Background
Opioid use has become a huge public health crisis and opioids are now one of the leading causes of deaths related to drugs worldwide. Identifying differences in predictors and treatment outcomes for people with opioid use disorder (OUD) that were introduced by prescription versus other means is important. It is also vital to understand what the goals are and needs that patients want to achieve out of OUD treatment.
Methods
We used systematic review methodology to first examine any adverse outcomes that may be associated with prescribing opioids for acute low back pain. We also conducted a systematic review and meta-analysis examining what are the differences in patients with OUD that were initially introduced to opioids by prescription in comparison to those introduced by recreational means. We then conducted an observational study using data obtained from the GENetics of Opioid Addiction (GENOA) research collaborative. We examined treatment outcome differences between individuals introduced to opioids through a licit prescription and those introduced through illicit means. We conducted a mixed-methods study asking what the desired goals of patients with OUD from the Pharmacogenetics of Opioid Substitution Treatment (POST) project are. Using data from POST, we also examined the treatment outcome differences between those that were receiving methadone treatment in comparison to those that were on buprenorphine. Results
The systematic review examining adverse outcomes of prescribing opioids for acute low back pain found that prescribing opioids for ALBP was significantly associated with long-term continued opioid use (1.57, 95% CI 1.06,2.33). The second systematic review found that those who were introduced to opioids through a legitimate prescription were significantly less likely to have illicit opioid use (0.70, 95% CI 0.50, 0.99) while in treatment. Our results from GENOA also showed that those introduced to opioids by prescription were more likely to have chronic pain, an older age of onset of opioid use, less likely to have hepatitis C and use cannabis. When we asked patients what goals they desired out of treatment, we found that the most frequently reported patient important outcomes were to stop treatment (39%) and avoid all drugs (25%). When comparing OUD patients by treatment we discovered that those receiving buprenorphine were less likely to consume illicit opioids and amphetamines but more likely to have used alcohol in comparison to those on methadone.
Conclusion
With this knowledge, we can recognize unique risk factors for each patient and provide more tailored treatment that can incorporate this into clinical practice to address specific concerns in various cohorts of OUD patients. Additionally, the variation in the selection of outcomes demand the need for further research to establish a set of outcomes that considers patients’ goals and preferences for OUD treatment. / Thesis / Candidate in Philosophy
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/26166 |
| Date | January 2021 |
| Creators | Sanger, Nitika |
| Contributors | Samaan, Zainab, Medical Sciences |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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