Double trouble: Psychiatric comorbidity and opioid addiction—All-cause and cause-specific mortality

Bogdanowicz, Karolina; Stewart, Robert; Broadbent, Matthew; Hatch, Stephani L.; Hotopf, Matthew; Strang, John; Hayes, Richard D.

doi:10.1016/j.drugalcdep.2014.12.025

Cited by 79 publications

(72 citation statements)

References 43 publications

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“…The results of this study align with the current studies which demonstrate a high prevalence of mental disorders in the OUD population (7,30,61). However, in this study, 87% of the population had a mental disorder, whereas the prevalence in the literature is approximately 50% (7,30,61). The high prevalence identi ed in our cohort may be because we examined a broad range of disorders and that our time parameter, including study time and follow-up, was much longer than in other studies (6, 7).…”

Section: Discussionsupporting

confidence: 91%

“…Moreover, the de nition of enrollment was different from that of the previous studies because all diagnostic information from physician visits was determined using billing data from OHIP. Similar to other studies, we also found that mental disorders in the OAT population are associated with a more complex pro le of health service utilization (7,(62)(63)(64).…”

Section: Discussionsupporting

confidence: 90%

“…Study outcomes were de ned based on the need to assess the association of all-cause mortality, frequent ED visits, and hospitalizations as a function of concurrent mental disorders and OUD, and not as an exposure leading to an event. All-cause mortality, ED visits, and hospitalizations have been used as indicators of complexity in the OUD population in other studies (7,27,50,51). Additionally, both frequent ED visits and hospitalizations are metrics used by health system planners and funders in Ontario to understand gaps in services in communities (50)(51)(52).…”

Section: Discussionmentioning

confidence: 99%

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A Cohort Study Evaluating the Association Between Concurrent Mental Disorders, Mortality, Morbidity, and Continuous Treatment Retention for Patients in Opioid Agonist Treatment (OAT) Across Ontario, Canada Using Administrative Health Data

Morin

Eibl

Gauthier

et al. 2020

Preprint

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Abstract Background: Due to the high prevalence of mental disorders among people with opioid use disorder, the objective of this study was to determine the association between concurrent mental disorders, mortality, morbidity and continuous treatment retention for patients in opioid agonist treatment in Ontario, Canada. Methods: We conducted a retrospective cohort study of patients enrolled in opioid agonist treatment between January 1, 2011, and December 31, 2015. Patients were stratified into two groups: those diagnosed with concurrent mental disorders and opioid use disorder and those with opioid use disorder only, using data from the Ontario Health Insurance Plan Database, Ontario Drug Benefit Plan Database. The primary outcome studied was all-cause mortality using data from the Registered Persons Database. Emergency Department visits from the National Ambulatory Care Database, hospitalizations Discharge Abstract Database, and continuous retention in treatment, defined as one year of uninterrupted opioid agonist treatment using data from the Ontario Drug Benefit Plan Database, were measured as secondary outcomes. Encrypted patient identifiers were used to link information across databases.Results: We identified 55,924 individuals enrolled in opioid agonist treatment, and 87% had a concurrent mental disorder diagnosis during this period. We observed that having a mental disorder was associated with an increased likelihood of all-cause mortality (Odds Ratio (OR) 1.4; 95% Confidence Interval (CI) 1.2-1.5. For patients diagnosed with mental disorders the estimated rate of ED visits per year was 2.25 times higher and estimated rate of hospitalization per year 1.67 times higher than for patients with no mental disorders. However, there was no association between having a diagnosis of a mental disorder and one-year treatment retention in OAT adjusted Hazard Ratio (HR) = 1.0; 95%CI 0.9 to 1.1).Conclusion: Our findings highlight the consequences of the high prevalence of mental disorders for individuals with opioid use disorder in Ontario, Canada

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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A Cohort Study Evaluating the Association Between Concurrent Mental Disorders, Mortality, Morbidity, and Continuous Treatment Retention for Patients in Opioid Agonist Treatment (OAT) Across Ontario, Canada Using Administrative Health Data

