Abstract：
OBJECTIVE: In British Columbia, Canada, clinical guidelines for the treatment of opioid use disorders (OUD) were updated in 2017, during a period in which the potency and composition of the illicit drug supply changed rapidly. We aimed to describe changes in opioid agonist treatment (OAT) prescribing practices at the population level in a setting in which fentanyl and its analogs have become the primary illicit opioid of use.
METHODS: This was a population-based retrospective cohort study using three linked health administrative databases in British Columbia (BC), Canada. All individuals with at least one OAT dispensation in BC between 1 January 2014 and 31 August 2021 took part.
METHODS: To assess changes in OAT prescribing practices over time, we calculated initiation doses, dose titration intervals, maintenance doses and take-home dosing intervals stratified by medication [methadone, buprenorphine-naloxone and slow-release oral morphine (SROM)] according to recommended guidelines.
RESULTS: A total of 265 410 OAT episodes (57.5% on methadone, 34.5% on buprenorphine-naloxone and 8.0% on SROM) were initiated during the study period. Compared with the guideline recommendation, observed initiation doses were higher among all medications from 2014 (2017 for SROM) to 2021 (buprenorphine-naloxone: 14-29%; methadone: 53-66%; SROM: 26-55%). Titration intervals were shorter for all medications, consistent with guidelines for buprenorphine-naloxone (26-49%), but shorter than recommended for methadone or SROM (28-51% and 12-41%, respectively). Higher maintenance dosing was observed for methadone (68-78%) and SROM (3-21%). Take-home allowances extending beyond the recommended guideline length increased across medications (buprenorphine-naloxone: 18-35%; methadone: 50-64%; SROM: 34-39%). Changes in prescribing patterns were similar for first-time OAT initiators.
CONCLUSIONS: In British Columbia, Canada, from 2014 to 2021, prescribers of opioid agonist treatment (OAT) appeared to initiate both new and experienced OAT clients at higher doses than guideline recommendations, titrate them more rapidly and maintain clients at higher doses. Take-home dose allowances also gradually increased.
METHODS: This was a population-based retrospective cohort study using three linked health administrative databases in British Columbia (BC), Canada. All individuals with at least one OAT dispensation in BC between 1 January 2014 and 31 August 2021 took part.
METHODS: To assess changes in OAT prescribing practices over time, we calculated initiation doses, dose titration intervals, maintenance doses and take-home dosing intervals stratified by medication [methadone, buprenorphine-naloxone and slow-release oral morphine (SROM)] according to recommended guidelines.
RESULTS: A total of 265 410 OAT episodes (57.5% on methadone, 34.5% on buprenorphine-naloxone and 8.0% on SROM) were initiated during the study period. Compared with the guideline recommendation, observed initiation doses were higher among all medications from 2014 (2017 for SROM) to 2021 (buprenorphine-naloxone: 14-29%; methadone: 53-66%; SROM: 26-55%). Titration intervals were shorter for all medications, consistent with guidelines for buprenorphine-naloxone (26-49%), but shorter than recommended for methadone or SROM (28-51% and 12-41%, respectively). Higher maintenance dosing was observed for methadone (68-78%) and SROM (3-21%). Take-home allowances extending beyond the recommended guideline length increased across medications (buprenorphine-naloxone: 18-35%; methadone: 50-64%; SROM: 34-39%). Changes in prescribing patterns were similar for first-time OAT initiators.
CONCLUSIONS: In British Columbia, Canada, from 2014 to 2021, prescribers of opioid agonist treatment (OAT) appeared to initiate both new and experienced OAT clients at higher doses than guideline recommendations, titrate them more rapidly and maintain clients at higher doses. Take-home dose allowances also gradually increased.
摘要：
目标：在不列颠哥伦比亚省，加拿大,阿片类药物使用障碍(OUD)治疗的临床指南于2017年更新,在此期间,非法药物供应的效力和成分发生了迅速变化.我们旨在描述在芬太尼及其类似物已成为主要非法使用阿片类药物的情况下，在人群水平上阿片类药物激动剂治疗（OAT）处方实践的变化。
方法：这是一项基于人群的回顾性队列研究，使用不列颠哥伦比亚省（BC）的三个链接卫生管理数据库，加拿大。在2014年1月1日至2021年8月31日期间，在不列颠哥伦比亚省至少有一次OAT分配的所有个人都参加了会议。
方法：为了评估OAT处方实践随时间的变化，我们计算了起始剂量，剂量滴定间隔，维持剂量和按药物分层的家庭给药间隔[美沙酮，根据推荐的指南，丁丙诺啡-纳洛酮和缓释口服吗啡（SROM）]。
结果：总共265410次OAT发作（美沙酮的57.5％，在研究期间开始使用丁丙诺啡-纳洛酮的34.5％和SROM的8.0％）。与指南建议相比，从2014年(SROM为2017年)至2021年,所有药物的观察起始剂量均较高(丁丙诺啡-纳洛酮:14-29%;美沙酮:53-66%;SROM:26-55%).所有药物的滴定间隔都较短，与丁丙诺啡-纳洛酮的指南一致（26-49％），但短于美沙酮或SROM的建议（28-51％和12-41％，分别)。美沙酮（68-78％）和SROM（3-21％）的维持剂量更高。超出推荐指南长度的家庭津贴增加了所有药物（丁丙诺啡-纳洛酮：18-35％；美沙酮：50-64％；SROM：34-39％）。首次OAT引发剂的处方模式变化相似。
结论：在不列颠哥伦比亚省，加拿大,从2014年到2021年，阿片类药物激动剂治疗（OAT）的处方者似乎以高于指南建议的剂量启动了新的和有经验的OAT客户，更快速地滴定它们，并将客户维持在更高的剂量。家庭剂量津贴也逐渐增加。
方法：这是一项基于人群的回顾性队列研究，使用不列颠哥伦比亚省（BC）的三个链接卫生管理数据库，加拿大。在2014年1月1日至2021年8月31日期间，在不列颠哥伦比亚省至少有一次OAT分配的所有个人都参加了会议。
方法：为了评估OAT处方实践随时间的变化，我们计算了起始剂量，剂量滴定间隔，维持剂量和按药物分层的家庭给药间隔[美沙酮，根据推荐的指南，丁丙诺啡-纳洛酮和缓释口服吗啡（SROM）]。
结果：总共265410次OAT发作（美沙酮的57.5％，在研究期间开始使用丁丙诺啡-纳洛酮的34.5％和SROM的8.0％）。与指南建议相比，从2014年(SROM为2017年)至2021年,所有药物的观察起始剂量均较高(丁丙诺啡-纳洛酮:14-29%;美沙酮:53-66%;SROM:26-55%).所有药物的滴定间隔都较短，与丁丙诺啡-纳洛酮的指南一致（26-49％），但短于美沙酮或SROM的建议（28-51％和12-41％，分别)。美沙酮（68-78％）和SROM（3-21％）的维持剂量更高。超出推荐指南长度的家庭津贴增加了所有药物（丁丙诺啡-纳洛酮：18-35％；美沙酮：50-64％；SROM：34-39％）。首次OAT引发剂的处方模式变化相似。
结论：在不列颠哥伦比亚省，加拿大,从2014年到2021年，阿片类药物激动剂治疗（OAT）的处方者似乎以高于指南建议的剂量启动了新的和有经验的OAT客户，更快速地滴定它们，并将客户维持在更高的剂量。家庭剂量津贴也逐渐增加。
