From the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada (TR, ZS); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada (TR, LN, AW, LT, ZS); Department of Family Medicine, McMaster University, Hamilton, ON, Canada (LN); Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada (NS); Northern Ontario School of Medicine, Sudbury, ON, Canada (DCM); Canadian Addiction Treatment Centres, Markham, ON, Canada (DCM); ICES North, Sudbury, ON, Canada (DCM); Health Sciences North Research Institute, Sudbury, ON, Canada (DCM); Department of Medicine, McMaster University, Hamilton, ON, Canada (AW).
J Addict Med. 2022;16(4):e257-e264. doi: 10.1097/ADM.0000000000000939. Epub 2021 Nov 16.
The opioid use disorder (OUD) crisis in North America has become "an epidemic within a pandemic" in the context of the COVID-19 virus. We aimed to explore the association between the COVID-19 pandemic and changes in opioid use patterns among patients receiving treatment for OUD.
We used prospectively collected data from 456 patients attending 31 opioid agonist clinics across Ontario, Canada. All included participants underwent routine urine drug screens (UDSs) both before and after the onset of the COVID-19 pandemic. A paired sample t -test was used to compare the proportion of opioid-positive UDSs collected pre- and post-pandemic, and linear regression analysis was used to explore factors associated with this change.
Participants had a mean age of 39.9 years (standard deviation = 10.9), 52%were male, and 81%were receivingmethadone treatment. The percentage of opioid-positive UDSs increased significantly during the pandemic, on average by 10.6% (95% confidence interval [CI] 8.17, 12.95, P < 0.001). Continued opioid use before the pandemic was associated with 9.43% increase, on average, in the percentage of opioid-positive UDSs during the pandemic (95% CI 3.79, 15.07). Self-reported past-month cocaine (adjusted betacoefficient 6.83, 95% CI 0.92, 12.73) and amphetamine (adjusted beta-coefficient 13.13, 95% CI 5.15, 21.1) use at study entry were also associated with increases in opioid-positive UDSs.
Increased opioid use is one measure of the negative impact the COVID-19 pandemic has had on individuals with OUD, an already marginalized population. Understanding factors associated with worse outcomes is essential to ensuring that treatment programs appropriately adapt to better serve this population during the pandemic.
在 COVID-19 病毒大流行的背景下，北美阿片类药物使用障碍（OUD）危机已成为“大流行中的流行病”。我们旨在探讨 COVID-19 大流行与接受 OUD 治疗的患者阿片类药物使用模式变化之间的关联。
我们使用了来自加拿大安大略省 31 个阿片类激动剂诊所的 456 名患者的前瞻性收集数据。所有纳入的参与者都在 COVID-19 大流行之前和之后进行了常规尿液药物检测（UDS）。采用配对样本 t 检验比较了大流行前后收集的阿片类药物阳性 UDS 的比例，并采用线性回归分析探讨了与这种变化相关的因素。
参与者的平均年龄为 39.9 岁（标准差=10.9），52%为男性，81%接受美沙酮治疗。大流行期间阿片类药物阳性 UDS 的比例显著增加，平均增加 10.6%（95%置信区间[CI]8.17，12.95，P<0.001）。大流行前持续使用阿片类药物与大流行期间阿片类药物阳性 UDS 的比例平均增加 9.43%相关（95% CI 3.79，15.07）。研究入组时自我报告的过去一个月可卡因（调整后的贝塔系数 6.83，95% CI 0.92，12.73）和安非他命（调整后的贝塔系数 13.13，95% CI 5.15，21.1）使用也与阿片类药物阳性 UDS 的增加相关。
阿片类药物使用的增加是 COVID-19 大流行对已经处于边缘地位的 OUD 患者产生负面影响的一个衡量标准。了解与更差结果相关的因素对于确保治疗计划在大流行期间适当调整以更好地为这一人群服务至关重要。
