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      The Impact of Injectable Opioid Agonist Treatment (iOAT) on Involvement in Criminalized Activities: A Secondary Analysis from a Clinical Trial in Vancouver, BC

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          Abstract

          Purpose

          A significant portion of the economic consequences of untreated Opioid Use Disorder (OUD) relate to individuals’ involvement in the criminal justice system. The present study uncovers if treatment with iOAT is related to the number of criminal charges amongst participants, what type of crime participants were involved in, and the frequency with which participants were victims of crime. This study contributes to the body of research on the effectiveness of iOAT reducing criminal involvement.

          Patients and Methods

          This is a secondary analysis of police record data obtained from the Vancouver Police Department over a three-year period during the Study to Assess Longer-term Opioid Medication Effectiveness clinical trial. The data was obtained from participants (N = 192) enrolled in the trial through a release of information form.

          Results

          During the three-year period, most charges (45.6%) were property offences, and 25.5% of participants were victims of crime. Participants with no treatment prior to randomization into the SALOME trial were 2.61 (95% CI = 1.64–4.14) more likely to have been charged with a crime than during the iOAT state.

          Conclusion

          IOAT can reduce individuals’ involvement with the criminal justice system and is thus a crucial part of the continuum of care. Addiction should be conceptualized as a healthcare rather than criminal issue.

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          Most cited references40

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          Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

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            Hydromorphone Compared With Diacetylmorphine for Long-term Opioid Dependence

            Diacetylmorphine hydrochloride (the active ingredient in heroin), delivered under supervision, is effective for the treatment of severe opioid use disorder. However, owing to political and regulatory barriers, it is not available in many settings around the world, which limits the options for many long-term street opioid injectors not attracted into or retained in available treatments.
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              Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study

              Abstract Objective To compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply. Design Population based retrospective cohort study. Setting Individual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada. Participants 55 347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018. Main outcome measures All cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply. Results 7030 (12.7%) of 55 347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk). Conclusions Retention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.
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                Author and article information

                Journal
                Subst Abuse Rehabil
                Subst Abuse Rehabil
                sar
                Substance Abuse and Rehabilitation
                Dove
                1179-8467
                15 November 2023
                2023
                : 14
                : 147-156
                Affiliations
                [1 ]Department of Education and Counselling Psychology, McGill University , Montreal, QC, Canada
                [2 ]Centre for Advancing Health Outcomes, Providence Health Care , Vancouver, BC, Canada
                [3 ]Providence Health Care, Providence Crosstown Clinic , Vancouver, BC, Canada
                [4 ]BC Centre for Disease Control, Provincial Health Services Authority , Vancouver, BC, Canada
                [5 ]School of Population and Public Health, University of British Columbia , Vancouver, BC, Canada
                Author notes
                Correspondence: Eugenia Oviedo-Joekes, Centre for Advancing Health Outcomes, St. Paul’s Hospital , 575-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada, Tel +1 604-682-2344 Ext. 62973, Fax +1-604-806-8210, Email eugenia.joekes@ubc.ca
                Article
                438451
                10.2147/SAR.S438451
                10657756
                b7a4647f-34ae-4994-956b-abe6c4dedafa
                © 2023 Dobischok et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 26 September 2023
                : 07 November 2023
                Page count
                Figures: 1, Tables: 3, References: 42, Pages: 10
                Funding
                Funded by: Canadian Institutes of Health Research, open-funder-registry 10.13039/501100000024;
                Funded by: Providence Health Care, open-funder-registry 10.13039/100012453;
                Funded by: InnerChange Foundation;
                Funded by: Providence Health Care, open-funder-registry 10.13039/100012453;
                Funded by: St. Paul’s Hospital Foundation;
                Funded by: Vancouver Coastal Health;
                Funded by: Michael Smith Foundation for Health Research, open-funder-registry 10.13039/501100000245;
                Funded by: Canada Institutes of Health Research;
                Funded by: Canada Research Chairs Program;
                SALOME was funded by an operating grant from the Canadian Institutes of Health Research [MCT-103817] in partnership with Providence Health Care and financing from the InnerChange Foundation, Providence Health Care Research Institute, St. Paul’s Hospital Foundation, and Vancouver Coastal Health. Additional financial support was provided by the Michael Smith Foundation for Health Research Career Award and the Canada Institutes of Health Research New Investigator Award (EOJ) and the Canada Research Chairs Program (MTS). The funding sources were not involved in any aspect of the study or manuscript. The SALOME trial received ethical approval from the University of British Columbia and Providence Healthcare research ethics boards, and all participants provided informed written consent.
                Categories
                Original Research

                heroin assisted treatment,diacetylmorphine,hydromorphone,crime,charges,police

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