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Emergency rooms should give opioid users withdrawal meds: study

Patients who have opioid overdoses and are brought to hospital would benefit from long-term therapy to prevent withdrawal cravings and symptoms
Used needles are seen here in downtown Sudbury Nov. 17, 2023.

Better patient outcomes could be achieved from emergency department visits for opioid overdoses if those visits were used to initiate opioid agonist therapy, says a study published recently in the Canadian Medical Association Journal.

Opioid agonist therapy (OAT) is regarded as helpful for people with an addiction to opioid drugs such as heroin, oxycodone, hydromorphone (Dilaudid), fentanyl and Percocet, said the study. 

The OAT therapy involves taking the opioid agonists methadone (Methadose) or buprenorphine (Suboxone), which are medications that help prevent withdrawal and reduce the cravings for opioid drugs. Advocates for OAT argue this can help people who have Opioid Use Disorder (OUD) by stabilizing their lives and reducing harms.

The Health Canada website said with opioid agonist therapy, long-acting opioid medications are given under the supervision of a health care provider. These drugs act more slowly in the body for a longer period of time.

The CMAJ study was authored by Tina Hu, Daniel McCormack, David N. Juurlink, Tonya J. Campbell, Ahmed M. Bayoumi, Pamela Leece, Jessica T. Kent and Tara Gomes representing scientists and physicians at the University of Toronto faculty of medicine, McMaster University department of family medicine, the Sunnybrook Research Institute, Public Health Ontario and the Department of Emergency Medicine (Kent), University of Toronto.

CMAJ said the objective of the study was to evaluate OAT initiation rates after a hospital encounter for opioid toxicity in Ontario emergency rooms and determine whether publication of a 2018 Canadian OUD management guideline was associated with increased initiation.

The study found that after more than 20,700 hospital visits for OUD patients with opioid toxicity, the median age was 35 years and just over 65 per cent of them were males. 

"Among hospital encounters for opioid toxicity, despite rising prevalence over time, only one in 18 patients (in Ontario) were dispensed OAT within a week of discharge in early 2020. These findings highlight missed opportunities to initiate therapies proven to reduce mortality in patients with OUD," said the study.

"Opioid use disorder (OUD) is a substantial public health problem with an increasing prevalence worldwide," said the study. 

From 2016 to 2021, the study said 26,690 opioid-related deaths occurred in Canada. 

Some of the startling facts in the study were that from 2016 to 2021, there were 26,690 opioid-related deaths that occurred in Canada. In Ontario, two-thirds of these deaths were among patients with OUD. The study said that, in 2021, one in 219 Ontarians was treated for OUD.

In Canada, opioid-related hospital admissions increased by 32 per cent between 2016 and 2021.  

Also in Ontario, opioid-related emergency department visits increased by 286 per cent. Among patients presenting to the emergency department with nonfatal opioid overdose, close to five per cent die within one year.

The report concluded that additional efforts are needed across Canada to improve initiation of OAT in acute care settings.

A full text copy of the study is available online here.