Frontiers in public health · 2026
Impact of opioid agonist therapies on non-fatal and fatal overdose: treatment patterns among individuals with opioid use disorder in Ontario, Canada.
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Lee Kenneth, Lam Vincent, Nicolle Jennifer, Drolet Martine, Abdel-Sattar Maher, Ng Ginnie, Snider-Adler Melissa
Аннотация
BACKGROUND: Although opioid agonist therapies (OAT) including buprenorphine extended-release (BUP-XR), transmucosal buprenorphine (TM-BUP), methadone and slow-release oral morphine (SROM) are effective and established medications for opioid use disorder (MOUD) available in Canada, differences in opioid-related overdose (OD) risk reduction across OAT types and patterns of treatment use are not well characterized.
OBJECTIVE: To assess the impact of OAT on opioid-related non-fatal and fatal OD among individuals with OUD in Ontario, Canada, and to examine patterns of OAT use.
METHODS: A retrospective, population-based, nested case-control study was conducted using ICES administrative health data. Adults with opioid use disorder (OUD) who were administered ≥1 OAT from January 2022 through June 2024 were included. Cases with opioid-related non-fatal or fatal OD were matched 1:10 to controls on age, sex, and follow-up duration. Adjusted odds ratios were estimated using weighted exact conditional logistic regression.
RESULTS: Among 45,243 individuals with OUD who started OAT, 4,109 (9.1%) experienced a non-fatal OD and 770 (1.7%) had a fatal OD. Fatal OD cases were most commonly aged 35-49 years; non-fatal cases were most prevalent among those aged 18-34 years. Most OD cases were male and resided in urban areas. Substance use disorders other than OUD and anxiety disorders were more prevalent among OD cases than controls. Of non-fatal and fatal OD cases, 75.9% and 84.9% were not covered by an OAT for at least 80% of the time between cohort entry and index OD event, respectively. Of all OATs, BUP-XR had the lowest proportion of patients with non-fatal and fatal OD compared to no treatment. Both BUP-XR and TM-BUP were associated with significantly lower odds of non-fatal and fatal OD compared to no OAT, while methadone and SROM did not show similar improvements.
CONCLUSION: OAT type and treatment continuity were associated with different OD risk reductions. Supporting sustained OAT engagement and expanding access to buprenorphine, including BUP-XR, may reduce non-fatal and fatal OD risk among individuals with OUD. Limitations include potential misclassification in administrative data, incomplete or inaccurate capture of opioid-related OD events and OAT use, and absence of a direct measure of OAT adherence.
OBJECTIVE: To assess the impact of OAT on opioid-related non-fatal and fatal OD among individuals with OUD in Ontario, Canada, and to examine patterns of OAT use.
METHODS: A retrospective, population-based, nested case-control study was conducted using ICES administrative health data. Adults with opioid use disorder (OUD) who were administered ≥1 OAT from January 2022 through June 2024 were included. Cases with opioid-related non-fatal or fatal OD were matched 1:10 to controls on age, sex, and follow-up duration. Adjusted odds ratios were estimated using weighted exact conditional logistic regression.
RESULTS: Among 45,243 individuals with OUD who started OAT, 4,109 (9.1%) experienced a non-fatal OD and 770 (1.7%) had a fatal OD. Fatal OD cases were most commonly aged 35-49 years; non-fatal cases were most prevalent among those aged 18-34 years. Most OD cases were male and resided in urban areas. Substance use disorders other than OUD and anxiety disorders were more prevalent among OD cases than controls. Of non-fatal and fatal OD cases, 75.9% and 84.9% were not covered by an OAT for at least 80% of the time between cohort entry and index OD event, respectively. Of all OATs, BUP-XR had the lowest proportion of patients with non-fatal and fatal OD compared to no treatment. Both BUP-XR and TM-BUP were associated with significantly lower odds of non-fatal and fatal OD compared to no OAT, while methadone and SROM did not show similar improvements.
CONCLUSION: OAT type and treatment continuity were associated with different OD risk reductions. Supporting sustained OAT engagement and expanding access to buprenorphine, including BUP-XR, may reduce non-fatal and fatal OD risk among individuals with OUD. Limitations include potential misclassification in administrative data, incomplete or inaccurate capture of opioid-related OD events and OAT use, and absence of a direct measure of OAT adherence.