Factors associated with patient perceived suboptimal dosing of in-hospital opioid agonist therapy among people who use illicit drugs in Vancouver, Canada

Abstract

Background:

Optimal dosing of opioid agonist therapy (OAT) is essential for treatment success. However, initiation and maintenance of OAT in hospital settings can be challenging given differing levels of opioid tolerance, withdrawal, and intoxication among patients.

Objective:

The objective of this study was to characterize the prevalence and factors associated with in-hospital patient perceived suboptimal OAT dosing among people who use illicit drugs (PWUD) in Vancouver, Canada.

Methods:

Data were derived from three prospective cohorts of PWUD in Vancouver, Canada. Bivariable and multivariable logistic regression models were used to examine factors associated with patient perceived suboptimal in-hospital OAT dose.

Results:

273 study participants were prescribed OAT while in hospital: 83 (30.4%) participants perceived their OAT dose to be suboptimal. In a multivariable model, factors positively associated with a perceived suboptimal OAT dose included: homelessness (adjusted odds ratio [AOR] = 2.85; 95% CI: 1.53–5.28), daily stimulant use (AOR = 2.03; 95% CI: 1.14–3.63) and illicit drug use while in hospital (AOR = 2.33; 95% CI: 1.31–4.16).

Conclusions:

Almost one third of participants perceived receiving a suboptimal OAT dose while in hospital. These observed correlations indicate that a patient’s perception of suboptimal OAT dosing in hospital may be more prevalent for patients who are homeless, report polysubstance use with stimulants and opioids and who obtain illicit drugs while hospitalized. While cautious prescribing of OAT in patients experiencing hospitalization is important, these findings demonstrate a high prevalence of and apparent risk factors for perceived suboptimal OAT dosing.

Keywords:

• Opioids
• OAT
• methadone
• homeless
• dosing

Acknowledgments

The study was supported by the US National Institutes of Health (NIH) (U01DA038886, U01DA021525). LT is supported by a Michael Smith Foundation for Health Research (MSFHR) Scholar Award. KH is supported by a CIHR New Investigator Award (MSH-141971), a MSFHR Scholar Award, and the St. Paul’s Foundation. HD is supported by a CIHR Doctoral Award. MJM is supported by a CIHR New Investigator Award, a MSFHR Scholar Award and the US NIH (U01DA021525). He is the Canopy Growth professor of cannabis science at the University of British Columbia, a position funded through arm’s length gifts to the university from the Government of British Columbia’s Ministry of Mental Health and Addictions and Canopy Growth, a licensed producer of cannabis. KD is supported by a MSFHR/St. Paul’s Hospital Foundation–Providence Health Care Career Scholar Award and a Canadian Institutes of Health Research New Investigator Award. SN is supported by a MSFHR, Providence Health Care Research Institute Early Career Research Initiative Award and the University of British Columbia Steven Diamond Professorship in Addiction Care Innovation Award. The funder had no direct role in the conduct of the analysis or the decision to submit the manuscript for publication. All inferences, opinions, and conclusions drawn in this publication are those of the author(s), and do not necessarily reflect the opinions or policies of the data steward. The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff.

Authors’ contributions

SE, KH, MJM, KD, and LT designed the study. HD performed the statistical analyses, and SE and LT interpreted the results and drafted the first draft of the manuscript. All other authors contributed extensively to the writing and critical revising of the manuscript, and the final manuscript product was approved by all authors.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.