Retention in Opioid Agonist Therapy Among First Nations People.

IF 9.7 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Alice Holton, Bisola Hamzat, Daniel McCormack, Sacha Bragg, Bernadette deGonzague, Graham Mecredy, Tonya Campbell, Tony Antoniou, Lorrilee McGregor, Jonathan Bertram, Tara Gomes
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引用次数: 0

Abstract

Importance: First Nations people are disproportionately impacted by the opioid crisis in Canada. While many First Nation communities have expanded access to treatment, there is a need to better understand the factors associated with early discontinuation of opioid agonist therapies (OAT).

Objective: To investigate factors associated with OAT retention within the first year of treatment among First Nations people in Ontario, Canada.

Design, setting, and participants: This was a population-based retrospective cohort study including all registered (status) First Nations people aged 15 years or older initiating OAT between January 2013 and March 2021. Data were analyzed between October 2022 and June 2024.

Exposure: Methadone and buprenorphine-naloxone initiation.

Main outcomes and measures: The main outcome was duration of OAT treatment, with discontinuation defined as a gap in therapy of more than 14 days. Cox proportional hazards models followed up individuals until the first occurrence of OAT discontinuation, death, end of 1-year follow-up, or switching between OAT treatments.

Results: A total of 17 880 OAT initiations among 7476 individuals (median [IQR] age, 31 [26-38] years; 8966 [50.1%] female) were identified, including 9074 new episodes of buprenorphine-naloxone and 8806 new episodes of methadone. Time to treatment discontinuation was shorter among buprenorphine-naloxone episodes (median [IQR], 42 [5-321] days) compared with methadone episodes (median [IQR], 71 [10-544] days) (P < .001). Several factors were associated with buprenorphine-naloxone and methadone retention, including living in moderately sized urban areas (buprenorphine-naloxone: adjusted hazard ratio [aHR], 0.81; 95% CI, 0.70-0.95; methadone: aHR, 0.79; 95% CI, 0.70-0.90) and being recently dispensed non-OAT opioids (buprenorphine-naloxone: aHR, 0.86; 95% CI, 0.80-0.94; methadone: aHR, 0.86; 95% CI, 0.79-0.93). In contrast, factors associated with higher rates of discontinuation included recent opioid toxic events (buprenorphine-naloxone: aHR, 1.36; 95% CI, 1.20-1.54; methadone: aHR, 1.24; 95% CI, 1.11-1.38), and recent methadone treatment (buprenorphine-naloxone: aHR, 1.09; 95% CI, 1.01-1.18; methadone: aHR, 1.67; 95% CI, 1.57-1.78). Methadone discontinuation increased over time; however this pattern was not observed for buprenorphine-naloxone.

Conclusions and relevance: This cohort study among First Nations people found low rates of OAT retention. Although retention was higher for methadone, it declined over time. These findings highlights important gaps in OAT provision for First Nations people that may be improved by investments into First Nations-led treatment programs that integrate traditional, land-based programs to better support people with opioid use disorder across Ontario.

阿片类激动剂治疗在原住民中的保留作用。
重要性:加拿大阿片类药物危机对原住民的影响尤为严重。虽然许多第一民族社区扩大了获得治疗的机会,但有必要更好地了解与阿片类激动剂治疗(OAT)早期停止相关的因素。目的:调查与加拿大安大略省原住民治疗第一年OAT保留率相关的因素。设计、环境和参与者:这是一项基于人群的回顾性队列研究,包括所有在2013年1月至2021年3月期间开始OAT的15岁或以上的注册(状态)原住民。研究人员分析了2022年10月至2024年6月期间的数据。暴露:美沙酮和丁丙诺啡-纳洛酮起始。主要结局和测量:主要结局是OAT治疗的持续时间,治疗间隔超过14天即定义为停药。Cox比例风险模型对个体进行随访,直到首次发生OAT停药、死亡、1年随访结束或在OAT治疗之间切换。结果:7476例患者共17 880例OAT起始(中位[IQR]年龄31[26-38]岁;其中丁丙诺啡-纳洛酮新发9074次,美沙酮新发8806次(50.1%)。丁丙诺啡-纳洛酮发作的停药时间(中位数[IQR], 42[5-321]天)比美沙酮发作的停药时间(中位数[IQR], 71[10-544]天)更短(P结论和相关性:这项在原住民中进行的队列研究发现OAT保留率较低。尽管美沙酮的保留率更高,但随着时间的推移,保留率会下降。这些发现突出了原住民OAT提供方面的重要差距,可以通过投资原住民主导的治疗项目来改善,这些治疗项目将传统的、基于土地的项目整合在一起,以更好地支持安大略省各地的阿片类药物使用障碍患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
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