• CMAJ · Dec 2023

    Initiation of opioid agonist therapy after hospital visits for opioid poisonings in Ontario.

    • Tina Hu, Daniel McCormack, David N Juurlink, Tonya J Campbell, Ahmed M Bayoumi, Pamela Leece, Jessica T Kent, and Tara Gomes.
    • Department of Family and Community Medicine (Hu, Leece), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; Department of Family Medicine (Hu), McMaster University, Hamilton, Ont.; ICES (McCormack, Juurlink, Kent, Gomes), Toronto, Ont.; Sunnybrook Research Institute (Juurlink); MAP Centre for Urban Health Solutions (Campbell, Bayoumi, Gomes), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Bayoumi, Gomes), University of Toronto; Health Promotion, Chronic Disease and Injury Prevention (Leece), Public Health Ontario; Department of Emergency Medicine (Kent), University of Toronto, Toronto, Ont.
    • CMAJ. 2023 Dec 17; 195 (49): E1709E1717E1709-E1717.

    BackgroundEmergency department visits and hospital admissions for opioid toxicity are opportunities to initiate opioid agonist therapy (OAT), which reduces morbidity and mortality in patients with opioid use disorder (OUD). The study objectives were to evaluate OAT initiation rates after a hospital encounter for opioid toxicity in Ontario, Canada, and determine whether publication of a 2018 Canadian OUD management guideline was associated with increased initiation.MethodsWe conducted a retrospective, population-based serial cross-sectional study of hospital encounters for opioid toxicity among patients with OUD between Jan. 1, 2013, and Mar. 31, 2020, in Ontario, Canada. The primary outcome was OAT initiation (methadone, buprenorphine-naloxone, or slow-release oral morphine) within 7 days of discharge, measured quarterly. We examined the impact of the release of the OUD management guideline on OAT initiation rates using Autoregressive Integrated Moving Average models.ResultsAmong 20 702 hospital visits for opioid toxicity among patients with OUD, the median age was 35 years, and 65.1% were male. Over the study period, the percentage of visits leading to OAT initiation within 7 days rose from 1.7% or less (Q1 2013) to 5.6% (Q1 2020); however, the publication of the Canadian OUD management guideline was not associated with a significant increase in these rates (0.14% slope change, 95% confidence interval -0.11% to 0.38%; p = 0.3).InterpretationAmong hospital encounters for opioid toxicity, despite rising prevalence over time, only 1 in 18 patients were dispensed OAT within a week of discharge in early 2020. These findings highlight missed opportunities to initiate therapies proven to reduce mortality in patients with OUD.© 2023 CMA Impact Inc. or its licensors.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.