Gender differences in access to methadone maintenance therapy in a Canadian setting

The Experience of Women With Opioid Use Disorder Accessing Methadone Treatment

ABSTRACT

The number of women experiencing opioid use disorder (OUD) in Canada has increased exponentially. In Canada, healthcare is socialized and free for all citizens and, often, medications like methadone are free as well, yet few individuals with OUD access treatment services. The purpose of this study was to describe the lived experiences of Canadian women with OUD who were receiving methadone treatment. Interpretive phenomenology was used to investigate the treatment experiences of seven women with OUD. The conceptual framework of self-care of chronic illness was used to examine this phenomenon. Data were analyzed using a seven-step process of interpretive phenomenological analysis. Four major themes emerged: learning how to be you again, reaching out for help, finding your way to methadone, and going down the path of methadone. Women's experiences were influenced by family, friends, and healthcare providers. Accessibility and self-determination were important factors in entering and sustaining treatment. This study contributes to the discipline of nursing by providing accurate information regarding women's experiences with OUD and uncovering practice changes that can attract and retain women in treatment.

Effectiveness and Safety of Low-Threshold Opioid-Agonist Treatment in Hard-To-Reach Populations with Opioid Dependence

OBJECTIVES

Opioid-use disorder is related to premature death worldwide. Opioid-agonist treatment (OAT) is an effective treatment for opioid dependence. OAT delivery platforms may influence treatment access and outcomes, especially for the most vulnerable groups. The aim of this study was to determine the effectiveness and safety of low-threshold OAT compared to the standard treatment.

METHODS

Patients with diagnosed opioid dependence undergoing low-threshold OAT at the Bergen delivery platform in Norway were enrolled in a cohort study in 2014-2019. A national OAT cohort was the reference group. The main outcomes were treatment retention, the use of illicit opioids, non-fatal overdose, overdose death, and all-cause mortality during the first year following treatment initiation and the full treatment period. Additionally, healthcare utilization in the periods before and during OAT was investigated.

RESULTS

Compared to the reference cohort, the low-threshold cohort (n = 128, mean age: 38 years, women: 28%) showed treatment retention rates of 95% versus 92%, illicit opioid use of 7% versus 10%, non-fatal overdose of 7% versus 6%, and death at 1.0% versus 1.3%, respectively. The incident rate ratios (IRRs) for healthcare utilization increased substantially during the OAT period compared to the period before; the IRR increased by 3.3 (95% confidence interval (CI): 2.8, 3.9) and 3.4 (95% CI: 3.1, 3.9) for all in- and outpatient healthcare, respectively.

CONCLUSIONS

Low-threshold OAT was at least as effective and safe as the standard OAT in terms of treatment retention, the use of illicit opioids, non-fatal overdose, and death. Healthcare utilization increased during the OAT compared to the period before. Lowering the threshold for OAT entrance within proper delivery platforms should be broadly considered to reduce harm and improve healthcare access among patients with opioid dependence.

Characterising the increasing prevalence of crystal methamphetamine use in Vancouver, Canada, from 2006-2017: A gender-based analysis

INTRODUCTION

Methamphetamine use is increasing in North America and is associated with numerous negative health effects and social harms. As drug-related harms are often gendered, this study sought to examine the differential impacts of gender on the trends, risk factors and health implications of crystal methamphetamine use among a Canadian cohort of people with high rates of injection polysubstance use.

METHODS

Data were collected from two prospective cohorts of people who inject drugs in Vancouver, Canada. We examined trends in reported crystal methamphetamine use from 2006-2017 using the Cochrane-Armitage test for trend. We used multivariable generalised estimating equations, stratified by gender, to determine independent risk factors and health outcomes associated with crystal methamphetamine use.

RESULTS

In total, 1984 participants were included in the study, including 694 (35%) women. The prevalence of reported crystal methamphetamine use within the previous 6 months rose from 19% in 2006 to 36% in 2017, with a rise seen in both genders (P < 0.001). Reported crystal methamphetamine use was associated with numerous risk behaviours and drug-related harms in both genders, and in women it was associated with an increase in experiences of sexual violence (adjusted odds ratio 1.64, 95% confidence interval 1.18, 2.27).

CONCLUSIONS

These findings demonstrate the rising prevalence of reported crystal methamphetamine use in Vancouver in a cohort with high rates of polysubstance use. This work highlights drug and sex-related risk behaviours associated with crystal methamphetamine use for both genders, and underscores the need to develop strategies to address the growing use of crystal methamphetamine.

Opioid substitution therapy: Lowering the treatment thresholds

BACKGROUND

Opioid substitution therapy (OST) has been established as the gold standard in treating opioid use disorders. Nevertheless, there is still a debate regarding the qualitative characteristics that define the optimal OST intervention, namely the treatment threshold. The aim of this review is twofold: first, to provide a summary and definition of "treatment thresholds", and second, to outline these thresholds and describe how they related to low and high threshold treatment characteristics and outcomes.

METHOD

We searched the main databases of Medline, PubMed, PsycInfo, EMBASE, CINAHL and the Cochrane Library. Original published research papers, reviews, and meta-analyses, containing the eligible keywords: "opioid substitution", "OST", "low threshold", "high threshold" were searched alone and in combination, up to June, 2015.

RESULTS

Treatment thresholds were defined as barriers a patient may face prior to and during treatment. The variables of these barriers were classified into treatment accessibility barriers and treatment design barriers. There are increasing numbers of studies implementing low threshold designs with an increasing body of evidence suggesting better treatment outcomes compared to high threshold designs.

CONCLUSION

Clinical characteristics of low threshold treatments that were identified to increase the effectiveness of OST intervention include increasing accessibility so as to avoid waiting lists, using personalized treatment options regarding medication choice and dose titration, flexible treatment duration, a treatment design that focuses on maintenance and harm reduction with emphasis on the retention of low adherence patients.