Centre on Drug Policy Evaluation, Unity Health Toronto, Toronto, ON, Canada; Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Centre on Drug Policy Evaluation, Unity Health Toronto, Toronto, ON, Canada; Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States.
Int J Drug Policy. 2022 Jun;104:103680. doi: 10.1016/j.drugpo.2022.103680. Epub 2022 Apr 13.
In March 2020, following a provincial COVID-19 emergency declaration, modifications to opioid agonist treatment (OAT) were introduced in Ontario, Canada to promote treatment access amid the pandemic and ongoing opioid overdose crisis. Modifications included federal exemptions to facilitate OAT prescription re-fills, extensions, and deliveries and interim treatment guidance emphasizing take-home (non-observed) doses and reduced urine drug screening for OAT patients.
We conducted an interrupted time series study using health administrative data from September 17, 2019-September 21, 2020, on 359 people who inject drugs with suspected opioid use disorder in Toronto, Ontario. We used segmented regression analyses to evaluate the joint effects of the provincial COVID-19 emergency declaration, federal OAT exemptions, and interim treatment guidance-all implemented between March 17-23, 2020-on the weekly proportion of participants enrolled in OAT (i.e., ≥1 day(s) covered with methadone or buprenorphine/naloxone), with an opioid-related overdose (based on emergency department visits and hospitalizations), and who died (all-cause), and the weekly proportion of OAT-enrolled participants receiving take-home doses (i.e., ≥1 day(s) covered) and undergoing urine drug screening.
Post-implementation, the interventions were associated with immediate absolute changes in OAT enrollment (+1.95%; 95% CI=0.04%-3.85%), receipt of take-home doses (+18.3%; 95% CI=13.2%-23.4%), and urine drug screening (-22.4%; 95% CI=[-26.9%]-[-17.9%]) and a gradual absolute increase of 0.56% in urine drug screening week-to-week (95% CI=0.27%-0.86%) beyond the pre-implementation trend. At 26 weeks post-implementation, OAT enrollment and urine drug screening approached pre-implementation levels whereas the increase in take-home doses was largely sustained (+15.0%; 95% CI=4.33%-25.6%). No post-implementation increases in opioid-related overdoses were observed. Death was not modelled (low event frequency).
Changes to OAT provision following provincial COVID-19 restrictions were associated with an immediate and sustained increase in take-home dose coverage among OAT-enrolled participants, without corresponding increases in opioid-related overdoses among all participants.
2020 年 3 月，在加拿大安大略省宣布全省 COVID-19 进入紧急状态后，对阿片类药物激动剂治疗（OAT）进行了修改，以在大流行期间和持续的阿片类药物过量危机期间促进治疗的可及性。修改包括联邦豁免，以方便 OAT 处方续药、延长和交付，并发布临时治疗指南，强调 OAT 患者的居家（非观察）剂量和减少尿液药物检测。
我们使用安大略省多伦多市 359 名疑似阿片类药物使用障碍的注射吸毒者 2019 年 9 月 17 日至 2020 年 9 月 21 日的健康管理数据，进行了一项中断时间序列研究。我们使用分段回归分析评估了省级 COVID-19 紧急声明、联邦 OAT 豁免和临时治疗指南的共同影响-所有这些都在 2020 年 3 月 17 日至 23 日之间实施-对每周参加 OAT（即至少 1 天接受美沙酮或丁丙诺啡/纳洛酮覆盖）的参与者比例、与阿片类药物相关的过量（基于急诊就诊和住院）和死亡（全因），以及每周接受居家剂量（即至少 1 天覆盖）和接受尿液药物检测的 OAT 参与者比例。
实施后，干预措施立即导致 OAT 登记率发生绝对变化（+1.95%；95%置信区间=0.04%-3.85%）、接受居家剂量的比例增加（+18.3%；95%置信区间=13.2%-23.4%）和尿液药物检测减少（-22.4%；95%置信区间=[-26.9%]-[-17.9%]），并且每周尿液药物检测的绝对增加趋势持续增加 0.56%（95%置信区间=0.27%-0.86%），超过了实施前的趋势。实施后 26 周，OAT 登记和尿液药物检测接近实施前水平，而居家剂量的增加则基本维持不变（+15.0%；95%置信区间=4.33%-25.6%）。未观察到与阿片类药物相关的过量增加。死亡未建模（事件频率低）。
在省级 COVID-19 限制之后，OAT 供应的变化与 OAT 登记参与者的居家剂量覆盖范围的立即和持续增加有关，而所有参与者的阿片类药物相关过量没有相应增加。
