Citation

Høj SB, Bruneau J, Hickman M. Eur. J. Public Health 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Oxford University Press)

DOI

10.1093/eurpub/ckab031

PMID

unavailable

Abstract

The 'cascade of care' has seen widespread uptake as a framework for measuring patient engagement in care for chronic conditions including HIV, hepatitis C and diabetes.1 Attention recently turned to its potential utility in the field of addiction care, particularly in relation to opioid use disorders (OUD) and opioid agonist treatment (OAT).2,3 The OUD cascade is now being positioned as a tool to guide public health action in epidemics of opioid addiction and overdose, in North America and elsewhere.2,3Critically, the measurement framework we choose reveals what we think needs to change and hence what we think the 'problem' is. The OUD cascade represents a problem of inadequate engagement and retention in OAT, and positions these as the primary objects of intervention and evaluation. However, it neither directly nor adequately captures the problem of excess mortality risks conferred by different opioids (such as fentanyls) and polydrug use (such as interaction between opioids and benzodiazepines) that have contributed to epidemics of overdose deaths nor clearly emerging issues in North America and Europe elated to the serious consequences of social and economic deprivation, which drives not only overdose but also suicide and other injuries.

Language: en