Literature Collection

"Canada is in the midst of an opioid crisis, making it important to disseminate standardized approaches and evidence-based recommendations for managing opioid use disorder. Opioid Agonist Treatment: A Synthesis of Canadian Guidelines for Treating Opioid Use Disorder is a national clinical guideline that harmonizes existing provincial and national guidelines, evidence-based practices and expert opinions into one document aimed at providing consistent and high-quality care to people with opioid use disorder. Opioid agonist therapy is the most effective treatment option for opioid use disorder, ideally combined with behavioural and social supports. It can stabilize the cycle of intoxication and withdrawal, reduce opioid cravings and block the intoxicating effects of other short-acting opioids, including fentanyl. People who are maintained on opioid agonist therapy typically experience improved health and social functioning and reduced risk of overdose. CAMH worked with subject matter experts and medical regulatory authorities across Canada to reach consensus on recommendations from existing guidelines. The aim of this unified guideline is to standardize expectations for Canadian prescribers, but not to replace any adopted guidelines. Please consult your professional regulatory body for specific guidance in your jurisdiction."--

INTRODUCTION: Although many drugs are implicated in the crisis, opioids and concomitant sedatives are associated with increased overdose risk in both rural and urban communities. Individuals in rural areas are up to 5-fold more likely to experience adverse outcomes related to opioids. The primary objective of this study was to evaluate concomitant use of opioid and benzodiazepine prescriptions in Texas, compare metropolitan and rural differences, and use these data to inform clinicians and to help develop harm reduction strategies. METHODS: Prescribing data were extracted from the Texas Prescription Drug Monitoring Program (PDMP) public use data file, the statewide monitoring program administered by the Texas State Board of Pharmacy. An overlapping drug combination prescription day was defined as any day in which a patient had at least one of the overlapping drug types-eg, opioid + benzodiazepine, opioid + benzodiazepine + carisoprodol. RESULTS: In Texas, 47.4 percent of the counties with the highest number of overlapping days (per patient) bordered other states. Providers who practice in rural areas prescribe opioid and benzodiazepine medications with 8.2 more overlapping days per quarter. DISCUSSION: Taking both opioid and benzodiazepine prescriptions is associated with increased overdose risk. Opioid prescription data provide a distinct view into the opioid epidemic that allows all states and counties to view the trends of opioid utilization. There are only a few studies using PDMP data to compare urban and rural trends. CONCLUSIONS: Rural patients had more benzodiazepine and opioid days overlap than urban patients. The prevalence is higher among older adults and providers who practice in rural areas (average 8.2 more days per quarter). Our findings in Texas indicate a trend downward in overlap for both rural and urban areas over the last year of measurement. However, rural areas are still significantly higher.

BACKGROUND: Pregnant and post-partum women with opioid dependence are an extremely vulnerable population within correctional facilities. A significant number of maternal inmates, however, still lack adequate provision of medications for opioid use disorder (OUD) and are subsequently forced into withdrawal. Currently, there exist no comprehensive reviews on the scope of literature regarding the management of this population. We aimed to provide a review on the research surrounding these women. DESIGN: A systematic search of PubMed Central was conducted to identify studies evaluating OUD among pregnant and post-partum incarcerated women. Citations from only the last 20 years were included to ensure both relevance and scope of information. RESULTS: The topics that emerged from this review included medications for OUD (MOUD) administration vs detoxification practices, treatment upon incarceration and upon release, and maternal and fetal outcomes. Across all articles, current care management of this population appeared inadequate. We further compiled all author recommendations and perspectives into a framework that can inform potential improvements in care coordination. CONCLUSIONS: This review identifies significant gaps in current management-particularly regarding administration of MOUDs-and emphasizes the need for standardization of addiction-related and perinatal healthcare. We also highlight gaps in the literature and potential areas for future research.