Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada.
Drug Alcohol Depend. 2022 Jul 1;236:109459. doi: 10.1016/j.drugalcdep.2022.109459. Epub 2022 Apr 14.
We assessed the impact of COVID-19, which includes the declaration of a state of emergency and subsequent release of pandemic-specific OAT guidance (March 17, 2020 to March 23, 2020) on the prevalence of OAT discontinuation.
We conducted a population-based time series analysis using interventional autoregressive integrated moving average models among Ontario residents who were stable (>60 days of continuous use) and not yet stable on OAT. Specifically, we examined whether COVID-19 impacted the weekly percentage of individuals who discontinued OAT, overall and stratified by treatment type (methadone vs. buprenorphine/naloxone). Additionally, we compared demographic characteristics and patient outcomes among people stable on OAT who discontinued treatment during (March 17, 2020 to November 30, 2020) and prior (July 3, 2019 to March 16, 2020) to the pandemic.
The weekly prevalence of OAT discontinuation across the study period ranged between 0.6% and 1.1%, among those stable on treatment compared to 7.3% and 16.6%, among those not stable on treatment. Following COVID-19, there was no significant change in the percentage of Ontarians who discontinued OAT, regardless of whether they were stabilized on treatment. Among those stable on OAT, a similar proportion of patients restarted therapy and experienced opioid-related harm following an OAT discontinuation. However, mortality following OAT discontinuation must be noted, as approximately 1.4% and 0.8% of people who discontinued methadone and buprenorphine/naloxone respectively, died within 30 days of discontinuation.
Trends in the prevalence of OAT discontinuation did not significantly change during the first eight months of the COVID-19 pandemic.
我们评估了 COVID-19 的影响，包括宣布紧急状态以及随后发布针对大流行的 OAT 指导（2020 年 3 月 17 日至 2020 年 3 月 23 日）对 OAT 停药率的影响。
我们使用干预自回归综合移动平均模型在安大略省已经稳定（连续使用超过 60 天）但尚未稳定接受 OAT 治疗的居民中进行了基于人群的时间序列分析。具体而言，我们研究了 COVID-19 是否影响每周停止 OAT 治疗的人数比例，总体以及按治疗类型（美沙酮与丁丙诺啡/纳洛酮）分层的比例。此外，我们比较了在大流行期间（2020 年 3 月 17 日至 2020 年 11 月 30 日）和大流行之前（2019 年 7 月 3 日至 2020 年 3 月 16 日）稳定接受 OAT 治疗的人群中，停药患者的人口统计学特征和患者结局。
在研究期间，与治疗稳定的人群相比，治疗不稳定的人群中 OAT 停药的每周发生率在 0.6%至 1.1%之间。在 COVID-19 之后，无论是否接受治疗，停止 OAT 的安大略省人数比例均无明显变化。在稳定接受 OAT 治疗的人群中，在停药后，相似比例的患者重新开始治疗并经历了与阿片类药物相关的伤害。但是，必须注意 OAT 停药后的死亡率，因为大约有 1.4%和 0.8%分别停止美沙酮和丁丙诺啡/纳洛酮治疗的人在停药后 30 天内死亡。
在 COVID-19 大流行的前八个月中，OAT 停药率的趋势没有明显变化。
