Few people receive effective therapy in opioid overdose treatment

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A recent study in the Canadian Medical Association Journal (CMAJ) reveals a concerning gap in the treatment of opioid use disorder (OUD) following hospital visits for overdoses.

The research, led by Dr. Tara Gomes at ICES and St. Michael’s Hospital in Toronto, shows that only about one in 18 people begin effective treatment known as Opioid Agonist Therapy (OAT) within a week of being hospitalized for an opioid overdose.

OUD is a growing public health crisis, with emergency department visits due to opioid-related issues nearly tripling in Ontario between 2016 and 2021 and a 32% increase in hospitalizations across Canada. OAT is recognized for significantly reducing illness and deaths among patients with OUD.

The study analyzed data from 20,702 emergency visits and inpatient hospital admissions for opioid toxicity between January 2013 and March 2020. The patient profile was predominantly male (65%), with a median age of 35 years, and mostly urban-based (90%).

Alarmingly, 29% of these visits were from patients with prior hospital visits for opioid overdoses, and 24% had received OAT in the past year.

However, the initiation of OAT post-hospital discharge was strikingly low at just 4.1%. Despite increased advocacy and the publication of a 2018 national guideline promoting buprenorphine-naloxone as the first-line treatment for OUD, there was no significant increase in OAT initiation rates.

The risk of death is particularly high in the days following an overdose. Prompt initiation of OAT, ideally starting in the emergency department, is crucial in improving patient outcomes.

Yet, the research highlighted disparities in OAT initiation, with older patients, those with mental health diagnoses, and individuals from lower-income neighborhoods facing greater barriers to receiving this treatment.

To address these disparities and improve treatment initiation rates, the authors suggest several strategies.

These include institutional OAT training, establishing OAT initiation protocols in hospitals, raising awareness about referral resources to outpatient addiction programs, and more.

A related practice article in the journal also points out the challenges in treating hospital patients with multiple substance use disorders, highlighting issues like undertreated withdrawal and pain.

This study underscores the urgent need for improved strategies and protocols in healthcare settings to ensure prompt and effective treatment for individuals recovering from opioid overdoses.

Enhancing access to OAT and addressing the barriers to its initiation are critical steps in tackling the opioid crisis and reducing related mortality and morbidity.

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The research findings can be found in Canadian Medical Association Journal.

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