| 59084 |
Creator |
538c0722d7d106c7098d06ea38e69498 |
| 59084 |
Creator |
ext-1090eeedac6de4f1f534b575c6e2fa4d |
| 59084 |
Creator |
ext-15fd9347188c8654006bdc2e58f5eafb |
| 59084 |
Creator |
ext-740c41bae698416f659daa64ec622427 |
| 59084 |
Creator |
ext-a1bd23ab827e8ebcb0541f2dbe16ba8c |
| 59084 |
Creator |
ext-a231c09fc79d9e613686a0427b9b3ed1 |
| 59084 |
Creator |
ext-b495f787c073c7bcf6b27ea9237b5765 |
| 59084 |
Creator |
ext-b50b0baac0530f993145952bba6fdf95 |
| 59084 |
Creator |
ext-cb5e8070741f1a628290b470025ba1db |
| 59084 |
Creator |
ext-f0d09c3776dccbd4e6e95bd7811aaef3 |
| 59084 |
Creator |
ext-f2a128f903c9e9e2d6aa62021850f52e |
| 59084 |
Date |
2019-02 |
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Is Part Of |
repository |
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Is Part Of |
p20504357 |
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abstract |
<b>Background</b> Opiate substitution treatment (OST) is the main treatment for people
addicted to heroin and other opioid drugs. However, there is limited information on
how the delivery of this treatment affects mortality risk.<br></br><br></br><b>Objectives</b>
To investigate the associations of mortality risk with periods during treatment and
following cessation of treatment, medication type, co-prescription of other medication
and dosing regimens during titration and detoxification. The trends with time of prescribed
medication, dose and treatment duration were also explored.<br></br><br></br><b>Design</b>
Prospective longitudinal observational study.<br></br><br></br><b>Setting</b> UK primary
care between 1998 and 2014.<br></br><br></br><b>Participants</b> A total of 12,780
patients receiving methadone, buprenorphine or dihydrocodeine.<br></br><br></br><b>Main
outcome measures</b> All-cause mortality relating to 657 deaths and drug-related poisoning
relating to 113 deaths.<br></br><br></br><b>Data sources</b> Clinical Practice Research
Datalink with linked information on cause of death from the Office for National Statistics.<br></br><br></br><b>Results</b>
For both outcomes, the lowest mortality risk was observed after 4 weeks of treatment
and the highest risk was observed in the first 4 weeks following cessation of treatment
[e.g. for drug-related poisoning, incidence rate ratio (IRR) 8.15, 95% confidence
interval (CI) 5.45 to 12.19]. There was evidence that the treatment period risks varied
with OST medication. The largest difference in risk was for the first 4 weeks of treatment
for both outcomes, with patients on buprenorphine being at lower risk than those on
methadone (e.g. for drug-related poisoning, IRR 0.08, 95% CI 0.01 to 0.48). The co-prescription
of benzodiazepines was associated with linearly increasing the risk of drug-related
deaths by dose (IRR 2.02, 95% CI 1.66 to 2.47), whereas z-drugs (zolpidem, zopiclone
and zaleplon) were associated with increased risk of both all-cause (IRR 1.83, 95%
CI 1.59 to 2.12) and drug-related (IRR 3.31, 95% CI 2.45 to 4.47) mortality. There
was weak evidence that higher initial and final doses were associated with increased
all-cause mortality risk. In the first 4 weeks of treatment, the risk increased by
4% for each 5-mg increment in methadone dose (1-mg increase in buprenorphine) (hazard
ratio 1.04, 95% CI 1.00 to 1.09). In the first 4 weeks after treatment ceased, a similar
increment in final dose increased the risk by 3% (hazard ratio 1.03, 95% CI 0.99 to
1.07). There were too few deaths to evaluate the effects on drug-related poisoning.
The proportion of OST patients receiving buprenorphine increased between 1998 and
2006. Median treatment duration was consistently shorter for buprenorphine than for
methadone for each year studied (overall median duration of 48 and 106 days, respectively).<br></br><br></br><b>Limitations</b>
As this was an observational study, the possibility remains of bias from unmeasured
factors, which covariate adjustment and inverse probability weighting can eliminate
only partially.<br></br><br></br><b>Conclusions</b> Using buprenorphine as an alternative
to methadone may not reduce mortality overall despite resulting in lower IRRs from
shorter treatment duration. Clinical guidance needs to consider strengthening warnings
about the co-prescription of a range of drugs for OST patients.<br></br><br></br><b>Future
work</b> Our analyses need to be replicated using other clinical data sets in the
UK and in other countries. New interventions and trials are required to investigate
improving the retention of OST patients in primary care.<br></br><br></br><b>Funding</b>
The National Institute for Health Research Health Services and Delivery Research programme. |
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authorList |
authors |
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issue |
3 |
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status |
published |
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status |
peerReviewed |
| 59084 |
uri |
http://data.open.ac.uk/oro/document/800106 |
| 59084 |
uri |
http://data.open.ac.uk/oro/document/800112 |
| 59084 |
uri |
http://data.open.ac.uk/oro/document/800113 |
| 59084 |
uri |
http://data.open.ac.uk/oro/document/800114 |
| 59084 |
uri |
http://data.open.ac.uk/oro/document/800115 |
| 59084 |
uri |
http://data.open.ac.uk/oro/document/800116 |
| 59084 |
uri |
http://data.open.ac.uk/oro/document/800647 |
| 59084 |
volume |
7 |
| 59084 |
type |
AcademicArticle |
| 59084 |
type |
Article |
| 59084 |
label |
Steer, Colin D.; Macleod, John; Tilling, Kate; Lim, Aaron G.; Marsden, John; Millar,
Tim; Strang, John; Telfer, Maggie; Whitaker, Heather ; Vickerman, Peter and Hickman,
Matthew (2019). The impact of opiate substitution treatment on mortality risk in
drug addicts: a natural experiment study. Health Services and Delivery Research,
7(3) |
| 59084 |
label |
Steer, Colin D.; Macleod, John; Tilling, Kate; Lim, Aaron G.; Marsden, John; Millar,
Tim; Strang, John; Telfer, Maggie; Whitaker, Heather ; Vickerman, Peter and Hickman,
Matthew (2019). The impact of opiate substitution treatment on mortality risk in
drug addicts: a natural experiment study. Health Services and Delivery Research,
7(3) |
| 59084 |
Publisher |
ext-9fc5e4ca656874dcccfd97912f47c2aa |
| 59084 |
Title |
The impact of opiate substitution treatment on mortality risk in drug addicts: a natural
experiment study |
| 59084 |
in dataset |
oro |