M Eugenia Socías1, Evan Wood1, Thomas Kerr1, Seonaid Nolan1, Kanna Hayashi2, Ekaterina Nosova3, Julio Montaner4, M-J Milloy5. 1. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. 2. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. 3. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. 4. Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. 5. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. Electronic address: bccsu-mjsm@cfenet.ubc.ca.
Abstract
BACKGROUND: A cascade of care framework has been proposed to identify and address implementation gaps in addiction medicine. Using this framework, we characterized temporal trends in engagement in care for opioid use disorder (OUD) in Vancouver, Canada. METHODS: Using data from two cohorts of people who use drugs, we assessed the yearly proportion of daily opioid users achieving four sequential stages of the OUD cascade of care [linkage to addiction care; linkage to opioid agonist treatment (OAT); retention in OAT; and stability] between 2006 and 2016. We evaluated temporal trends of cascade indicators, adjusting for socio-demographic characteristics, HIV/HCV status, substance use patterns, and social-structural exposures. RESULTS: We included 1615 daily opioid users. Between 2006 and 2016, we observed improvements in linkage to care (from 73.2% to 78.9%, p = <0.001), linkage to (from 69.2% to 70.6%, p = 0.011) and retention in OAT (from 29.1% to 35.5%, p = <0.001), and stability (from 10.4% to 17.1%, p = <0.001). In adjusted analyses, later calendar year of observation was associated with increased odds of linkage to care (Adjusted Odds Ratio [AOR] = 1.02, 95% Confidence Interval [CI]: 1.01-1.04), retention in OAT (AOR 1.02, 95% CI: 1.01-1.04) and stability (AOR = 1.03, 95% CI: 1.01-1.05), but not with linkage to OAT (AOR 1.00, 95% CI: 0.98-1.01). CONCLUSIONS: Temporal improvements in OUD cascade of care indicators were observed. However, only a third of participants were retained in OAT in 2016. These findings suggest the need for novel approaches to improve engagement in care for OUD to address the escalating opioid-related overdose crisis.
BACKGROUND: A cascade of care framework has been proposed to identify and address implementation gaps in addiction medicine. Using this framework, we characterized temporal trends in engagement in care for opioid use disorder (OUD) in Vancouver, Canada. METHODS: Using data from two cohorts of people who use drugs, we assessed the yearly proportion of daily opioid users achieving four sequential stages of the OUD cascade of care [linkage to addiction care; linkage to opioid agonist treatment (OAT); retention in OAT; and stability] between 2006 and 2016. We evaluated temporal trends of cascade indicators, adjusting for socio-demographic characteristics, HIV/HCV status, substance use patterns, and social-structural exposures. RESULTS: We included 1615 daily opioid users. Between 2006 and 2016, we observed improvements in linkage to care (from 73.2% to 78.9%, p = <0.001), linkage to (from 69.2% to 70.6%, p = 0.011) and retention in OAT (from 29.1% to 35.5%, p = <0.001), and stability (from 10.4% to 17.1%, p = <0.001). In adjusted analyses, later calendar year of observation was associated with increased odds of linkage to care (Adjusted Odds Ratio [AOR] = 1.02, 95% Confidence Interval [CI]: 1.01-1.04), retention in OAT (AOR 1.02, 95% CI: 1.01-1.04) and stability (AOR = 1.03, 95% CI: 1.01-1.05), but not with linkage to OAT (AOR 1.00, 95% CI: 0.98-1.01). CONCLUSIONS: Temporal improvements in OUD cascade of care indicators were observed. However, only a third of participants were retained in OAT in 2016. These findings suggest the need for novel approaches to improve engagement in care for OUD to address the escalating opioid-related overdose crisis.
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