Home Medizin Daten deuten darauf hin, dass Opioid-Agonisten-Therapie zu wenig genutzt wird

Daten deuten darauf hin, dass Opioid-Agonisten-Therapie zu wenig genutzt wird

von NFI Redaktion

New data suggest that only a few patients with opioid toxicity receive opioid agonist therapy (OAT). In a retrospective study examining approximately 21,000 hospital visits related to opioid use disorder (OUD) in Ontario, Canada, only 4.1% resulted in community-based initiation of OAT within 7 days of discharge.

„I suspected as a physician that OAT initiation rates would be low. However, I wouldn’t have expected them to be this low,“ said study author Tina Hu, MD, a family and community medicine physician and assistant professor at the University of Toronto, in an interview with Medscape Medical News. „OAT is a proven and effective treatment for OUD that reduces both morbidity and mortality. In the midst of a public health crisis… [I] to me, it is incomprehensible that we don’t seize every encounter in healthcare as an opportunity to discuss OAT with patients with OUD and initiate life-saving treatment.“ The results were published on December 18, 2023, in CMAJ.

The researchers conducted a retrospective, population-based, serial cross-sectional study to investigate community-based OAT initiation in Ontario. They obtained data from ICES, the Abstract Database of the Canadian Institute for Health Information Discharge, and other sources to examine emergency room or hospital visits related to opioid toxicity between January 1, 2013, and March 31, 2020.

Of the 47,910 emergency room or hospital admissions for opioid toxicity in Ontario during the study period, 20,702 (43.2%) events in 14,053 patients (average age 35 years) met the inclusion criteria. The main reasons for exclusion were prior OAT claims within 30 days of the index visit (17.9%) and no documented OUD diagnosis in the previous 5 years (24.8%).

Out of the 20,702 OUD events, there were 5,219 hospital admissions and 15,483 emergency room visits. A total of 215 hospital admissions and 636 emergency room visits within 7 days of discharge led to the initiation of OAT.

A secondary analysis found that the rate of readmissions or return outpatient or emergency room visits within 7 days of the initial discharge after an OUD event was 22.1%. „This is the time frame associated with a very high risk of mortality following an overdose,“ said Hu. „Despite this connection to healthcare services, these patients did not receive OAT, highlighting the critically missed opportunities to engage patients in treatment to prevent future mortality and morbidity related to opioid use.“

Of the 379 OAT prescribers that the researchers identified, most were male (70.2%) general practitioners (67.6%) with an average age of 46 who had been in practice for at least 10 years (73.9%). Hu suspected that the reasons for the underprescribing of OAT are likely multifactorial, but attributed to resource and training shortages.

„These lamentably low rates – even during a public health crisis – not only underscore the need to improve the care of people with OUD in acute care, but also how far medical systems in Canada must go to provide effective evidence-based care for people with substance use disorders,“ he added.

These data should also be considered in the context of ongoing debates about the most effective strategies for responding to the overdose epidemic. „The results clearly demonstrate that strategies relying solely on clinical interventions, in the short term, are insufficient to adequately respond to the rising morbidity and mortality of opioids. Community-based interventions to reduce the risks associated with exposure to unregulated drug supply, especially harm-reduction based interventions that offer alternatives to this supply, are now urgently needed while clinical pathways for people with OUD are established and improved,“ he concluded.

The study was funded by a scholarship from the Canadian Institutes of Health Research and supported by ICES. Hu reported no relevant conflicts. Milloy disclosed that his university receives salary support from the US National Institute on Drug Abuse. He is a member of the Canadian Research Initiative in Substance Misuse, a government-funded research consortium on substance abuse, but was not involved in the creation of the 2018 guidelines for opioid use disorder.

Kate Johnson is a Montreal-based freelance medical journalist who has been writing about all areas of medicine for over 30 years.

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