One year of methadone maintenance treatment in a fentanyl endemic area: Safety, repeated exposure, retention, and remission

et al. 2022

BMC Health Serv Res

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 patients 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 to 2020. Study participants included all patients 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 2 years, and more than 2 years. Correlates associated with OAT retention for 90 days, 90 to 365 days, 1 to 2 years, and more than 2 years were also evaluated and compared across rural and urban areas in northern and southern Ontario. Results A total of 32,487 patients were included in the study. Compared to patients who were retained in OAT for 90 days, patients who were retained for 90 to 365 days, 1 to 2 years, or more than 2 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 retention have the potential to improve outcomes of OAT.

Section: Introductionmentioning

confidence: 99%

Measuring treatment attrition at various stages of engagement in Opioid Agonist Treatment in Ontario Canada using a cascade of care framework

Tahsin

et al. 2022

BMC Health Serv Res

“…14 The cascade of care framework is an effective way to report individuals' engagement and attrition from a treatment system. 11 The key objective of a cascade of care framework is to measure patients' engagement at the critical stages of treatment, such as engagement in care, initiation of medication, and subsequent retention. 15 By tracking these key stages of the treatment system, we can better understand care fragmentation and subsequently target policy and clinical intervention to bridge the care gaps.…”

Section: Introductionmentioning

confidence: 99%

“…9 The literature has shown that one-year retention in OAT is associated with positive outcomes, including reduced mortality rates, reduced drug use, reduced infections and high-risk behaviors, reduced crime, improved psychosocial relationships, and increased employment rates. 10,11 However, previous studies have shown that individuals often only stay in treatment for 30-60 days 12,13 which may be reducing the effectiveness of OAT. Moreover, reports have shown low engagement for people with OUD in the current treatment system in Ontario.…”

Section: Introductionmentioning

confidence: 99%

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

Tahsin

et al. 2022

Preprint

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.

“…Sustained engagement in OAT, ideally for one year or more (16)(17)(18), is thus critical to realizing the protective bene ts of this vital tool to address the opioid overdose crisis.…”

Section: Introductionmentioning

confidence: 99%

“…The cost of UDS billing has been the source of debate in Ontario (17,18), resulting in recent UDS billing fee cuts (21) and recommendations for less frequent screening (22). Ideal UDS frequency is therefore critical to treat OUD effectively in a specialized OAT setting.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Impact of Urine Drug Screen Frequency on Retention in Opioid Agonist Treatment in Ontario, Canada

Dabous

et al. 2021

Preprint

ObjectiveThe objective of this study was to evaluate how UDS frequency impacts treatment retention in OAT. MethodsData for this retrospective cohort study of 55,921 adults with OUD in Ontario, Canada, were derived from administrative data sources between January 1, 2011, and December 31, 2015. All patient information was linked anonymously across databases using encrypted ten-digit health card numbers. Descriptive statistics were calculated for comparing urine drug screening frequency groups (less than monthly, monthly, bi-weekly and, weekly) using standardized differences (d) where d less than 10% indicated a statistically significant difference. A logistic regression model was then used to calculate odds ratios for the association between UDS frequency and one-year treatment retention adjusting for baseline covariates, including sex, age, location of residence, income quintile, mental disorders, HIV status and deep tissue infections. ResultsOver 70 percent of the cohort had four or more UDS per month (weekly or more UDS). Significant associations were observed between UDS frequency and one-year treatment retention in OAT bi-weekly (adjusted Odds Ratio (aOR) = 3.20, 95% confidence interval (CI) 2.75-3.75); weekly UDS (aOR = 6.86, 95% CI, 5.88-8.00) and; more than weekly (aOR = 8.03, 95% CI, 6.87-9.38) using the monthly or less groups as the reference.ConclusionThis study identified a significant association between weekly UDS and one-year treatment retention in OAT. Therefore, these findings put into question the recent changes in OAT guidelines recommending UDS only be conducted monthly. More research is needed to strengthen the evidence base for UDS frequency in OAT.