Tag: OUD: Opioid Use Disorder

Linking Opioid Use Disorder & High Levels of Out-patient Care Prior to Diagnosis

Published on by Andrew MarshallLeave a comment

Research Paper Title

The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada.

Background

The ‘cascade of care’ framework, measuring attrition at various stages of care engagement, has been proposed to guide the public health response to the opioid overdose public health emergency in British Columbia, Canada.

The researchers estimated the cascade of care for opioid use disorder and identified factors associated with care engagement for people with opioid use disorder (PWOUD) provincially.

Methods

Retrospective study using a provincial-level linkage of four health administrative databases.

All PWOUD in BC from 01 January 1996 to 30 November 2017.

The eight-stage cascade of care included diagnosed PWOUD, ever on opioid agonist treatment (OAT), recently on OAT, currently on OAT and retained on OAT: ≥ 1, ≥ 3, ≥ 12 and ≥ 24 months).

Health-care use, homelessness and other demographics were obtained from physician billing records, hospitalisations, and drug dispensation records. Receipt of income assistance was indicated by enrolment in Pharmacare Plan C.

Results

A total of 55 470 diagnosed PWOUD were alive at end of follow-up. As of 2017, a majority of the population (n = 39 456; 71%) received OAT during follow-up; however, only 33% (n = 18 519) were currently engaged in treatment and 16% (n = 8960) had been retained for at least 1 year.

Compared with those never on OAT, those currently engaged in OAT were more likely to be aged under 45 years [adjusted odds ratio (aOR) = 1.75, 95% confidence interval (CI) = 1.64, 1.89], male (aOR = 1.72, 95% CI = 1.64, 1.82), with concurrent substance use disorders (aOR = 2.56, 95% CI = 2.44, 2.70), hepatitis C virus (HCV) (aOR = 1.22, 95% CI = 1.14, 1.33) and either homeless or receiving income-assistance (aOR = 4.35, 95% CI = 4.17, 4.55).

Regular contact with the health-care system-either in out-patient or acute care settings-was common among PWOUD not engaged in OAT, regardless of time since diagnosis or treatment discontinuation.

Conclusions

People with opioid use disorder in British Columbia, Canada show high levels of out-patient care prior to diagnosis.

Younger age, male sex, urban residence, lower income level and homelessness appear to be independently associated with increased opioid agonist treatment engagement.

Reference

Piske, M., Zhou, H., Min, J.E., Hongdilokkul, N., Pearce, L.A., Homayra, F., Socias, M.E., McGowan, G. & Nosyk, B. (2020) The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada. Addiction (Abingdon, England). doi: 10.1111/add.14947. [Epub ahead of print].

Do Pregnant & Postpartum Women in OUD Treatment have the Potential to Benefit from Access to PSS throughout their Perinatal Period?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Peer support specialists and perinatal opioid use disorder: Someone that’s been there, lived it, seen it.

Background

Perinatal opioid use disorder (OUD) has increased drastically since 2000 and is associated with myriad adverse outcomes.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends using peer support services to promote sustained remission from substance use disorders (SUDs).

Integrating peer support specialists into perinatal OUD treatment has the potential to improve maternal and child health.

However, there is limited published research on the experiences of pregnant and parenting women with peer support specialists during SUD treatment.

The purpose of this study was to:

  1. Describe experiences of perinatal women undergoing OUD treatment with peer support specialists; and
  2. Describe recommendations for improving or enhancing peer support services.

Methods

For this qualitative descriptive study, the researchers conducted two focus groups in a private location in a clinic that serves postpartum women with OUD (N = 9) who were parenting a child under the age of 5.

The focus groups were voice recorded, professionally transcribed, and analyzed in MAXQDA using content analysis.

Results

Four themes emerged from the data:

  1. Feeling Supported by Peer Support Specialists;
  2. Qualities of an ‘Ideal’ Peer Support Specialist;
  3. Strategies to Improve Interactions with Peer Support Specialists; and
  4. Importance of Communication Across the Perinatal Period.

Participants reported that PSSs had a strong, positive impact on their recovery.

Postpartum women report overall positive experiences receiving peer support services during their pregnancy and postpartum period.

However, participants offered suggestions to improve their interactions with PSSs, such as clarifying the boundaries between peer supporters and clients.

Conclusions

Pregnant and postpartum women in OUD treatment have the potential to benefit from access to PSS throughout their perinatal period.

Future research is needed to determine the impact of PSS on sustained recovery for perinatal women with OUD.

Reference

Fallin-Bennett, A., Elswick, A. & Ashford, K. (2019) Peer support specialists and perinatal opioid use disorder: Someone that’s been there, lived it, seen it. Addictive Behaviors. 102:106204. doi: 10.1016/j.addbeh.2019.106204. [Epub ahead of print].