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Slaunwhite A, Min JE, Palis H, Urbanoski K, Pauly B, Barker B, Crabtree A, Bach P, Krebs E, Dale L, Meilleur L, Nosyk B. Effect of Risk Mitigation Guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study. BMJ 2024; 384:e076336. [PMID: 38199614 PMCID: PMC10777271 DOI: 10.1136/bmj-2023-076336] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To determine the effect of opioid and stimulant Risk Mitigation Guidance (RMG) dispensations on mortality and acute care visits during the dual public health emergencies of overdose and covid-19. DESIGN Population based retrospective cohort study. SETTING British Columbia, Canada. PARTICIPANTS 5882 people with opioid or stimulant use disorder who received RMG prescriptions for opioids (n=5356) and/or stimulants (n=1061) (535 received both) from 27 March 2020 to 31 August 2021. MAIN OUTCOME MEASURES All cause and overdose specific mortality and acute care visits in the week after RMG opioid or stimulant dispensation. RMG recipients were matched 1:1 with controls through use of high dimensional propensity score matching. Marginal structural models, executed on weekly time steps, were used to measure the effect of dispensations on outcomes. RESULTS RMG opioid dispensations of one day or more were associated with reduced all cause mortality (adjusted hazard ratio 0.39, 95% confidence interval 0.25 to 0.60) and overdose related mortality (0.45, 0.27 to 0.75) in the subsequent week. Dispensations of RMG stimulants (≥1 days) were not significantly associated with reduced all cause mortality (adjusted hazard ratio 0.50, 0.20 to 1.23) or overdose related mortality (0.53, 0.18 to 1.56). The protective effect of RMG opioid dispensations increased with the number of days the medications were dispensed in a given week. People who received four or more days of RMG opioid dispensations had reduced all cause mortality (adjusted hazard ratio 0.09, 0.04 to 0.21) and overdose related mortality (0.11, 0.04 to 0.32) compared with the control group. Opioid RMG dispensations did not significantly modify the odds of all cause or overdose related acute care visits. Dispensations of RMG stimulants were associated with a significant decrease in the odds of acute care visits for any cause but did not affect the odds of overdose related acute care visits. CONCLUSIONS RMG opioid dispensations were associated with reduced overdose related and all cause mortality among a sample of people with opioid use disorder. Pharmaceutical alternatives to the illegal drug supply are promising interventions to reduce mortality in people with opioid use disorder.
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Affiliation(s)
- Amanda Slaunwhite
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Jeong Eun Min
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | - Heather Palis
- BC Centre for Disease Control, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
- Department of Nursing, University of Victoria, Victoria, BC, Canada
| | - Brittany Barker
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
- First Nations Health Authority, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Alexis Crabtree
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Paxton Bach
- BC Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Emmanuel Krebs
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- BC Cancer, Vancouver, BC, Canada
| | - Laura Dale
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
| | | | - Bohdan Nosyk
- Centre for Advancing Health Outcomes, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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