Facilitating medical withdrawal from opiates in rural Ontario

Kiepek, Niki; Hancock, Lindsay; Toppozini, Debbie; Cromarty, Helen; Morgan, Alanna; Kelly, Len

doi:10.22605/rrh2193

Cited by 17 publications

(24 citation statements)

References 25 publications

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“…This association with individuals' location of residence is important because it shows the regional variation in OAT retention within various cascades. Interestingly, despite the wellknown barriers to accessing addiction and related services in rural areas due to limited access to providers and long distances to travel, 24,52,53 our ndings are also re ected in a previous Ontario based-study which found that OAT patients in Northern regions (both urban and rural) were more likely to be retained in methadone maintenance therapy compared to the Southern regions. 54 Notably, the study by Eibl et al, used administrative data from 2003-2012 in contrast to our study timeline which is 2014-2020, which strengthens the evidence-base relating to geography and OAT.…”

Section: Discussionsupporting

confidence: 69%

Measuring Treatment Attrition at Various Stages of Engagement in Opioid Agonist Treatment in Ontario Canada Using a Cascade of Care Framework

Tahsin

Morin

Vojtesek

et al. 2022

Preprint

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Background The cascade of care framework is an effective way to measure attrition at various stages of engagement in Opioid Agonist Treatment (OAT). The primary objective of the study was to describe the cascade of care for individuals who have accessed OAT from a network of specialized addiction clinics in Ontario, Canada. The secondary objectives were to evaluate correlates associated with retention in OAT at various stages and the impact of patients' location of the residence on retention in OAT. Design: A multi-clinic retrospective cohort study was conducted using electronic medical record (EMR) data from the largest network of OAT clinics in Canada (70 clinics) from 2014-2020. Study participants included all individuals who received OAT from the network of clinics during the study period. Measurements: In this study, four stages of the cascade of care framework were operationalized to identify treatment engagement patterns, including patients retained within 90 days, 90 to 365 days, one to two years, and more than two years. Correlates associated with OAT retention for 90 days, 90 to 365 days, one to two years, and more than two years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 individuals were included in the study. Compared to individuals who were retained in OAT for 90 days, individuals who were retained for 90 to 365 days, one to two years, or more than two years were more likely to have a higher number of treatment attempts, a higher number of average monthly urine drug screening and a lower proportion of positive urine drug screening results for other drug use. Conclusion Distinct sociodemographic and clinical factors are likely to influence treatment retention at various stages of engagement along the OAT continuum. Research is required to determine if tailored strategies specific to people at different stages of engagement have the potential to improve outcomes of OAT.

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Section: Discussionsupporting

confidence: 69%

Measuring Treatment Attrition at Various Stages of Engagement in Opioid Agonist Treatment in Ontario Canada Using a Cascade of Care Framework

Tahsin

Morin

Vojtesek

et al. 2022

Preprint

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“…One additional source was retrieved via a scan of article references. A total of 27 sources were identified that met inclusion criteria, including 12 qualitative [19][20][21][22][23][24][25][26][27][28][29][30], 6 quantitative [31][32][33][34][35][36], 6 mixed-methods [37][38][39][40][41][42], and 3 reviews [43][44][45]. Most of the articles examined perspectives or outcomes of client or community members on substance use programmes wholly or partially aimed at opioid use [19, 24-26, 31-37, 40, 42].…”

Section: Resultsmentioning

confidence: 99%

“…Contextual factors contributing to opioid dependence described in the articles often included discussions of a complex interaction of social conditions in the sampled community. The social determinants of health outlined included poverty [22,40,42], unemployment [22,42], poor health [22], low education levels [22,42], low economic development [22], incarceration [39], singlemotherhood [40], domestic violence [40], racism [42], residential school experiences [22], legacies of colonialism on territorial and cultural dislocation [27], and emotional responses to colonization including grief [39], and emotional trauma and loneliness through the loss of loved ones and personal identity [43]. The social determinants of health in Indigenous contexts have been outlined in the literature; for the purpose of this realist review, the context extraction focused on program descriptions (Table 1).…”

Section: Contextmentioning

confidence: 99%

“…Such programmes support cultural reconnection and spiritual and emotional healing in addition to substance use treatment. Examples of programmes that integrate spirituality included Elders in residence [22], participation in ceremony [31], utilizing treatment facilities as meeting places for healing circles [36] where clients are able to share openly and informally, and land-based aftercare [36], such as fishing, taking walks, and gardening. Emotional care was profiled as including supports to heal from personal traumas [24], and ensuring safe environments for grief support [43].…”

