Opioid Coprescription Through Risk Mitigation Guidance and Opioid Agonist Treatment Receipt

Author:

Min Jeong Eun1,Guerra-Alejos Brenda Carolina1,Yan Ruyu1,Palis Heather2,Barker Brittany345,Urbanoski Karen46,Pauly Bernie67,Slaunwhite Amanda128,Bach Paxton910,Ranger Corey11,Heaslip Ashley1012,Nosyk Bohdan15

Affiliation:

1. Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada

2. BC Centre for Disease Control, Vancouver, British Columbia, Canada

3. First Nations Health Authority, Vancouver, British Columbia, Canada

4. School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada

5. Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada

6. Canadian Institute for Substance Use Research, Victoria, British Columbia, Canada

7. Department of Nursing, University of Victoria, Victoria, British Columbia, Canada

8. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada

9. British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada

10. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

11. AVI Health and Community Services, Victoria, British Columbia, Canada

12. Island Medical Program, University of Victoria, Victoria, British Columbia, Canada

Abstract

ImportanceAt 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).ObjectiveTo 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 ParticipantsThis 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.ExposureOpioid RMG receipt (≥4 days, 1-3 days, or 0 days of opioid RMG dispensed) in a given week.Main Outcome and MeasuresThe 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.ResultsA 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 RelevanceThis 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.

Publisher

American Medical Association (AMA)

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