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- Title
Opioid Coprescription Through Risk Mitigation Guidance and Opioid Agonist Treatment Receipt.
- Authors
Min, Jeong Eun; Guerra-Alejos, Brenda Carolina; Yan, Ruyu; Palis, Heather; Barker, Brittany; Urbanoski, Karen; Pauly, Bernie; Slaunwhite, Amanda; Bach, Paxton; Ranger, Corey; Heaslip, Ashley; Nosyk, Bohdan
- Abstract
Key Points: Question: Is coprescription of hydromorphone tablets or sustained-release oral morphine (opioid risk mitigation guidance [RMG]) and opioid agonist treatment (OAT) associated with subsequent OAT receipt? Findings: This population-based, retrospective cohort study included 4636 individuals who received at least 1 opioid RMG dispensation and were receiving OAT at the time of first opioid RMG dispensation and their matched unexposed group. The study found that receipt of opioid RMG for 4 days or more was associated with a 46% increase in the probability of OAT receipt in the subsequent week compared with those not receiving opioid RMG. Meaning: These findings require further investigation to determine safety and isolate the hypothesized therapeutic effectiveness of potential combination formulations of OAT. This cohort study examines the association of coprescription of hydromorphone tablet or sustained-release oral morphine and opioid agonist treatment (OAT) vs OAT alone with the probability of subsequent OAT treatment among people with opioid use disorder in British Columbia, Canada. Importance: At the onset of the COVID-19 pandemic, the government of British Columbia, Canada, released clinical guidance to support physicians and nurse practitioners in prescribing pharmaceutical alternatives to the toxic drug supply. These alternatives included opioids and other medications under the risk mitigation guidance (RMG), a limited form of prescribed safer supply, designed to reduce the risk of SARS-CoV-2 infection and harms associated with illicit drug use. Many clinicians chose to coprescribe opioid medications under RMG alongside opioid agonist treatment (OAT). Objective: To examine whether prescription of hydromorphone tablets or sustained-release oral morphine (opioid RMG) and OAT coprescription compared with OAT alone is associated with subsequent OAT receipt. Design, Setting, and Participants: This population-based, retrospective cohort study was conducted from March 27, 2020, to August 31, 2021, included individuals from 10 linked health administrative databases from British Columbia, Canada. Individuals who were receiving OAT at opioid RMG initiation and individuals who were receiving OAT and eligible but unexposed to opioid RMG were propensity score matched at opioid RMG initiation on sociodemographic and clinical variables. Data were analyzed between January 2023 and February 2024. Exposure: Opioid RMG receipt (≥4 days, 1-3 days, or 0 days of opioid RMG dispensed) in a given week. Main Outcome and Measures: The main outcome was OAT receipt, defined as at least 1 dispensed dose of OAT in the subsequent week. A marginal structural modeling approach was used to control for potential time-varying confounding. Results: A total of 4636 individuals (2955 [64%] male; median age, 38 [31-47] years after matching) were receiving OAT at the time of first opioid RMG dispensation (2281 receiving ongoing OAT and 2352 initiating RMG and OAT concurrently). Opioid RMG receipt of 1 to 3 days in a given week increased the probability of OAT receipt by 27% in the subsequent week (adjusted risk ratio, 1.27; 95% CI, 1.25-1.30), whereas receipt of opioid RMG for 4 days or more resulted in a 46% increase in the probability of OAT receipt in the subsequent week (adjusted risk ratio, 1.46; 95% CI, 1.43-1.49) compared with those not receiving opioid RMG. The biological gradient was robust to different exposure classifications, and the association was stronger among those initiating opioid RMG and OAT concurrently. Conclusions and Relevance: This cohort study, which acknowledged the intermittent use of both medications, demonstrated that individuals who were coprescribed opioid RMG had higher adjusted probability of continued OAT receipt or reengagement compared with those not receiving opioid RMG.
- Subjects
BRITISH Columbia; SUBSTANCE abuse; COMBINATION drug therapy; DRUG overdose; STATISTICAL correlation; MEDICAL protocols; MORPHINE; CONTROLLED release preparations; RESEARCH funding; METHADONE hydrochloride; MULTIPLE regression analysis; QUESTIONNAIRES; OPIOID abuse; RETROSPECTIVE studies; STRUCTURAL equation modeling; DESCRIPTIVE statistics; ORAL drug administration; DRUG tablets; LONGITUDINAL method; ODDS ratio; OPIOID analgesics; RESEARCH; MEDICAL records; ACQUISITION of data; DRUGS; CONFIDENCE intervals; COMPARATIVE studies; DATA analysis software; NALOXONE; DRUG utilization; FENTANYL; COVID-19 pandemic; PROPORTIONAL hazards models; BUPRENORPHINE
- Publication
JAMA Network Open, 2024, Vol 7, Issue 5, pe2411389
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.11389