Morin

Eibl

Gauthier

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Given that the 1991 NHIS did not include assessments of mental disorders, negative mood served as a proxy for mental health status. Among treated cohorts of people who use drugs, there is evidence that comorbid mental disorders are associated with premature mortality (Bogdanowicz et al, 2015; Nyhlén et al, 2011). Given the high prevalence of comorbidity for illegal drug use and mental disorders (Compton et al, 2007; Grant et al, 2004; Kessler et al, 2005), as well as the association of mental disorders with elevated mortality risk (Walker et al, 2015), mental disorders are a concern in this population.…”

Section: Discussionmentioning

confidence: 99%

Excess mortality among people who report lifetime use of illegal drugs in the United States: A 20-year follow-up of a nationally representative survey

Walker

Pratt

Schoenborn

et al. 2017

Drug and Alcohol Dependence

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Objective The purpose of this study was to determine the mortality risks, over 20 years of follow-up in a nationally representative sample, associated with illegal drug use and to describe risk factors for mortality. Methods We analyzed data from the 1991 National Health Interview Survey, which is a nationally representative household survey in the United States, linked to the National Death Index through 2011. This study included 20,498 adults, aged 18–44 years in 1991, with 1,047 subsequent deaths. A composite variable of self-reported lifetime illegal drug use was created (hierarchical categories of heroin, cocaine, hallucinogens/inhalants, and marijuana use). Results Mortality risk was significantly elevated among individuals who reported lifetime use of heroin (HR=2.40, 95% CI: 1.65–3.48) and cocaine (HR=1.27, 95% CI: 1.04–1.55), but not for those who used hallucinogens/inhalants or marijuana, when adjusting for demographic characteristics. Baseline health risk factors (smoking, alcohol use, physical activity, and BMI) explained the greatest amount of this mortality risk. After adjusting for all baseline covariates, the association between heroin or cocaine use and mortality approached significance. In models adjusted for demographics, people who reported lifetime use of heroin or cocaine had an elevated mortality risk due to external causes (poisoning, suicide, homicide, and unintentional injury). People who had used heroin, cocaine, or hallucinogens/inhalants had an elevated mortality risk due to infectious diseases. Conclusions Heroin and cocaine are associated with considerable excess mortality, particularly due to external causes and infectious diseases. This association can be explained mainly by health risk behaviors.

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“…This is particularly salient as a recent study shows alcohol use disorder to be a risk factor for opioid overdose fatalities. 41 Treatment programs to prevent overdose deaths in the homeless population should be capable of broadly addressing the co-occurring use of alcohol and multiple classes of drugs.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review

Bauer¹,

Brody²,

León³

et al. 2016

Journal of Health Care for the Poor and Underserved

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Drug overdose is a major cause of death among homeless people, but little is known about the characteristics of homeless overdose decedents. We conducted a retrospective record review of 219 adult patients of Boston Health Care for the Homeless Program (BHCHP) who died of drug overdose in 2003–2008. We assessed the substances implicated in overdose and the health and service use characteristics of decedents prior to death. Eighty-one percent of overdose deaths involved opioids and 40% involved multiple drugs. Problem substance use (85%), psychiatric illness (61%), and chronic pain (45%) were common, and 32% had documentation of all three. Half were well-connected to BHCHP, and 35% had a clinic visit within 90 days of death. The complex health histories and frequent health care contacts of homeless drug overdose decedents suggest that clinical facilities may be an important frontline venue for overdose education, naloxone distribution, and integrated substance use treatment programming.

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Double trouble: Psychiatric comorbidity and opioid addiction—All-cause and cause-specific mortality

Abstract: This study highlights the importance of assessment for PD and AUD in OUD patients in order to identify individuals at substantially elevated mortality risk to enable a more personalized approach to their medical care.

Cited by 79 publications

References 43 publications

A Cohort Study Evaluating the Association Between Concurrent Mental Disorders, Mortality, Morbidity, and Continuous Treatment Retention for Patients in Opioid Agonist Treatment (OAT) Across Ontario, Canada Using Administrative Health Data

A Cohort Study Evaluating the Association Between Concurrent Mental Disorders, Mortality, Morbidity, and Continuous Treatment Retention for Patients in Opioid Agonist Treatment (OAT) Across Ontario, Canada Using Administrative Health Data

Excess mortality among people who report lifetime use of illegal drugs in the United States: A 20-year follow-up of a nationally representative survey

Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review

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