This project will leverage the learnings from its predecessor project, OATS, and will use refreshed linked administrative data along with some new data sources, to understand risk for mortality and other adverse outcomes during and after opioid agonist treatment (OAT). It will use standard biostatistical approaches and sophisticated machine learning techniques.
North America is in the midst of an opioid use epidemic, and opioid use is also increasing dramatically in Australia. OAT is an effective treatment for opioid dependence, but there are important questions regarding risk of adverse clinical outcomes, including death, that are yet to be answered. Who is most at risk of adverse outcomes? What patient, provider and treatment setting actors may influence this risk? Answers to these and other questions are critical to inform the massive scale-up of OAT internationally that will be required to respond to the opioid epidemic.
Aim 1: Determine the magnitude of risk for specific adverse clinical outcomes (e.g. mortality, hospitalization and ED presentation, and unplanned treatment cessation) during and after OAT with methadone and buprenorphine
Aim 2: Identify patient, treatment setting, and provider risk factors associated with adverse clinical outcomes during and after OAT with methadone and buprenorphine
Aim 3: Develop risk prediction models using machine learning to identify patients at greatest risk of adverse clinical outcomes during and after OAT
The study uses a population cohort of OAT patients (n≈55,000) treated between 2001 (when buprenorphine became available for OAT in New South Wales) and 2022. These data have been probabilistically linked to State-wide hospitalization, emergency department, incarceration, perinatal, cancer, infectious diseases, ambulance and mortality data. Linkage was undertaken by the Centre for Health Record Linkage (CHeReL) using probabilistic record linkage methods and ChoiceMaker software. We will examine incidence (Aim 1) and risk (Aim 2) for specific adverse clinical outcomes during OAT, with a special focus on the period of OAT induction, as well as the remainder of time in OAT and the 4 weeks immediately following cessation of OAT. Adverse clinical outcomes to be examined will include infectious diseases, perinatal outcomes and health outcomes at critical time points such as upon release from incarceration.
All data for this project has been linked and the data is currently being validated.
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