Opioid Agonist Treatment Use Among First Nation Peoples in Ontario, Canada: A Repeated Cross-sectional Study of Prevalence Trends From 2013 to 2023.

Abstract

The opioid toxicity crisis has disproportionately harmed First Nation Peoples, prompting efforts to expand access to opioid agonist therapy (OAT). We described trends in OAT use among this population in Ontario, Canada. We conducted a population-based repeated cross-sectional study of registered ("Status") First Nation Peoples aged 15 years or older dispensed OAT in Ontario, Canada, between January 1, 2013 and December 31, 2023. We reported quarterly proportions (%) of First Nation Peoples who were dispensed OAT, including methadone, buprenorphine/naloxone, or buprenorphine extended-release (BUP-ER), overall and by OAT formulation. In addition, we examined the annual prevalence of OAT dispensing, overall and by formulation, stratified by age, sex, and residence within/outside of First Nation communities in 2023. Between 2013 and 2023, quarterly OAT dispensed among First Nation Peoples doubled from 2.7% to 5.0%, plateauing at ∼5% in early 2020. Methadone dispensing remained steady, ranging from 2.0% to 2.6% of all First Nation Peoples, and was the most commonly prescribed OAT until mid-2018 when it was overtaken by buprenorphine-containing products (i.e., buprenorphine/naloxone, BUP-ER). Dispensing of buprenorphine-containing products among this population rose from 0.6% in Q1 of 2013 to 3.1% in Q4 of 2023; specifically, 2.8% buprenorphine/naloxone, 0.5% BUP-ER. In 2023, 6.1% (N = 8,518/140,615) First Nation Peoples accessed OAT, with higher rates among individuals aged 25-44 years and residing within First Nation communities. Information on changing trends in OAT use among First Nation Peoples may inform evolving approaches to delivering quality OUD treatment to this population that uphold their rights to dignity, autonomy, and culturally safe care.