Opioid Agonist Therapy and Mortality Among First Nations and Other Residents with Concurrent Alcohol Use Disorder in British Columbia, Canada: A Population-based Cohort Study

Overview

Journal Drug Alcohol Depend

Publisher Elsevier

Specialty Psychiatry

Date 2023 Aug 6

PMID 37544037

Authors

Brittany Barker

Jeong Eun Min

Fahmida Homayra

Micah Piske

Soha Sabeti

Louise Meilleur

Bohdan Nosyk

Nel Wieman

Affiliations

Soon will be listed here.

Abstract

Background: Despite the prevalence of alcohol use among people with opioid use disorder (PWOUD) engaged in opioid agonist therapy (OAT), clinical care guidance for concurrent alcohol use disorder (AUD) and OUD is scarce. We assessed the prevalence and risk of mortality for concurrent AUD among PWOUD who accessed OAT in British Columbia (BC).

Methods: Data were obtained from six linked population-level health administrative datasets to identify PWOUD from January 1996 to March 2020. All-cause age and sex standardized mortality ratios (SMR) were calculated to determine the mortality risk by OAT status (on vs. discontinued), stratified by First Nations and other residents with concurrent AUD and OUD. Adjusted risk ratios compared the relative risk of mortality by AUD status (AUD detected vs. not) among First Nations and other residents.

Results: We identified 62,110 PWOUD who received OAT, including 6305 (10.2%) First Nations. OAT substantially lowered the SMR among First Nations (SMR=6.6, 95% CI: 5.4-8.1) and other residents (SMR=6.6; 95% CI: 6.2-7.0) with concurrent AUD and OUD, compared to those who discontinued (SMR=22.7, 95% CI: 20.4-25.1, SMR=17.5, 95% CI: 16.8-18.2 respectively). The risk of mortality was 1.9 (95% CI: 1.6-2.2) times higher for First Nations and 2.0 (95% CI: 1.8-2.2) times higher for other residents with concurrent OUD and AUD compared to those without an indication of AUD.

Conclusions: The protective effect of OAT remained despite the presence of a concurrent AUD among both First Nations and other residents with OUD. Findings have implications for clinical care management of concurrent disorders.

References

Goodman A, Fleming K, Markwick N, Morrison T, Lagimodiere L, Kerr T . "They treated me like crap and I know it was because I was Native": The healthcare experiences of Aboriginal peoples living in Vancouver's inner city. Soc Sci Med. 2017; 178:87-94. PMC: 5367883. DOI: 10.1016/j.socscimed.2017.01.053. View

Greenwood M, de Leeuw S, Lindsay N . Challenges in health equity for Indigenous peoples in Canada. Lancet. 2018; 391(10131):1645-1648. DOI: 10.1016/S0140-6736(18)30177-6. View

Hartzler B, Donovan D, Huang Z . Rates and influences of alcohol use disorder comorbidity among primary stimulant misusing treatment-seekers: meta-analytic findings across eight NIDA CTN trials. Am J Drug Alcohol Abuse. 2011; 37(5):460-71. PMC: 3269497. DOI: 10.3109/00952990.2011.602995. View

Soyka M . Alcohol use disorders in opioid maintenance therapy: prevalence, clinical correlates and treatment. Eur Addict Res. 2014; 21(2):78-87. DOI: 10.1159/000363232. View

Nava F, Manzato E, Leonardi C, Lucchini A . Opioid maintenance therapy suppresses alcohol intake in heroin addicts with alcohol dependence: preliminary results of an open randomized study. Prog Neuropsychopharmacol Biol Psychiatry. 2008; 32(8):1867-72. DOI: 10.1016/j.pnpbp.2008.08.019. View

Srivastava A, Kahan M, Ross S . The effect of methadone maintenance treatment on alcohol consumption: a systematic review. J Subst Abuse Treat. 2007; 34(2):215-23. DOI: 10.1016/j.jsat.2007.04.001. View

