Examining inequities in access to opioid agonist treatment (OAT) take-home doses (THD): A Canadian OAT guideline synthesis and systematic review.

Journal

The International journal on drug policy
ISSN: 1873-4758
Titre abrégé: Int J Drug Policy
Pays: Netherlands
ID NLM: 9014759

Informations de publication

Date de publication:
29 Mar 2024
Historique:
received: 23 06 2023
revised: 08 01 2024
accepted: 30 01 2024
medline: 31 3 2024
pubmed: 31 3 2024
entrez: 30 3 2024
Statut: aheadofprint

Résumé

Daily supervised Opioid Agonist Treatment (OAT) medication has been identified as a barrier to treatment retention. Canadian OAT guidelines outline take-home dose (THD) criteria, yet, OAT prescribers use their clinical judgement to decide whether an individual is 'clinically stable' to receive THD. There is limited information regarding whether these decisions may result in inequitable access to THD, including in the context of updated COVID-19 guidance. The current Canadian OAT THD guideline synthesis and systematic review aimed to address this knowledge gap. This systematic review included a two-pronged approach. First, we searched available academic literature in Embase, Medline, and PsychINFO up until October 12th, 2022, to identify studies that compared characteristics of individuals on OAT who had and had not been granted access to THD to explore potential inequities in access. Next, we identified all Canadian national and provincial OAT guidelines through a semi-structured grey literature search (conducted between September-October 2022) and extracted all THD 'stability' and allowances/timeline criteria to compare against characteristics identified in the literature search. Data from both review arms were synthesized and narratively presented. A total of n = 56 guidelines and n = 7 academic studies were included. The systematic review identified a number of patient characteristics such as age, sex, race/ethnicity, marital status, housing, employment, neighborhood income, drug use, mental health, health service utilization, as well as treatment duration that were associated with differential access to THD. The Canadian OAT THD guideline synthesis identified many of these same characteristics as 'stability' criteria, underscoring the potential for Canadian OAT guidelines to result in inequitable access to THD. This two-pronged literature review demonstrated that current guidelines likely contribute to inequitable OAT THD access due primarily to inconsistent 'stability' criteria across guidelines. More research is needed to understand differential OAT THD access with a focus on prescriber decision-making and evaluating associated treatment and safety outcomes. The development of a client-centered, equity-focused, and evidence-informed decision making framework that incorporates more clear definitions of 'stability' criteria and indications for prescriber discretion is warranted.

Sections du résumé

BACKGROUND BACKGROUND
Daily supervised Opioid Agonist Treatment (OAT) medication has been identified as a barrier to treatment retention. Canadian OAT guidelines outline take-home dose (THD) criteria, yet, OAT prescribers use their clinical judgement to decide whether an individual is 'clinically stable' to receive THD. There is limited information regarding whether these decisions may result in inequitable access to THD, including in the context of updated COVID-19 guidance. The current Canadian OAT THD guideline synthesis and systematic review aimed to address this knowledge gap.
METHODS METHODS
This systematic review included a two-pronged approach. First, we searched available academic literature in Embase, Medline, and PsychINFO up until October 12th, 2022, to identify studies that compared characteristics of individuals on OAT who had and had not been granted access to THD to explore potential inequities in access. Next, we identified all Canadian national and provincial OAT guidelines through a semi-structured grey literature search (conducted between September-October 2022) and extracted all THD 'stability' and allowances/timeline criteria to compare against characteristics identified in the literature search. Data from both review arms were synthesized and narratively presented.
RESULTS RESULTS
A total of n = 56 guidelines and n = 7 academic studies were included. The systematic review identified a number of patient characteristics such as age, sex, race/ethnicity, marital status, housing, employment, neighborhood income, drug use, mental health, health service utilization, as well as treatment duration that were associated with differential access to THD. The Canadian OAT THD guideline synthesis identified many of these same characteristics as 'stability' criteria, underscoring the potential for Canadian OAT guidelines to result in inequitable access to THD.
CONCLUSIONS CONCLUSIONS
This two-pronged literature review demonstrated that current guidelines likely contribute to inequitable OAT THD access due primarily to inconsistent 'stability' criteria across guidelines. More research is needed to understand differential OAT THD access with a focus on prescriber decision-making and evaluating associated treatment and safety outcomes. The development of a client-centered, equity-focused, and evidence-informed decision making framework that incorporates more clear definitions of 'stability' criteria and indications for prescriber discretion is warranted.

Identifiants

DOI: 10.1016/j.drugpo.2024.104343 PMID: 38554565
pubmed: 38554565
pii: S0955-3959(24)00028-8
doi: 10.1016/j.drugpo.2024.104343
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

104343

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Auteurs

Cayley Russell (C)

Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1; Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada, M5S 1A8. Electronic address: cayley.russell@camh.ca.

Jenna Ashley (J)

Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1.

Farihah Ali (F)

Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1; Ontario Node, Canadian Research Initiative in Substance Misuse (CRISM), Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1.

Nikki Bozinoff (N)

Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario, Canada, M5T 1R8; Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, Canada, M5G1V7.

Kim Corace (K)

Department of Psychiatry, Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, Ontario, Canada, K1H 8M5; Substance Use and Concurrent Disorders Program, The Royal Ottawa Mental Health Center, 1145 Carling Avenue, Ottawa, Ontario, Canada, K1Z 7K4; University of Ottawa Institute of Mental Health Research, The Royal Ottawa Mental Health Center, 1145 Carling Avenue, Ottawa, Ontario, Canada, K1Z 7K4.

David C Marsh (DC)

NOSM University, 935 Ramsey Lake Road, Sudbury, Ontario, Canada, P3E 2C6; ICES North, 56 Walford Road, Sudbury, Ontario, Canada, P3E 2H3; Health Science North Research Institute, 56 Walford Road, Sudbury, Ontario, Canada, P3E 2H3.

Christopher Mushquash (C)

Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.

Jennifer Wyman (J)

Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, Canada, M5G1V7; Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.

Maria Zhang (M)

Pharmacy Services, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada, M6J 1H4; Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Canada, M5S 3M2.

Shannon Lange (S)

Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, M5S 2S1; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada, M5S 1A8; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., Toronto, Ontario, Canada, M5T 1R8; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada, M5T 1R8.

Classifications MeSH