Evaluating interventions to facilitate opioid agonist treatment access among people who inject drugs in Toronto, Ontario during COVID-19 pandemic restrictions
“…Barriers to service access due to pandemic-related restrictions, including closures, capacity limitations, reduced hours of operation, have been reported in many settings ( Glick et al, 2020 ; Russell et al, 2021 ; Trayner et al, 2022 ; Whitfield et al, 2020 ). In addition to these service disruptions, SCS clients may have avoided attending in order to minimise their infection risk, particularly given the underlying vulnerabilities many clients face ( Ali et al, 2020 ; Bouck et al, 2022 ). Following the large, immediate decrease in monthly SCS visits, the trend of increasing SCS visits over time continued.…”
Section: Discussionmentioning
confidence: 99%
“…In addition to aforementioned safer supply medications, national guidance promoting increased telehealth and take-home dose coverage for OAT was established following the public health emergency declaration ( CRISM, 2020 ; CDSA Exemption and Interpretive Guide for Controlled Substances, 2020 ). Positive findings have emerged from Toronto, Ontario, where the pandemic was associated with an increase in OAT enrolment and take-home doses, but not in opioid-involved overdoses ( Bouck et al, 2022 ). While we do not have data on pandemic responses that occurred in Montréal outside of SCS, people who use drugs in Canada also developed other innovations to promote safety, including “virtual spotting” or supervising drug consumption remotely over video or telephone (outside of an SCS) ( Perri et al, 2021 ).…”
“…Barriers to service access due to pandemic-related restrictions, including closures, capacity limitations, reduced hours of operation, have been reported in many settings ( Glick et al, 2020 ; Russell et al, 2021 ; Trayner et al, 2022 ; Whitfield et al, 2020 ). In addition to these service disruptions, SCS clients may have avoided attending in order to minimise their infection risk, particularly given the underlying vulnerabilities many clients face ( Ali et al, 2020 ; Bouck et al, 2022 ). Following the large, immediate decrease in monthly SCS visits, the trend of increasing SCS visits over time continued.…”
Section: Discussionmentioning
confidence: 99%
“…In addition to aforementioned safer supply medications, national guidance promoting increased telehealth and take-home dose coverage for OAT was established following the public health emergency declaration ( CRISM, 2020 ; CDSA Exemption and Interpretive Guide for Controlled Substances, 2020 ). Positive findings have emerged from Toronto, Ontario, where the pandemic was associated with an increase in OAT enrolment and take-home doses, but not in opioid-involved overdoses ( Bouck et al, 2022 ). While we do not have data on pandemic responses that occurred in Montréal outside of SCS, people who use drugs in Canada also developed other innovations to promote safety, including “virtual spotting” or supervising drug consumption remotely over video or telephone (outside of an SCS) ( Perri et al, 2021 ).…”
“…Most providers became more comfortable prescribing take-homes after observing little or no increase in diversion, overdose, or other adverse events. This perception is broadly supported by a rapidly growing body of literature on client outcomes (e.g., Amram et al, 2021 ; Bouck et al, 2022 ; Corace et al, 2022 ; Ezie et al, 2022 ; Garg et al, 2022 ; Lintzeris et al, 2022 ). Though the impact of supervised dosing on diversion and client health outcomes has been examined in previous systematic reviews, findings have been inconclusive ( Hov et al, 2016 ; Saulle et al, 2017 ).…”
Section: Discussionmentioning
confidence: 87%
“…To this end, the objective of this systematic review was to synthesize the evidence on providers’ experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic. Though there is a substantial body of research examining the impact of COVID-19-related changes to substance use treatment (e.g., Bouck et al, 2022 ; Garg et al, 2022 ; Krawczyk et al, 2022a ; Lintzeris et al, 2022 ; May et al, 2022 ), this is, to our knowledge, the first systematic review of international scope to focus on providers’ experiences. Knowledge of these experiences is necessary to understand the effects of increased flexibility in prescribing take-home medications for opioid use disorder during COVID-19, to explain differences in the uptake of regulatory changes, and to inform post-pandemic policies and guidelines.…”
“…In response to pandemic shifts in health care delivery, a number of changes in the delivery of care may have affected access to OAT. Some studies in Canada and in other jurisdictions have demonstrated increased access to OAT related to implementation of virtual care services for OUD, increase in take-home doses and home delivery of medications, and reduced urine drug screening requirements, among other measures. Some of these pandemic-related changes were also associated with lower rates of treatment interruption and discontinuation .…”
ImportanceData suggest that the opioid crisis in North America has recently been reflected in opioid-related mortality among youths. Despite recommendation for its use, youths encounter barriers to accessing OAT, including stigma, burden of witnessed dosing, and lack of availability of youth-oriented services and prescribers comfortable treating this population.ObjectiveTo compare rates of opioid agonist treatment (OAT) and opioid-related mortality between youths aged 15 to 24 years and adults aged 25 to 44 years in Ontario, Canada, over time.Design, Setting, and ParticipantsThis cross-sectional analysis of rates of OAT and opioid-related deaths between 2013 and 2021 used data obtained from the Ontario Drug Policy Research Network, Public Health Ontario, and Statistics Canada. Individuals included in the analysis were aged 15 to 44 years and residing in Ontario, the most populous province in Canada.ExposuresYouths aged 15 to 24 years compared with adults aged 25 to 44 years.Main Outcomes and MeasuresOAT (methadone, buprenorphine, and slow-release oral morphine) per 1000 population and opioid-related deaths per 100 000 population.ResultsBetween 2013 and 2021, 1021 youths aged 15 to 24 years died from opioid toxicity; 710 were male (69.5%). In the final year of the study period, 225 youths (146 male [64.9%]) died from opioid toxicity, and 2717 (1494 male [55.0%]) were dispensed OAT. Over the study period, the rate of opioid-related deaths among youths in Ontario increased 369.2% from 2.6 to 12.2 per 100 000 population (48 to 225 total deaths) and the rate of OAT use decreased 55.9% from 3.4 to 1.5 per 1000 (6236 to 2717 individuals). For adults aged 25 to 44 years, the rate of opioid-related deaths increased 371.8% from 7.8 to 36.8 per 100 000 (283 to 1502 deaths), and the rate of OAT increased 27.8% from 7.9 to 10.1 per 1000 population (28 667 to 41 200 individuals). Trends for youths and adults persisted across both sexes.Conclusions and RelevanceThe findings of this study suggest that opioid-related deaths are increasing among youths while OAT use is paradoxically declining. The reasons for these observed trends require further investigation, including a consideration of changing trends in opioid use and opioid use disorder among youths, barriers to OAT, and opportunities to optimize care and reduce harms for youths who use substances.
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