{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:47:44Z","timestamp":1788922064894,"version":"build-2803163510"},"reference-count":86,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,2,6]],"date-time":"2020-02-06T00:00:00Z","timestamp":1580947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>The \u2018cascade of care\u2019 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, 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective study using a provincial\u2010level linkage of four health administrative databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting and participants<\/jats:title><jats:p>All PWOUD in BC from 1\u00a0January 1996 to 30\u00a0November 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>The eight\u2010stage cascade of care included diagnosed PWOUD, ever on opioid agonist treatment (OAT), recently on OAT, currently on OAT and retained on OAT: \u2265\u00a01, \u2265\u00a03, \u2265\u00a012 and \u2265\u00a024\u00a0months). Health\u2010care 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>A total of 55\u2009470 diagnosed PWOUD were alive at end of follow\u2010up. As of 2017, a majority of the population (<jats:italic>n<\/jats:italic>\u00a0=\u00a039\u2009456; 71%) received OAT during follow\u2010up; however, only 33% (<jats:italic>n<\/jats:italic>\u00a0=\u00a018\u2009519) were currently engaged in treatment and 16% (<jats:italic>n<\/jats:italic>\u00a0=\u00a08960) had been retained for at least 1\u00a0year. Compared with those never on OAT, those currently engaged in OAT were more likely to be aged under 45\u00a0years [adjusted odds ratio (aOR)\u00a0=\u00a01.75, 95% confidence interval (CI)\u00a0=\u00a01.64, 1.89], male (aOR\u00a0=\u00a01.72, 95% CI\u00a0=\u00a01.64, 1.82), with concurrent substance use disorders (aOR\u00a0=\u00a02.56, 95% CI\u00a0=\u00a02.44, 2.70), hepatitis C virus (HCV) (aOR\u00a0=\u00a01.22, 95% CI\u00a0=\u00a01.14, 1.33) and either homeless or receiving income\u2010assistance (aOR\u00a0=\u00a04.35, 95% CI\u00a0=\u00a04.17, 4.55). Regular contact with the health\u2010care system\u2014either in out\u2010patient or acute care settings\u2014was common among PWOUD not engaged in OAT, regardless of time since diagnosis or treatment discontinuation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>People with opioid use disorder in British Columbia, Canada show high levels of out\u2010patient 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14947","type":"journal-article","created":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T14:57:16Z","timestamp":1578063436000},"page":"1482-1493","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":94,"title":["The cascade of care for opioid use disorder: a retrospective study in British Columbia, Canada"],"prefix":"10.1111","volume":"115","author":[{"given":"Micah","family":"Piske","sequence":"first","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoxuan","family":"Zhou","sequence":"additional","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong E.","family":"Min","sequence":"additional","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natt","family":"Hongdilokkul","sequence":"additional","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A.","family":"Pearce","sequence":"additional","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahmida","family":"Homayra","sequence":"additional","affiliation":[{"name":"BC Centre for Excellence in HIV\/AIDS  Vancouver BC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2556-7049","authenticated-orcid":false,"given":"M. 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