙诺啡/纳洛酮 （62.7%）。北方患者更年轻，更可能是女性，生活在农村地区，面临无家可归。安大略省南部的死亡率 （22.1%） 高于安大略省北部 （13.2%）。保留率随着时间的推移而下降，73.4% 的患者在研究结束时仍在接受治疗。

 结论

研究结果突出了 OAT 交付的地区差异，并强调需要针对特定地区的策略，尤其是在农村地区，以提高保留率和降低死亡率。