Commentary on Piske <i>et al</i>. (2020): Medication initiation is key to reduce deaths amid opioid crisis
Bibliographic record
Abstract
Commentary on Piske et al. (2020): Medication initiation is key to reduce deaths amid opioid crisisThe OUD Cascade of Care is a public health framework for guiding efforts to more effectively respond to the opioid epidemic.Officials can track progress across each stage, from diagnosis to recovery, to help identify gaps across systems.This may be especially meaningful for improving outcomes among more complex patient populations.The OUD Cascade of Care has become a preferred framework for public health agencies monitoring progress amid the opioid epidemic [1,2].Similar to trends in many parts of the United States, Piske and colleagues [3] observed a greater than threefold increase in the number of individuals diagnosed with opioid use disorder (OUD) across British Columbia, which has the highest provincial opioid-related death rate in Canada.Canada, however, has developed a much more capacious and low-threshold treatment system for OUD which other countries, especially the United States, could learn from.Indeed, the authors explain that the most commonly used forms of opioid agonist treatment (OAT), methadone and buprenorphine/naloxone, can be prescribed by primary physicians [with no need for a Drug Enforcement Administration (DEA) 'X-waiver'] and dispensed via community-based pharmacies-something that US federal agencies have long refused to allow [4].Since mid-2017 alternative forms of OAT, including slow-release oral morphine and injectables, have also been offered in these low-threshold settings.The authors identified annual increases of up to 12% in the number of people with OUD who had ever initiated OAT, probably a reflection of long-standing provincial efforts to expand access to low-barrier addiction treatment.The authors also describe how, to expand access to OAT, the province of British Columbia has opened integrated care clinics, addiction treatment support programs, approved new forms of OAT with new clinical guidelines and eliminated copayment fees for the vast majority of clients, in addition to most physician eligibility requirements for prescribing capabilities.While there are clinical pilot programs in forward-thinking states such as Vermont and Massachusetts [5], none have been as all-encompassing as the level of regulatory reform referenced by the authors.It is not a surprise, then, that the authors' findings along the OUD Cascade of Care far surpass estimates for US populations.They found that, in 2017, 71% of those diagnosed had engaged in past-year OAT and 33% were currently on OAT; however, only 16% had been retained on medication for more than a year.The comparable
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.058 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.007 | 0.006 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.010 | 0.004 |
| Research integrity | 0.080 | 0.078 |
| Insufficient payload (model declined to judge) | 0.027 | 0.023 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".