Ziafat Kimia, Liu Lisa, Kievit Bradley, Papamihali Kristi, Graham Brittany, Otterstatter Michael, Buxton Jane A
The University of British Columbia, Vancouver, British Columbia, Canada.
BC Centre for Disease Control, Vancouver, British Columbia, Canada.
BMJ Open. 2025 Jan 15;15(1):e090704. doi: 10.1136/bmjopen-2024-090704.
This study evaluates the prevalence and correlates of opioid agonist therapy (OAT) discontinuation across British Columbia (BC), using a sample of individuals who used substances and accessed harm reduction sites.
This study uses data from the 2019 cross-sectional Harm Reduction Client Survey (HRCS).
The 2019 survey was administered from October to December at 22 harm reduction supply distribution sites across the 5 Regional Health Authorities of BC.
The 2019 HRCS was administered among individuals who used illicit substances in the past 6 months and were aged 19 years and above.
The primary outcome was defined as self-reported discontinuation of OAT in the past 6 months. Measures of association (χ and Fisher's exact tests) and logistic regression models were used to assess the strength of association between OAT discontinuation and demographic, socioeconomic, accessibility, drug use and harm reduction correlates.
Of the 194 participants included, 59.8% self-identified as cis man, 37.6% self-identified as Indigenous, 38.1% were aged 30-39 years and 43.8% had discontinued OAT in the past 6 months. Multivariable logistic regression analyses identified that those aged ≥50 years (AOR=0.12, 95% CI (0.03 to 0.45)) and those who took the survey in medium/large urban areas (AOR=0.27, 95% CI (0.07 to 0.98)) were significantly less likely to discontinue OAT, while those who experienced an overdose in the past 6 months were significantly more likely (AOR=3.77, 95% CI (1.57 to 9.03)) to have discontinued OAT in the past 6 months. Substance use, including opioids and stimulants, was similar among those who continued and discontinued OAT. Of the 73 participants who discontinued OAT and provided a reason, one-third reported discontinuing OAT because treatment was not effective, 27.4% could not get to the pharmacy during open hours, 23.3% could not make their clinic appointment and 15.1% reported challenges with transportation/travel.
OAT discontinuation prevention efforts for individuals using substances in BC need to address disparities in healthcare accessibility, especially in rural areas and among younger individuals. Continued access to harm reduction services can allow for safer consumption of substances for individuals enrolled in OAT programs.
本研究使用曾使用过毒品并前往减害场所的个体样本，评估不列颠哥伦比亚省（BC省）阿片类激动剂疗法（OAT）停药的患病率及其相关因素。
本研究使用了2019年横断面减害客户调查（HRCS）的数据。
2019年的调查于10月至12月在BC省5个地区卫生当局的22个减害物资分发点进行。
2019年HRCS的调查对象为过去6个月内使用过非法药物且年龄在19岁及以上的个体。
主要结局定义为过去6个月内自我报告的OAT停药情况。采用关联度测量（χ检验和费舍尔精确检验）和逻辑回归模型来评估OAT停药与人口统计学、社会经济、可及性、药物使用及减害相关因素之间的关联强度。
在纳入的194名参与者中，59.8%自我认定为顺性别男性，37.6%自我认定为原住民，38.1%年龄在30 - 39岁之间，43.8%在过去6个月内停用了OAT。多变量逻辑回归分析表明，年龄≥50岁者（比值比[AOR]=0.12，95%置信区间CI）以及在中/大型城市地区接受调查者（AOR=0.27，95%CI(0.07至0.98)）停用OAT的可能性显著较低，而过去6个月内经历过药物过量者在过去6个月内停用OAT的可能性显著较高（AOR=3.77，95%CI(1.57至9.03)）。继续使用和停用OAT者的药物使用情况（包括阿片类药物和兴奋剂）相似。在73名停用OAT并给出原因的参与者中，三分之一报告停用是因为治疗无效，27.4%表示在药房营业时间无法前往，23.3%表示无法赴诊所预约，15.1%报告在交通/出行方面存在困难。
BC省针对使用毒品个体的OAT停药预防工作需要解决医疗可及性方面的差异，尤其是在农村地区和年轻个体中。持续获得减害服务可以让参加OAT项目的个体更安全地使用毒品。
