基于人群的妊娠期阿片类激动剂治疗药物配给的时间序列分析。

A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy.

机构信息

Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.

Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.

出版信息

Addiction. 2024 Jun;119(6):1111-1122. doi: 10.1111/add.16459. Epub 2024 Mar 13.

DOI:10.1111/add.16459

PMID:38476027

Abstract

BACKGROUND AND AIMS

Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada.

DESIGN

This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed.

SETTING AND PARTICIPANTS

The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period.

MEASUREMENTS

We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario.

FINDINGS

Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015).

CONCLUSION

Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.

摘要

背景与目的

由于北美阿片类药物使用障碍的患病率不断上升，因此寻找有效的阿片类药物治疗选择是当务之急。我们评估了三种人群层面干预措施对安大略省加拿大妊娠期间使用阿片类激动剂治疗（OAT）的时间影响。

设计

这是一项基于人群的时间序列分析，旨在确定每月接受美沙酮和丁丙诺啡处方的孕妇比例的趋势。评估了将丁丙诺啡/纳洛酮添加到公共药物处方集、发布妊娠特异性指南和 COVID-19 大流行开始的影响。

地点和参与者

该研究于 2013 年 7 月 1 日至 2022 年 3 月 31 日在加拿大安大略省进行，包括在此期间在任何安大略省医院分娩的活产或死产的人。

测量

我们确定了在估计受孕日期和分娩日期之间开出的任何美沙酮或丁丙诺啡处方，并计算了安大略省所有孕妇中 OAT 暴露妊娠的每月患病率。

结果

总体而言，自 2018 年年中以来，妊娠期间 OAT 的使用率有所下降。美沙酮暴露的妊娠率从 2015 年安大略省所有妊娠的 0.46%下降到 2022 年的 0.16%的低点。在主要分析中，没有一项干预措施对总体 OAT 率有统计学意义；然而，在分层分析中，处方集变更后丁丙诺啡略有增加[0.006%，95%置信区间（CI）=0.0032-0.0081，P<0.0001]，发布 2017 年指南后丁丙诺啡减少（-0.005%，95%CI=-0.0080 至-0.0020，P=0.001）和 COVID-19 大流行开始后（-0.003%，95%CI=-0.0054 至-0.0006，P=0.015）。