Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England.

Abstract

AIMS:

To compare the change in illicit opioid users' risk of fatal drug-related poisoning (DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support, and investigate the modifying effect of patient characteristics, criminal justice system (CJS) referral and treatment completion.

DESIGN:

National data linkage cohort study of the English National Drug Treatment Monitoring System and the Office for National Statistics national mortality database. Data were analysed using survival methods.

SETTING:

All services in England that provide publicly funded, structured treatment for illicit opioid users.

PARTICIPANTS:

Adults treated for opioid dependence during April 2005 to March 2009: 151,983 individuals; 69% male; median age 32.6 with 442,950 person-years of observation.

MEASUREMENTS:

The outcome was fatal DRP occurring during periods in or out of treatment, with adjustment for age, gender, substances used, injecting status and CJS referral.

FINDINGS:

There were 1499 DRP deaths [3.4 per 1000 person-years, 95% confidence interval (CI) = 3.2-3.6]. DRP risk increased while patients were not enrolled in any treatment [adjusted hazard ratio (aHR) = 1.73, 95% CI = 1.55-1.92]. Risk when enrolled only in a psychological intervention was double that during OAP (aHR = 2.07, 95% CI = 1.75-2.46). The increased risk when out of treatment was greater for men (aHR = 1.88, 95% CI = 1.67-2.12), illicit drug injectors (aHR = 2.27, 95% CI = 1.97-2.62) and those reporting problematic alcohol use (aHR = 2.37, 95% CI = 1.90-2.98).

CONCLUSIONS:

Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.

• Authors: Matthias Pierce, Sheila M Bird, Matthew Hickman, John Marsden, Graham Dunn, Andrew Jones, Tim Millar
• Journal: Addiction (Abingdon, England) (Addiction) Vol. 111 Issue 2 Pg. 298-308 (Feb 2016) ISSN: 1360-0443 [Electronic] England
• PMID: 26452239 (Publication Type: Comparative Study, Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Chemical References

• Analgesics, Opioid
• Narcotics
• Buprenorphine
• Methadone

Topics

• Adolescent
• Adult
• Analgesics, Opioid (poisoning)
• Buprenorphine (therapeutic use)
• Cohort Studies
• Combined Modality Therapy
• Drug Overdose (mortality)
• England (epidemiology)
• Female
• Humans
• Male
• Methadone (therapeutic use)
• Middle Aged
• Narcotics (therapeutic use)
• Opiate Substitution Treatment (mortality)
• Opioid-Related Disorders (mortality, rehabilitation)
• Psychotherapy (methods)
• Young Adult