Statistical inference and Monte Carlo algorithms

Prescribing practices in opioid agonist treatment and changes in compliance to clinical dosing guidelines in British Columbia, Canada

BACKGROUND AND AIM

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.

DESIGN, SETTING AND PARTICIPANTS

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.

MEASUREMENTS

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.

FINDINGS

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.

CONCLUSION

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.

Empirical Modeling of Electron Transport in Fe/Ti Layered Double Hydroxide Using Exponential, Gaussian and Mixed Gauss-Exponential Distribution

Fe/Ti-layered double hydroxide (LDH) has been hydrothermally prepared and characterized using X-ray diffraction, scanning electron microscopy, atomic force microscopy, Fourier transform infrared spectroscopy, and UV-visible diffuse reflectance spectroscopy for evaluation of its structure, morphology, and optical properties. The purpose of doping Ti⁴⁺ with Fe³⁺ toward the synthesis of Fe/Ti LDH is to extend the absorption of the nanomaterial to longer wavelength, which is known to exhibit higher electron transport performance. To provide a practical realization, electron transport modeling across the band gap has been interpreted using exponential, Gaussian, and mixed Gauss-exponential distribution. The conduction band energy (E _C) has been calculated by using the observed values of band gap (E _g) and ξ-potential of the LDH. A detailed study has been undertaken to investigate the pattern of theoretical density of the LDH on the basis of unknown (E _C = 0) and known (calculated) values of E _C. Fermi-Dirac statistics has been used extensively for estimating the occupancy probability of electron (e^-)-hole (h⁺) pair formation within the valence and conduction bands, respectively, with different temperatures, as well as for given energy levels. Monte Carlo simulations have also been performed to evaluate the suitability of the choice of the model, on the basis of the probability of availability of e^-s within the conduction band. To provide a practical realization of the suggested models, electronic transition across the band gap of Fe/Ti LDH has been extensively investigated.