Study finds low utilization of opioid agonist therapy after overdose

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After a hospital visit for an overdose, only one in 18 people with opioid use disorder begin a treatment known to be highly effective in reducing illness and deaths, according to new research in CMAJ (Canadian Medical Association Journal).

“These results highlight critical missed opportunities to prevent future mortality and morbidity related to opioid use, despite connection to health care for many patients in the days after a toxicity event,” writes Dr. Tara Gomes, a researcher at ICES and St. Michael’s Hospital, part of Unity Health Toronto, with co-authors.

Between 2016 and 2021 in Ontario, there was almost a threefold increase in opioid-related emergency department visits with a 32% increase in related hospitalizations in Canada making opioid use disorder (OUD) is a major public health issue.

Opioid agonist therapy (OAT) is highly effective at reducing illness and deaths in patients with OUD, however, it is underutilised.

Only 4.1% of hospital encounters for opioid overdoses led to OAT initiation within a week of discharge from the hospital. Despite increased advocacy and publication of a 2018 national guideline aimed at promoting buprenorphine–naloxone as the preferred first-line treatment for OUD, there was no significant increase in OAT initiation rates.

Care during the days following an overdose is critical, as the risk of death is at its highest, and studies show that patients are more likely to continue OAT if it is started in the emergency department, underlining the need for prompt initiation of treatment.

“Our research shows that there were substantial disparities in OAT initiation rates, with potential barriers to prescribing for older patients, those with mental health diagnoses, and those in the lowest neighborhood income quintile,” write the authors. To increase treatment initiation rates, creating OAT initiation protocols, promoting awareness of outpatient addiction programs, and more are recommended.

A practice article illustrates the challenges of treating patients with multiple substance use disorders in hospitals, who often are experiencing undertreated withdrawal and pain.

More information:
Canadian Medical Association Journal (2023). DOI: 10.1503/cmaj.231014. www.cmaj.ca/lookup/doi/10.1503/cmaj.231014

Citation:
Few patients receive opioid agonist therapy after opioid overdose, despite benefits: Study (2023, December 18)
retrieved 18 December 2023
from https://medicalxpress.com/news/2023-12-patients-opioid-agonist-therapy-overdose.html

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