Retention in Opioid Agonist Therapy Among First Nations People
Notice bibliographique
Résumé
Importance: First Nations people are disproportionately impacted by the opioid crisis in Canada. While many First Nation communities have expanded access to treatment, there is a need to better understand the factors associated with early discontinuation of opioid agonist therapies (OAT). Objective: To investigate factors associated with OAT retention within the first year of treatment among First Nations people in Ontario, Canada. Design, Setting, and Participants: This was a population-based retrospective cohort study including all registered (status) First Nations people aged 15 years or older initiating OAT between January 2013 and March 2021. Data were analyzed between October 2022 and June 2024. Exposure: Methadone and buprenorphine-naloxone initiation. Main Outcomes and Measures: The main outcome was duration of OAT treatment, with discontinuation defined as a gap in therapy of more than 14 days. Cox proportional hazards models followed up individuals until the first occurrence of OAT discontinuation, death, end of 1-year follow-up, or switching between OAT treatments. Results: A total of 17 880 OAT initiations among 7476 individuals (median [IQR] age, 31 [26-38] years; 8966 [50.1%] female) were identified, including 9074 new episodes of buprenorphine-naloxone and 8806 new episodes of methadone. Time to treatment discontinuation was shorter among buprenorphine-naloxone episodes (median [IQR], 42 [5-321] days) compared with methadone episodes (median [IQR], 71 [10-544] days) (P < .001). Several factors were associated with buprenorphine-naloxone and methadone retention, including living in moderately sized urban areas (buprenorphine-naloxone: adjusted hazard ratio [aHR], 0.81; 95% CI, 0.70-0.95; methadone: aHR, 0.79; 95% CI, 0.70-0.90) and being recently dispensed non-OAT opioids (buprenorphine-naloxone: aHR, 0.86; 95% CI, 0.80-0.94; methadone: aHR, 0.86; 95% CI, 0.79-0.93). In contrast, factors associated with higher rates of discontinuation included recent opioid toxic events (buprenorphine-naloxone: aHR, 1.36; 95% CI, 1.20-1.54; methadone: aHR, 1.24; 95% CI, 1.11-1.38), and recent methadone treatment (buprenorphine-naloxone: aHR, 1.09; 95% CI, 1.01-1.18; methadone: aHR, 1.67; 95% CI, 1.57-1.78). Methadone discontinuation increased over time; however this pattern was not observed for buprenorphine-naloxone. Conclusions and Relevance: This cohort study among First Nations people found low rates of OAT retention. Although retention was higher for methadone, it declined over time. These findings highlights important gaps in OAT provision for First Nations people that may be improved by investments into First Nations-led treatment programs that integrate traditional, land-based programs to better support people with opioid use disorder across Ontario.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».