{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:13:40Z","timestamp":1787912020120,"version":"build-2784847793"},"reference-count":34,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,4,7]],"date-time":"2024-04-07T00:00:00Z","timestamp":1712448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT\u2010190265"],"award-info":[{"award-number":["PJT\u2010190265"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and aim<\/jats:title><jats:p>In British Columbia, Canada, clinical guidelines for the treatment of opioid use disorders (OUD) were updated in 2017, during a period in which the potency and composition of the illicit drug supply changed rapidly. We aimed to describe changes in opioid agonist treatment (OAT) prescribing practices at the population level in a setting in which fentanyl and its analogs have become the primary illicit opioid of use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and participants<\/jats:title><jats:p>This was a population\u2010based retrospective cohort study using three linked health administrative databases in British Columbia (BC), Canada. All individuals with at least one OAT dispensation in BC between 1 January 2014 and 31 August 2021 took part.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>To assess changes in OAT prescribing practices over time, we calculated initiation doses, dose titration intervals, maintenance doses and take\u2010home dosing intervals stratified by medication [methadone, buprenorphine\u2013naloxone and slow\u2010release oral morphine (SROM)] according to recommended guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>A total of 265\u2009410 OAT episodes (57.5% on methadone, 34.5% on buprenorphine\u2013naloxone and 8.0% on SROM) were initiated during the study period. Compared with the guideline recommendation, observed initiation doses were higher among all medications from 2014 (2017 for SROM) to 2021\u00a0(buprenorphine\u2013naloxone: 14\u201329%; methadone: 53\u201366%; SROM: 26\u201355%). Titration intervals were shorter for all medications, consistent with guidelines for buprenorphine\u2013naloxone (26\u201349%), but shorter than recommended for methadone or SROM (28\u201351% and 12\u201341%, respectively). Higher maintenance dosing was observed for methadone (68\u201378%) and SROM (3\u201321%). Take\u2010home allowances extending beyond the recommended guideline length increased across medications (buprenorphine\u2013naloxone: 18\u201335%; methadone: 50\u201364%; SROM: 34\u201339%). Changes in prescribing patterns were similar for first\u2010time OAT initiators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In British Columbia, Canada, from 2014 to 2021, prescribers of opioid agonist treatment (OAT) appeared to initiate both new and experienced OAT clients at higher doses than guideline recommendations, titrate them more rapidly and maintain clients at higher doses. Take\u2010home dose allowances also gradually increased.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16491","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T03:13:25Z","timestamp":1712546005000},"page":"1453-1459","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prescribing practices in opioid agonist treatment and changes in compliance to clinical dosing guidelines in British Columbia, Canada"],"prefix":"10.1111","volume":"119","author":[{"given":"Brenda Carolina","family":"Guerra\u2010Alejos","sequence":"first","affiliation":[{"name":"Centre for Advancing Health Outcomes  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youwei","family":"Yan","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Kurz","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes  Vancouver British Columbia Canada"},{"name":"Faculty of Health Sciences Simon Fraser University  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishan","family":"Mudalige","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong Eun","family":"Min","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahmida","family":"Homayra","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2513-3718","authenticated-orcid":false,"given":"Bohdan","family":"Nosyk","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes  Vancouver British Columbia Canada"},{"name":"Faculty of Health Sciences Simon Fraser University  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2023.100535"},{"key":"e_1_2_10_3_1","volume-title":"Opioid\u2010 and Stimulant\u2010related Harms in Canada","author":"Federal, Provincial and Territorial Special Advisory Committee on the Epidemic of Opioid Overdoses","year":"2023"},{"key":"e_1_2_10_4_1","unstructured":"National Institute on Drug Abuse.Drug overdose death rates2023[updated 30\u2009June 2023]. 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