阿片类药物使用障碍患者阿片类药物过量后的护理途径：一项多水平队列研究

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-03-08 DOI:10.1016/j.drugalcdep.2025.112643

Shaleesa Ledlie , Mina Tadrous , Ahmed M. Bayoumi , Daniel McCormack , Jes Besharah , Charlotte Munro , Tonya Campbell , Tara Gomes

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引用次数: 0

摘要

背景阿片类药物使用障碍（OUD）患者在阿片类药物过量住院期间接受的护理为支持提供了机会，但阿片类药物激动剂治疗（OAT）的启动率仍然很低。因此，我们试图确定与阿片类药物过量住院后开始治疗相关的因素。方法：我们对2014年1月1日至2021年12月31日在加拿大安大略省因阿片类药物过量而出院的OUD患者进行了一项基于人群的队列研究。我们的主要结局是在出院后30天内开始治疗（OAT和/或更安全的阿片类药物供应）。比例风险脆弱性模型用于解释医院和地理水平变量的聚类，并为每个因素计算原因特异性风险比。结果总体而言，13,253人经历了22,848次阿片类药物过量，并从安大略省的175家医院出院。10.3%的阿片类药物过量患者开始接受治疗。与开始治疗相关的个人相关变量包括丙型肝炎诊断（HR=1.15, 95% CI= 1.01-1.30）和公共药物福利资格（HR=1.50, 95% CI= 1.36-1.66）。住院时间较长也与仅在随访的前10天内开始治疗的显著增加相关(HR=1.10 / 5天住院；95% ci = 1.06-1.15)。从致命性阿片类药物过量率最高分位数的地区出院的人开始治疗的风险增加(HR=1.26；95% CI= 1.06-1.51)，与最低分位数的地区相比。结论在阿片类药物过量管理经验不足的地区，确定与药物过量后开始治疗相关的因素可能与延长住院时间和提高可及性有关。

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Pathways of care following opioid overdose among people with opioid use disorder: A multilevel cohort study

Background

The care that people with opioid use disorder (OUD) receive during hospitalizations for opioid overdoses present opportunities for support, yet initiation of opioid agonist treatment (OAT) remains low. Therefore, we sought to determine factors associated with treatment initiation following hospitalization for an opioid overdose.

Methods

We conducted a population-based cohort study of people with OUD discharged from hospital following an opioid overdose between January 1, 2014 and December 31, 2021 in Ontario, Canada. Our primary outcome was initiation of treatment (OAT and/or safer opioid supply) within 30 days of discharge. Proportional hazards frailty models were used to account for the clustering of hospital and geographic-level variables with cause-specific hazards ratios calculated for each factor.

Results

Overall, 13,253 individuals experienced 22,848 opioid overdoses and were discharged from 175 hospitals across Ontario. Treatment was initiated in 10.3 % of opioid overdoses. Person-related variables associated with treatment initiation included hepatitis C diagnoses (HR=1.15, 95 % CI=1.01–1.30) and public drug benefit eligibility (HR=1.50, 95 % CI=1.36–1.66). Longer stays in hospital were also associated with a significant increase in treatment initiation over the first 10 days of follow-up only (HR=1.10 per 5 days in hospital; 95 % CI=1.06–1.15). People discharged from regions with the highest quantile of fatal opioid overdose rates had an increased hazard of treatment initiation (HR=1.26; 95 % CI=1.06–1.51), compared to regions in the lowest quantile.

Conclusion

The identification of factors associated with treatment initiation following overdose may be associated with promoting longer stays in hospital and enhancing accessibility in regions with less experience managing opioid overdoses.

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.