Complications in Using Real-World Data to Study the Health of People Who Use Drugs

Figgatt, Mary; Schranz, Asher J; Hincapie-Castillo, Juan M.; Golightly, Yvonne M.; Dasgupta, Nabarun

doi:10.1097/ede.0000000000001564

Cited by 2 publications

(1 citation statement)

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“…However, validation studies of people with drug use-associated bacterial and fungal infections display a fair positive predictive value, which supports using these data to identify study cohorts. 37 Additionally, it is possible there is measurement error in opioid agonist therapy use, specifically with some opioid agonist therapy not being documented. To reduce potential measurement error due to missing data, we used Medicaid claims data because this was one of the only insurers that covered methadone in opioid treatment programs during the study period; we did not examine heterogeneity of effect between buprenorphine and methadone due to sample size limitations, but could be a direction for future research.…”

Section: Discussionmentioning

confidence: 99%

Medications for Opioid Use Disorder and Mortality and Hospitalization Among People With Opioid Use-related Infections

Figgatt,

Hincapie-Castillo,

Schranz

et al. 2023

Epidemiology

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Background: Severe skin and soft tissue infections related to injection drug use have increased in concordance with a shift to heroin and illicitly manufactured fentanyl. Opioid agonist therapy medications (methadone and buprenorphine) may improve long-term outcomes by reducing injection drug use. We aimed to examine the association of medication use with mortality among people with an opioid use-related skin or soft tissue infections. Methods: An observational cohort study of Medicaid enrollees aged 18 years or older following their first documented medical encounters for opioid use-related skin or soft tissue infections during 2007-2018 in North Carolina. The exposure was documented medication use (methadone or buprenorphine claim) in the first 30 days following initial infection compared to no medication claim. Using Kaplan–Meier estimators, we examined the difference in 3-year incidence of mortality by medication use, weighted for year, age, comorbidities, and length of hospital stay. Results: In this sample, there were 13,286 people with opioid use-related skin or soft tissue infections. The median age was 37 years, 68% were women, and 78% were white. In Kaplan–Meier curves for the total study population, 12 of every 100 patients died during the first 3 years. In weighted models, for every 100 people who used medications, there were 4 fewer deaths over 3 years (95% confidence interval:2 to 6). Conclusions: In this study, people with opioid use-related skin and soft tissue infections had high risk of mortality following their initial healthcare visit for infections. Methadone or buprenorphine use was associated with reductions in mortality.

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Section: Discussionmentioning

confidence: 99%