Search

Background and aim: 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. Design, setting and participants: This was a population‐based 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. Measurements: To assess changes in OAT prescribing practices over time, we calculated initiation doses, dose titration intervals, maintenance doses and take‐home dosing intervals stratified by medication [methadone, buprenorphine–naloxone and slow‐release oral morphine (SROM)] according to recommended guidelines. Findings A total of 265 410 OAT episodes (57.5% on methadone, 34.5% on buprenorphine–naloxone 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 (buprenorphine–naloxone: 14–29%; methadone: 53–66%; SROM: 26–55%). Titration intervals were shorter for all medications, consistent with guidelines for buprenorphine–naloxone (26–49%), but shorter than recommended for methadone or SROM (28–51% and 12–41%, respectively). Higher maintenance dosing was observed for methadone (68–78%) and SROM (3–21%). Take‐home allowances extending beyond the recommended guideline length increased across medications (buprenorphine–naloxone: 18–35%; methadone: 50–64%; SROM: 34–39%). Changes in prescribing patterns were similar for first‐time OAT initiators. Conclusion: 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‐home dose allowances also gradually increased. [ABSTRACT FROM AUTHOR]

Hydrogen isotope permeation in structural steels can cause severe issues, including steel brittleness, fuel loss, and radioactive pollution in fusion reactors. To tackle this issue, we report a simple synthesis of α‐Al2O3/AlPO4 composite coating by the thermochemical reaction method to serve as an effective barrier hampering hydrogen isotope permeation. This coating was formed at 500°C and composed of α‐Al2O3 and AlPO4 phases. A relatively uniform and compact structure with thickness of ∼35 μm made its corrosion resistance reaching above 3000 times that of the 321 steel substrate. With just one‐side coated, the α‐Al2O3/AlPO4 coating achieved a considerable deuterium permeation reduction factor of 1935 at 450°C, three orders of magnitude higher than 321 steels. What's more, after the deuterium permeation test, no pores or cracks were generated. The excellent bonding between the coating and the substrate was resulted from the formation of CrxPy at their interface induced by Cr diffusion from the substrate. The results obtained from the current study shed new light on seeking reliable and viable ceramic coatings to tackle hydrogen permeation issues. [ABSTRACT FROM AUTHOR]