Klimas J, Wood E, Nguyen P, Dong H, Milloy M, Kerr T . The Impact of Enrolment in Methadone Maintenance Therapy on Initiation of Heavy Drinking among People Who Use Heroin. Eur Addict Res. 2016; 22(4):210-4. PMC: 4862898. DOI: 10.1159/000444513. View

Piske M, Thomson T, Krebs E, Hongdilokkul N, Bruneau J, Greenland S . Comparative effectiveness of buprenorphine-naloxone versus methadone for treatment of opioid use disorder: a population-based observational study protocol in British Columbia, Canada. BMJ Open. 2020; 10(9):e036102. PMC: 7482450. DOI: 10.1136/bmjopen-2019-036102. View

Jacklin K, Henderson R, Green M, Walker L, Calam B, Crowshoe L . Health care experiences of Indigenous people living with type 2 diabetes in Canada. CMAJ. 2017; 189(3):E106-E112. PMC: 5250516. DOI: 10.1503/cmaj.161098. View

10.

Nolan S, Klimas J, Wood E . Alcohol use in opioid agonist treatment. Addict Sci Clin Pract. 2016; 11(1):17. PMC: 5146864. DOI: 10.1186/s13722-016-0065-6. View

11.

Jones C, Paulozzi L, Mack K . Alcohol involvement in opioid pain reliever and benzodiazepine drug abuse-related emergency department visits and drug-related deaths - United States, 2010. MMWR Morb Mortal Wkly Rep. 2014; 63(40):881-5. PMC: 4584609. View

12.

Ye X, Sutherland J, Henry B, Tyndall M, Kendall P . At-a-glance - Impact of drug overdose-related deaths on life expectancy at birth in British Columbia. Health Promot Chronic Dis Prev Can. 2018; 38(6):248-251. PMC: 6034969. DOI: 10.24095/hpcdp.38.6.05. View

13.

Nosyk B, Colley G, Yip B, Chan K, Heath K, Lima V . Application and validation of case-finding algorithms for identifying individuals with human immunodeficiency virus from administrative data in British Columbia, Canada. PLoS One. 2013; 8(1):e54416. PMC: 3557280. DOI: 10.1371/journal.pone.0054416. View

14.

Hartzler B, Donovan D, Huang Z . Comparison of opiate-primary treatment seekers with and without alcohol use disorder. J Subst Abuse Treat. 2010; 39(2):114-23. PMC: 2910795. DOI: 10.1016/j.jsat.2010.05.008. View

15.

Piske M, Zhou H, Min J, Hongdilokkul N, Pearce L, Homayra F . The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada. Addiction. 2020; 115(8):1482-1493. DOI: 10.1111/add.14947. View

16.

Hyett S, Marjerrison S, Gabel C . Improving health research among Indigenous Peoples in Canada. CMAJ. 2018; 190(20):E616-E621. PMC: 5962392. DOI: 10.1503/cmaj.171538. View

17.

Weatherall T, Conigrave K, Conigrave J, Lee K . What is the prevalence of current alcohol dependence and how is it measured for Indigenous people in Australia, New Zealand, Canada and the United States of America? A systematic review. Addict Sci Clin Pract. 2020; 15(1):32. PMC: 7499847. DOI: 10.1186/s13722-020-00205-7. View

18.

Dobler-Mikola A, Hattenschwiler J, Meili D, Beck T, Boni E, Modestin J . Patterns of heroin, cocaine, and alcohol abuse during long-term methadone maintenance treatment. J Subst Abuse Treat. 2005; 29(4):259-65. DOI: 10.1016/j.jsat.2005.08.002. View

19.

Anglin M, Almog I, Fisher D, Peters K . Alcohol use by heroin addicts: evidence for an inverse relationship. A study of methadone maintenance and drug-free treatment samples. Am J Drug Alcohol Abuse. 1989; 15(2):191-207. DOI: 10.3109/00952998909092720. View

20.

Joseph H, Appel P . Alcoholism and methadone treatment: consequences for the patient and program. Am J Drug Alcohol Abuse. 1985; 11(1-2):37-53. DOI: 10.3109/00952998509016848. View