BACKGROUND AND AIMS The 'cascade of care' framework, measuring attrition at various stages of care engagement, has been proposed to guide the public health response to the opioid overdose public health emergency in British Columbia (BC), Canada. We estimated the cascade of care for opioid use disorder and identified factors associated with care engagement for people with opioid use disorder (PWOUD) provincially. DESIGN Retrospective study using a provincial-level linkage of four health administrative databases. SETTING AND PARTICIPANTS All PWOUD in BC from January 1st, 1996 to November 30th, 2017. MEASUREMENTS The eight-stage cascade of care included diagnosed PWOUD, ever on opioid agonist treatment (OAT), recently on OAT, currently on OAT, and retained on OAT: ≥1m, ≥3m, ≥12m, ≥24m). Health care use, homelessness and other demographics were obtained from physician billing records, hospitalizations and drug dispensation records. Receipt of income assistance was indicated by enrollment in Pharmacare Plan C(48). FINDINGS A total of 55,470 diagnosed PWOUD were alive at end of follow-up. As of 2017, a majority of the population (N=39,456; 71%) received OAT during follow-up; however, only 33% (N=18,519) were currently engaged in treatment and 16% (N=8,960) had been retained for at least one year. Compared with those never on OAT, those currently engaged in OAT were more likely to be under 45 years of age (adjusted odds ratio: 1.75; 95% confidence interval: 1.64,1.89), male (1.72; 1.64,1.82), with concurrent substance use disorders (2.56; 2.44,2.70), HCV (1.22; 1.14,1.33) and either homeless or receiving income-assistance (4.35; 4.17,4.55). Regular contact with the healthcare system - either in outpatient or acute care settings - was common among PWOUD not engaged in OAT regardless of time since diagnosis or treatment discontinuation. CONCLUSIONS People with opioid use disorder in British Columbia, Canada show high levels of outpatient care prior to diagnosis. Younger age, male sex, urban residence, lower income level, and homelessness appear to be independently associated with increased opioid agonist treatment engagement.

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阿片类药物使用障碍的级联护理：加拿大不列颠哥伦比亚省的一项回顾性研究

背景和目标 在加拿大不列颠哥伦比亚省 (BC) 提出了“级联护理”框架，用于衡量护理参与各个阶段的流失，以指导公共卫生应对阿片类药物过量服用的突发公共卫生事件。我们估计了阿片类药物使用障碍的护理级联，并确定了与省级阿片类药物使用障碍 (PWOUD) 患者的护理参与相关的因素。设计 使用省级链接的四个卫生行政数据库的回顾性研究。设置和参与者 1996 年 1 月 1 日至 2017 年 11 月 30 日期间 BC 省的所有 PWOUD。 测量 八级级联护理包括确诊的 PWOUD、曾接受阿片类药物激动剂治疗 (OAT)、最近接受 OAT、目前接受 OAT 并保留在OAT：≥1m、≥3m、≥12m、≥24m）。保健用途，无家可归者和其他人口统计数据来自医生账单记录、住院和药物分配记录。通过加入 Pharmacare 计划 C(48) 表明收到了收入援助。结果 随访结束时，共有 55,470 名确诊的 PWOUD 存活。截至 2017 年，大多数人口（N=39,456；71%）在随访期间接受了 OAT；然而，目前只有 33% (N=18,519) 正在接受治疗，16% (N=8,960) 已保留至少一年。与从未接受过 OAT 的人相比，目前从事 OAT 的人更有可能在 45 岁以下（调整后的优势比：1.75；95% 置信区间：1.64、1.89）、男性（1.72；1.64、1.82），同时患有物质使用障碍（2.56；2.44、2.70）、HCV（1.22；1.14、1.33）和无家可归或接受收入援助（4.35；4.17、4.55）。无论是在门诊还是在急症护理环境中，定期与医疗保健系统联系在不参与 OAT 的 PWOUD 中都很常见，无论自诊断或治疗中断以来的时间如何。结论 加拿大不列颠哥伦比亚省的阿片类药物使用障碍患者在诊断前表现出高水平的门诊护理。年龄较小、男性、城市居民、收入水平较低和无家可归似乎与阿片类激动剂治疗参与度增加独立相关。