Section: Mechanism: Compassionmentioning

confidence: 99%

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A realist review of best practices and contextual factors enhancing treatment of opioid dependence in Indigenous contexts

et al. 2023

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Objectives The objective of this study was to examine international literature to identify best practices for treatment of opioid dependence in Indigenous contexts. Methods We utilized a systematic search to identify relevant literature. The literature was analysed using a realist review methodology supported by a two-step knowledge contextualization process, including a Knowledge Holders Gathering to initiate the literature search and analysis, and five consensus-building meetings to focus and synthesize relevant findings. A realist review methodology incorporates an analysis of the complex contextual factors in treatment by identifying program mechanisms, namely how and why different programs are effective in different contexts. Results A total of 27 sources were identified that met inclusion criteria. Contextual factors contributing to opioid dependence described in the literature often included discussions of a complex interaction of social determinants of health in the sampled community. Twenty-four articles provided evidence of the importance of compassion in treatment. Compassion was evidenced primarily at the individual level, in interpersonal relationships based on nonjudgmental care and respect for the client, as well as in more holistic treatment programs beyond biophysical supports such as medically assisted treatment. Compassion was also shown to be important at the structural level in harm reduction policies. Twenty-five articles provided evidence of the importance of client self-determination in treatment programs. Client self-determination was evidenced primarily at the structural level, in community-based programs and collaborative partnerships based in trust and meaningful engagement but was also shown to be important at the individual level in client-directed care. Identified outcomes moved beyond a reduction in opioid use to include holistic health and wellness goals, such as improved life skills, self-esteem, feelings of safety, and healing at the individual level. Community-level outcomes were also identified, including more families kept intact, reduction in drug-related medical evacuations, criminal charges and child protection cases, and an increase in school attendance, cleanliness, and community spirit. Conclusions The findings from this realist review indicate compassion and self-determination as key program mechanisms that can support outcomes beyond reduced incidence of substance use to include mitigating systemic health inequities and addressing social determinants of health in Indigenous communities, ultimately healing the whole human being.

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“…It is important that medical clinics not limit patient engagement and success to factors within the patientprovider dyad, as this will overlook the importance of community support, culture, social restoration, and belonging. Cultural awareness and creative and adaptive strategies are needed to respond to the geographical, cultural, and institutional circumstances that typify rural and remote communities [65,66]. Although evaluation of OAT programs is typically centred on the patient-provider dyad, the Sioux Lookout OAT program is community-wide and focused on welcoming substance-dependent patients back to their families and previous roles.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to opioid agonist therapy in rural and remote communities in Canada: an integrative review

Pijl-Zieber

Alraja

Duff

et al. 2022

Subst Abuse Treat Prev Policy

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Background People living in rural and remote communities in Canada are often disproportionately impacted by opioid use disorder. When compared to urban centres, rural and remote populations face additional barriers to treatment, including geographical distance as well as chronic shortages of health care professionals. This integrative review of the literature was conducted to explore the facilitators and barriers of OAT in rural and remote Canadian communities. Methods A search of the literature identified relevant studies published between 2001 and 2021. Results The search strategy yielded 26 scholarly peer-reviewed publications, which explored specific barriers and facilitators to rural and remote OAT in Canada, along with two reports and one fact sheet from the grey literature. Most of the scholarly articles were descriptive studies (n = 14) or commentaries (n = 9); there were only three intervention studies. Facilitators and barriers to OAT programs were organized into six themes: intrapersonal/patient factors, social/non-medical program factors, family/social context factors (including community factors), infrastructure/environmental factors, health care provider factors, and system/policy factors. Conclusions Although themes in the literature resembled the social-ecological framework, most of the studies focused on the patient-provider dyad. Two of the most compelling studies focused on community factors that positively impacted OAT success and highlighted a holistic approach to care, nested in a community-based holistic model. Further research is required to foster OAT programs in rural and remote communities.

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Facilitating medical withdrawal from opiates in rural Ontario

Cited by 17 publications

References 25 publications

Measuring Treatment Attrition at Various Stages of Engagement in Opioid Agonist Treatment in Ontario Canada Using a Cascade of Care Framework

Measuring Treatment Attrition at Various Stages of Engagement in Opioid Agonist Treatment in Ontario Canada Using a Cascade of Care Framework

A realist review of best practices and contextual factors enhancing treatment of opioid dependence in Indigenous contexts

Barriers and facilitators to opioid agonist therapy in rural and remote communities in Canada: an integrative review

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