Lessons from the HIV pandemic could help identify gaps in accessing treatment for opioid use disorder

published on July 31, 2018

New research from the BC Centre on Substance Use (BCCSU) suggests applying successful strategies to fight HIV/AIDS in response to overdose crisis.

In a study published in the August issue of the peer-reviewed journal Drug and Alcohol Dependence, BCCSU researchers used data from approximately 10 years of interviews from people with opioid use disorders (e.g., heroin, fentanyl, pain killers, etc.) to analyse their engagement in addiction treatment. Called a “cascade of care” analysis, this approach uses pre-defined metrics for health care success and was developed to focus efforts to curb the HIV pandemic.

Researchers studied 1,615 daily opioid users in Vancouver, BC, between 2006 and 2016. While they observed improvements during that time in the proportion of people who were linked to addiction care (73.2% to 78.9%), accessed opioid agonist treatments (OAT) like methadone and buprenorphine/naloxone (69.2% to 70.6%), were retained on OAT (29.1% to 35.5%), and achieved stability (10.1% to 17.1%), the findings reveal enormous gaps that still exist in delivering evidence-based treatment. In particular, they found that only one-third of individuals were retained in evidence-based addiction care in 2016, the final year of the study.

Untreated opioid use disorder is a key driver of the overdose crisis in BC and across North America. Last year, 1,422 people in BC died of an illicit drug overdose. A report for the BC Coroners Service Death Panel in April identified the need to expand access to evidence-based addiction care across the continuum, as well as the full spectrum of recovery supports.

“Novel approaches to improve engagement in evidence-based treatment for opioid use disorder are urgently needed to address the escalating overdose crisis,” says Dr. Eugenia Socías, UBC assistant professor and research scientist at the BCCSU, and lead author of the study. “Understanding who is – or isn’t – accessing treatment and why is critical to developing effective responses.”

For example, researchers found that those who were older, Caucasian, or living with HIV or hepatitis C were more likely to achieve higher status on the cascade. Conversely, periods of daily crack use, homelessness, and incarceration were generally associated with less likelihood of achieving the four cascade stages.

The cascade of care approach was successfully applied in British Columbia to evaluate the quality of health care delivery for HIV – including access to medications and retention in treatment – helping to identify gaps and implement strategies in response. As a result, rates of new HIV infection among people who use drugs have declined and remained low since peaking in the mid-1990s.

The study authors believe the cascade of care framework has potential to monitor and evaluate efforts to treat and care for people with opioid use disorder, and anticipate and address future crises.

“Our objective with this research was to use the cascade of care approach to identify gaps faced by people living with opioid use disorder,” said Dr. M-J Milloy, senior author and research scientist at BCCSU. “These findings suggest approaches that have been successful in developing responses to HIV could be similarly implemented to monitor care for substance use disorders and develop targeted strategies so more people can access evidence-based care in support of their health and wellbeing.”

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About the BC Centre on Substance Use
The BC Centre on Substance Use (BCCSU) is a provincially networked organization with a mandate to develop, help implement, and evaluate evidence-based approaches to substance use and addiction. As a research centre of Providence Health Care Research Institute and a University of British Columbia Faculty of Medicine Centre, the BCCSU’s vision is to transform substance use policies and care in BC by translating research into education and evidence-based care guidance. By supporting the collaborative development of evidence-based policies, guidelines and standards, the BCCSU seeks to improve the integration of best practices and care across the continuum of substance use, thereby serving all British Columbians. The BCCSU seeks to achieve these goals through integrated activities of its three core functions: research and evaluation, education and training, and clinical care guidance.

For more information or to schedule an interview, please contact:
Kevin Hollett, BC Centre on Substance Use
778-918-1537
khollett@cfenet.ubc.ca