Background Opioid Agonist Therapy (OAT) is the most effective intervention to reduce overdose risk, and administrative health data are now increasingly used to study OAT outcomes. However, current methods for constructing OAT episodes rely heavily on fixed permissible gaps and often overlook switches between medications, concurrent therapies, and the temporal complexity of dispensing patterns. We aimed to develop a robust episode-construction framework that more precisely reflects real-world OAT use within administrative health data. Methods We analyzed OAT dispensations from people living with HIV in British Columbia (2010–2020). Episodes were constructed using three components: Allen’s interval algebra, temporal margins (<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\mathcal{E}\)</EquationSource> </InlineEquation>), and drug-specific permissible gaps. Allen’s algebra characterized the temporal relation between two dispensations as meets (one starts when another ends), before (a positive gap), overlaps (partial overlap), starts (same start, earlier end), finishes (later start, same end), contains (one fully encloses another), or equals (identical start and end). Temporal margins distinguished short from long overlaps within the same OAT medication and differentiated switches from concurrent therapy when different OATs overlapped. Permissible gaps defined the maximum interruption allowed before episode discontinuation and were mapped onto Allen’s before relation. Using this combined framework, we identified monotherapy (single-OAT use), transition (medication switches), multitherapy (concurrent OAT use), and transition-multitherapy episodes. Results The before relation predominated across all OATs, particularly for methadone (99.43%). The equals relation was notably prevalent for buprenorphine (21.46%), slow-release oral morphine (20.87%), and injectable OAT (1.91%). To build monotherapy episodes, we applied <InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(\mathcal{E}\)</EquationSource> </InlineEquation>=7 days, while <InlineEquation ID="IEq3"> <EquationSource Format="TEX">\(\mathcal{E}\)</EquationSource> </InlineEquation>=14 days differentiated transition from multitherapy episodes. We identified 10,386 episodes: 93.53% monotherapy, 3.72% transition, 2.27% multitherapy, and < 1% transition-multitherapy. Conclusion We propose an episode-building framework based on Allen’s relations, temporal margins, and permissible gaps that fine-tune OAT classification in administrative health data. The method is transferable to other settings and populations with suitable parameter adjustments.

A methodological framework for constructing opioid agonist therapy episodes in administrative health data

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2026年3月12日

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Kiana Yazdani,
Cassidy Tam,
Christopher C. Fisher,
Scott D. Emerson,
Jason Trigg,
Katherine W. Kooij,
Mary A. De Vera,
Fidel Vila-Rodriguez,
Robert S. Hogg,
Julio S. G. Montaner,
Viviane Dias Lima

摘要

Background

Opioid Agonist Therapy (OAT) is the most effective intervention to reduce overdose risk, and administrative health data are now increasingly used to study OAT outcomes. However, current methods for constructing OAT episodes rely heavily on fixed permissible gaps and often overlook switches between medications, concurrent therapies, and the temporal complexity of dispensing patterns. We aimed to develop a robust episode-construction framework that more precisely reflects real-world OAT use within administrative health data.

Methods

We analyzed OAT dispensations from people living with HIV in British Columbia (2010–2020). Episodes were constructed using three components: Allen’s interval algebra, temporal margins ( \(\mathcal{E}\) ), and drug-specific permissible gaps. Allen’s algebra characterized the temporal relation between two dispensations as meets (one starts when another ends), before (a positive gap), overlaps (partial overlap), starts (same start, earlier end), finishes (later start, same end), contains (one fully encloses another), or equals (identical start and end). Temporal margins distinguished short from long overlaps within the same OAT medication and differentiated switches from concurrent therapy when different OATs overlapped. Permissible gaps defined the maximum interruption allowed before episode discontinuation and were mapped onto Allen’s before relation. Using this combined framework, we identified monotherapy (single-OAT use), transition (medication switches), multitherapy (concurrent OAT use), and transition-multitherapy episodes.

Results

The before relation predominated across all OATs, particularly for methadone (99.43%). The equals relation was notably prevalent for buprenorphine (21.46%), slow-release oral morphine (20.87%), and injectable OAT (1.91%). To build monotherapy episodes, we applied \(\mathcal{E}\) =7 days, while \(\mathcal{E}\) =14 days differentiated transition from multitherapy episodes. We identified 10,386 episodes: 93.53% monotherapy, 3.72% transition, 2.27% multitherapy, and < 1% transition-multitherapy.

Conclusion

We propose an episode-building framework based on Allen’s relations, temporal margins, and permissible gaps that fine-tune OAT classification in administrative health data. The method is transferable to other settings and populations with suitable parameter adjustments.