Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder

JAMA, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 17, 2024

Importance Previous studies on the comparative effectiveness between buprenorphine and methadone provided limited evidence differences in treatment effects across key subgroups were drawn from populations who use primarily heroin or prescription opioids, although fentanyl is increasing North America. Objective To assess risk of discontinuation mortality among individuals receiving buprenorphine/naloxone vs for opioid disorder. Design, Setting, Participants Population-based retrospective cohort study using linked health administrative databases British Columbia, Canada. The included recipients January 1, 2010, March 17, 2020, 18 years older not incarcerated, pregnant, palliative cancer care at initiation. Exposures Receipt incident (first-time) users prevalent new (including first subsequent attempts). Main Outcomes Measures Hazard ratios (HRs) with 95% compatibility (confidence) intervals estimated (lasting ≥5 days ≥6 buprenorphine/naloxone) all-cause within 24 months discrete-time survival models comparisons medications as assigned initiation regardless adherence (“initiator”) received according to dosing guidelines (approximating per-protocol analysis). Results A total 30 891 (39% buprenorphine/naloxone; 66% male; median age, 33 [25th-75th, 26-43] years) initiator analysis 25 614 analysis. Incident had a higher compared analyses (88.8% 81.5% discontinued months; adjusted HR, 1.58 [95% CI, 1.53-1.63]), change estimates when evaluated optimal dose (42.1% 30.7%; 1.67 1.58-1.76]). Per-protocol while exhibited ambiguous results (0.08% 0.13% 0.57 0.24-1.35]) 0.09%; 0.97 0.54-1.73]). consistent after introduction patient sensitivity analyses. Conclusions Relevance was associated lower buprenorphine/naloxone. similar methadone, CI estimate hazard ratio wide.

Language: Английский

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“If it wasn’t for them, I don’t think I would be here”: experiences of the first year of a safer supply program during the dual public health emergencies of COVID-19 and the drug toxicity crisis

Harm Reduction Journal, Journal Year: 2024, Volume and Issue: 21(1)

Published: June 7, 2024

In response to the devastating drug toxicity crisis in Canada driven by an unregulated opioid supply predominantly composed of fentanyl and analogues, safer programs have been introduced. These provide people using street-acquired opioids with prescribed, pharmaceutical opioids. We use six core components identified who drugs explore participant perspectives on first year operations a program Victoria, BC, during dual public health emergencies COVID-19 examine whether met drug-user defined elements effective model.

Language: Английский

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Comparative effectiveness of methadone take-home dose initiation in British Columbia, Canada: protocol for a population-based retrospective cohort study using target trial guidelines

BMJ Open, Journal Year: 2025, Volume and Issue: 15(3), P. e095198 - e095198

Published: March 1, 2025

Due to inferior safety profile and higher risk of diversion than buprenorphine/naloxone, guidelines typically recommend stringent eligibility criteria such as daily witnessed ingestion methadone for at least 12 weeks before considering take-home doses. Recent research has focused on whether or not initiate doses, often using pandemic-era data when temporary prescribing changes provided a natural experiment the impact access However, none these studies adequately examined optimal timing safely starting doses enhance treatment outcomes. To determine initiating we will compare effects different initiation times time discontinuation, all-cause mortality acute-care visits among individuals who completed induction in British Columbia, Canada, from 2010 2022. We propose emulating target trial linked population-level health administrative all aged 18 older living completing between 1 January 31 December The exposure strategies include no dosing dose ≤4, 5-12, 13-24 25-52 since induction. outcomes visits. per-protocol analysis with clone-censor-weighting approach address immortal bias implicit comparison alternative times. Subgroup sensitivity analyses, including cohort restrictions, study timeline variations, modifications outcome reclassifications, are proposed assess robustness our results. protocol, creation plan have been classified approved quality improvement initiative by Providence Health Care Research Ethics Board Simon Fraser University Office Ethics. Results be disseminated local advocacy groups decision-makers, national international clinical guideline developers, presented conferences published peer-reviewed journals.

Language: Английский

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Opioid medication doses among safer supply clients: Current safer supply doses and previous OAT experience

Drug and Alcohol Dependence Reports, Journal Year: 2025, Volume and Issue: unknown, P. 100338 - 100338

Published: April 1, 2025

Language: Английский

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Short-Acting, Full Agonist Opioids During Initiation of Opioid Agonist Treatment in the Fentanyl Era

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(5), P. e2411398 - e2411398

Published: May 15, 2024

Jeong Eun Min, MSc; Brenda Carolina Guerra-Alejos, MD, MPH; Ruyu Yan, BA; Heather Palis, PhD; Brittany Barker, Karen Urbanoski, Bernie Pauly, RN, Amanda Slaunwhite, Paxton Bach, Corey Ranger, RN; Ashley Heaslip, Bohdan Nosyk, PhD

Language: Английский

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