Recent Opioid Agonist Treatment Discontinuation Trends in British Columbia, 2012-2018

Background:

Given the elevated risk of mortality immediately following opioid agonist treatment discontinuation, peer support services to facilitate uninterrupted opioid agonist treatment (OAT) hold promise as a new model of personalized care. We sought to describe trends in weekly and monthly trends in OAT episode discontinuations to determine the potential resource needs for implementing peer support services for all individuals on OAT in BC.

Methods:

This population-based retrospective study utilized a provincial-level linkage of health administrative databases to identify all people with opioid use disorder (PWOUD) who received OAT between January 2012 and August 2018. We derived the percentage of PWOUD discontinuing OAT every month and estimated peer workforce needs from the published literature. We also reported discontinuation results for methadone and buprenorphine/naloxone. Finally, we considered weekly discontinuations between September 2017 and August 2018, accounting for weeks during which income assistance disbursement occurred.

Results:

Our study included 37,207 PWOUD discontinuing 158,027 OAT episodes during the study period. The number of discontinuations among all PWOUD on OAT were relatively stable month-to-month and increased from 10.6% to 14.9% between 2012-2018. We estimated a need for 56-135 peers to provide monthly support services. The monthly percentage of discontinuations was 21.2% for buprenorphine/naloxone and 10.0% for methadone. Weekly discontinuations were greater in income disbursement weeks (816; IQR: 752, 901) compared to other weeks (655; IQR: 615, 683; p<0.01).

Conclusions:

We identified a high, and stable rate of monthly OAT discontinuations and a consistently higher rate of discontinuing treatment among PWOUD accessing buprenorphine/naloxone. We also provided a basis for peer workforce needs to support OAT engagement in British Columbia. There is an urgent need to develop the evidence base for interventions to support OAT engagement and to improve clinical management of OUD to address the opioid-related overdose crisis.

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