{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:35:08Z","timestamp":1787891708073,"version":"build-2784847793"},"reference-count":50,"publisher":"BMJ","license":[{"start":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:00:00Z","timestamp":1704844800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2023,11,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the effect of opioid and stimulant Risk Mitigation Guidance (RMG) dispensations on mortality and acute care visits during the dual public health emergencies of overdose and covid-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population based retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>British Columbia, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>5882 people with opioid or stimulant use disorder who received RMG prescriptions for opioids (n=5356) and\/or stimulants (n=1061) (535 received both) from 27 March 2020 to 31 August 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>All cause and overdose specific mortality and acute care visits in the week after RMG opioid or stimulant dispensation. RMG recipients were matched 1:1 with controls through use of high dimensional propensity score matching. Marginal structural models, executed on weekly time steps, were used to measure the effect of dispensations on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>RMG opioid dispensations of one day or more were associated with reduced all cause mortality (adjusted hazard ratio 0.39, 95% confidence interval 0.25 to 0.60) and overdose related mortality (0.45, 0.27 to 0.75) in the subsequent week. Dispensations of RMG stimulants (\u22651 days) were not significantly associated with reduced all cause mortality (adjusted hazard ratio 0.50, 0.20 to 1.23) or overdose related mortality (0.53, 0.18 to 1.56). The protective effect of RMG opioid dispensations increased with the number of days the medications were dispensed in a given week. People who received four or more days of RMG opioid dispensations had reduced all cause mortality (adjusted hazard ratio 0.09, 0.04 to 0.21) and overdose related mortality (0.11, 0.04 to 0.32) compared with the control group. Opioid RMG dispensations did not significantly modify the odds of all cause or overdose related acute care visits. Dispensations of RMG stimulants were associated with a significant decrease in the odds of acute care visits for any cause but did not affect the odds of overdose related acute care visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RMG opioid dispensations were associated with reduced overdose related and all cause mortality among a sample of people with opioid use disorder. Pharmaceutical alternatives to the illegal drug supply are promising interventions to reduce mortality in people with opioid use disorder.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2023-076336","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T20:30:21Z","timestamp":1704918621000},"page":"e076336","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":86,"title":["Effect of Risk Mitigation Guidance for opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study"],"prefix":"10.1136","volume":"384","author":[{"given":"Amanda","family":"Slaunwhite","sequence":"first","affiliation":[{"name":"School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada"},{"name":"BC Centre for Disease Control, Vancouver, BC, Canada"},{"name":"Centre for Advancing Health Outcomes, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong Eun","family":"Min","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Palis","sequence":"additional","affiliation":[{"name":"BC Centre for Disease Control, Vancouver, BC, Canada"},{"name":"Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Urbanoski","sequence":"additional","affiliation":[{"name":"Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada"},{"name":"School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernie","family":"Pauly","sequence":"additional","affiliation":[{"name":"Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada"},{"name":"Department of Nursing, University of Victoria, Victoria, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Barker","sequence":"additional","affiliation":[{"name":"Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada"},{"name":"School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada"},{"name":"First Nations Health Authority, Vancouver, BC, Canada"},{"name":"Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Crabtree","sequence":"additional","affiliation":[{"name":"School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada"},{"name":"BC Centre for Disease Control, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paxton","family":"Bach","sequence":"additional","affiliation":[{"name":"BC Centre on Substance Use, Vancouver, BC, Canada"},{"name":"Department of Medicine, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Krebs","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes, Vancouver, BC, Canada"},{"name":"BC Cancer, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Dale","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Meilleur","sequence":"additional","affiliation":[{"name":"First Nations Health Authority, Vancouver, BC, 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, BC, Canada"},{"name":"Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,10]]},"reference":[{"key":"2025110102274774000_384.jan10_4.e076336.1","doi-asserted-by":"publisher","DOI":"10.1186\/s13011-021-00423-5"},{"key":"2025110102274774000_384.jan10_4.e076336.2","doi-asserted-by":"publisher","DOI":"10.1177\/14034948221075025"},{"key":"2025110102274774000_384.jan10_4.e076336.3","unstructured":"Public Health Agency of Canada. 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