Concurrent psychiatry for patients enrolled in opioid agonist treatment: a propensity score matched cohort study in Onta
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(2019) 14:29
RESEARCH
Open Access
Concurrent psychiatry for patients enrolled in opioid agonist treatment: a propensity score matched cohort study in Ontario Canada Kristen A. Morin1, Joseph K. Eibl2, Joseph M. Caswell6, Graham Gauthier2, Brian Rush4, Christopher Mushquash2,5, Nancy E. Lightfoot1 and David C. Marsh2,3*
Abstract Objective: The objective was to characterize the relationship between geography, concurrent psychiatric services, all-cause mortality, and acute health care use for individuals enrolled in Opioid Agonist Treatment, in Ontario, Canada. Methods: We conducted a propensity score matching study of patients enrolled in Opioid Agonist Treatment in Ontario for the first time between January 1, 2011, and December 31, 2015. We first compared outcomes between patients who were actively engaged and patients who were not actively engaged in Opioid Agonist Treatment. We created treatment and a control groups on the basis of an individual’s access to psychiatric care within an episode of Opioid Agonist Treatment. Relative risk and number needed to treat were calculated to determine the correlation between psychiatric care and health outcomes among patients enrolled in Opioid Agonist Treatment at two time points within an episode of care and for two geographic regions in Ontario (north and south). Results: During the first year of Opioid Agonist Treatment, concurrent psychiatric care was associated with a reduction in all-cause mortality in southern Ontario (RR 0.80, 95% CI, 0.73–0.87), a reduction in emergency department visits in both northern and southern Ontario (north: RR = 0.76, 95% CI, 0.72–0.81; south: RR = 0.87, 95% CI, 0.86–0.88), and a reduction in hospitalizations (north: RR = 0.88, 95% CI. 0.82–0.94, south: RR = 0.92, 95% CI, 0.91–0.93). Conclusion: Our findings have significant clinical and political implications for health system planning highlighting the need for integrated mental health and addiction services for individuals with Opioid Use Disorder. Keywords: Opioid use disorder, Mental disorders, Mental Health services, Psychiatry, Concurrent Health services, Rural Health
Background Opioid use disorder (OUD) is a significant and growing contributor to the global burden of disease [1] and opioid poisoning has been characterized as a crisis devastating families and communities [2] across Canada. In 2016, there were nearly 3000 opioid-related deaths in Canada [3] which accounted for nearly 30,000 years of life lost [4]. It is * Correspondence: [email protected] 2 Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada 3 Canadian Addiction Treatment Centres, Richmond Hill, ON, Canada Full list of author information is available at the end of the article
estimated that 50 to 90% of patients with OUD have a concurrent mental disorder and that patients with this type of co-morbidity have a significant increased risk of death, infectious disease, acute and chronic health complications [5– 8]. Despite these factors, there are challenges with coordinating mental health and addiction ser
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