Opioid use disorder and type 2 diabetes mellitus: Effect of participation in buprenorphine-naloxone substitution programs on glycemic control.

OBJECTIVE: To measure the effect of buprenorphine-naloxone as opioid substitution therapy on glycemic control in patients with type 2 diabetes mellitus and opioid use disorder. DESIGN: Retrospective cohort study and secondary data analysis. SETTING: Northwestern Ontario. PARTICIPANTS: Patients with diabetes receiving opioid substitution therapy, as well as patients with diabetes only, who live in 6 remote First Nations communities. MAIN OUTCOME MEASURES: Glycated hemoglobin A1c values during a 2-year time period in the 2 groups. RESULTS: Over a 2-year period, there was an absolute decrease of 1.20% in mean glycated hemoglobin A1c values in patients with diabetes who also received opioid substitution therapy, compared with patients with diabetes who were not being treated for opioid dependence, whose values rose by 0.02%. CONCLUSION: Patients with diabetes who also suffer from opioid use disorder achieve significant (P = .011) improvement in glycemic control when treated with buprenorphine-naloxone substitution therapy compared with other patients with diabetes. Treating opioid use disorder with buprenorphine-naloxone substitution therapy has an unintended positive effect on diabetes management.

Evaluation of 6 remote First Nations community-based buprenorphine programs in northwestern Ontario: Retrospective study.

OBJECTIVE: To evaluate established opioid addiction treatment programs that use traditional healing in combination with buprenorphine-naloxone maintenance treatment in 6 First Nations communities in the Sioux Lookout region of northwestern Ontario. DESIGN: Retrospective cohort study. SETTING: Six First Nations communities in northwestern Ontario. PARTICIPANTS: A total of 526 First Nations participants in opioid-dependence treatment programs. INTERVENTION: Buprenorphine-naloxone substitution therapy and First Nations healing programming. MAIN OUTCOME MEASURES: Retention rates and urine drug screening (UDS) results. RESULTS: Treatment retention rates at 6, 12, and 18 months were 84%, 78%, and 72%, respectively. We estimate that the rate at 24 months will also be more than 70%. The UDS programming varied and was implemented in only 1 community. Initially urine testing was voluntary and it then became mandatory. Screening with either method found the proportion of urine samples with negative results for illicit opioids ranged between 84% and 95%. CONCLUSION: The program's treatment retention rates and negative UDS results were higher than those reported for most methadone and buprenorphine-naloxone programs, despite a patient population where severe posttraumatic stress disorder is endemic, and despite the programs' lack of resources and addiction expertise. Community-based programs like these overcome the initial challenge of cultural competence. First Nations communities in other provinces should establish their own buprenorphinenaloxone programs, using local primary care physicians as prescribers. Sustainable core funding is needed for programming, long-term aftercare, and trauma recovery for such initiatives.