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

Pierce, Matthias; Bird, Sheila M.; Hickman, Matthew; Marsden, John; Dunn, Graham; Jones, Andrew; Millar, Tim

doi:10.1111/add.13193

Cited by 136 publications

(126 citation statements)

References 27 publications

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“…We included information on self‐harm, previous overdose, alcohol use, prison history and homelessness in propensity‐score adjustments, and crucially we found no evidence of a difference in DRP during the first 4 weeks after leaving treatment, when one would expect any difference in relapse rates between patients on methadone and buprenorphine to have the greatest influence. Unfortunately, it is a common problem that large drug treatment cohorts lack refined measures on addiction severity and patient or clinical perceptions and preferences on OST modality 22, 24, 43.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of drug‐related deaths are among individuals not in treatment 22, 56. Restricting access to OST is associated with high rates of mortality among opioid‐dependent people who have been discharged or denied treatment 57.…”

Section: Discussionmentioning

confidence: 99%

“…OST is highly cost‐effective, whether delivered in the community or prison 17, 18, 19. Prolonged OST is associated with improved survival 5; however, recent studies highlight very high mortality risk in the month after treatment cessation 20, 21, 22, 23. There have also been reports of an elevated risk of mortality during the first month of OST 20, 21, 24, 25.…”

Section: Introductionmentioning

confidence: 99%

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The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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AimsTo estimate whether opioid substitution treatment (OST) with buprenorphine or methadone is associated with a greater reduction in the risk of all‐cause mortality (ACM) and opioid drug‐related poisoning (DRP) mortality.DesignCohort study with linkage between clinical records from Clinical Practice Research Datalink and mortality register.SettingUK primary care.ParticipantsA total of 11 033 opioid‐dependent patients who received OST from 1998 to 2014, followed‐up for 30 410 person‐years.MeasurementsExposure to methadone (17 373, 61%) OST episodes or buprenorphine (9173, 39%) OST episodes. ACM was available for all patients; information on cause of death and DRP was available for 5935 patients (54%) followed‐up for 16 363 person‐years. Poisson regression modelled mortality by treatment period with an interaction between OST type and treatment period (first 4 weeks on OST, rest of time off OST, first 4 weeks off OST, rest of time out of OST censored at 12 months) to test whether ACM or DRP differed between methadone and buprenorphine. Inverse probability weights were included to adjust for confounding and balance characteristics of patients prescribed methadone or buprenorphine.FindingsACM and DRP rates were 1.93 and 0.53 per 100 person‐years, respectively. DRP was elevated during the first 4 weeks of OST [incidence rate ratio (IRR) = 1.93 95% confidence interval (CI) = 0.97–3.82], the first 4 weeks off OST (IRR = 8.15, 95% CI = 5.45–12.19) and the rest of time out of OST (IRR = 2.13, 95% CI = 1.47–3.09) compared with mortality risk from 4 weeks to end of treatment. Patients on buprenorphine compared with methadone had lower ACM rates in each treatment period. After adjustment, there was evidence of a lower DRP risk for patients on buprenorphine compared with methadone at treatment initiation (IRR = 0.08, 95% CI = 0.01–0.48) and rest of time on treatment (IRR = 0.37, 95% CI = 0.17–0.79). Treatment duration (mean and median) was shorter on buprenorphine than methadone (173 and 40 versus 363 and 111, respectively). Model estimates suggest that there was a low probability that methadone or buprenorphine reduced the number of DRP in the population: 28 and 21%, respectively.ConclusionsIn UK general medical practice, opioid substitution treatment with buprenorphine is associated with a lower risk of all‐cause and drug‐related poisoning mortality than methadone. In the population, buprenorphine is unlikely to give greater overall protection because of the relatively shorter duration of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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“…6 There is ample evidence that medication-assisted treatment is the most effective way to retain these patients in treatment and improve social function. 23 Recent evidence suggests it reduces the risk of overdose death, 24 and buprenorphine may reduce pain severity. 25,26 Unfortunately, referral is an inadequate plan for many.…”

Section: Discussionmentioning

confidence: 99%

Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

Grande¹,

Thompson²,

Au³

et al. 2016

The Journal of the American Board of Family Medicine

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Purpose: Problem drug-related behavior (PDB) among patients on chronic opioid therapy may reflect an opioid use disorder. This study assessed PDB prevalence and the relationship between PDB and ongoing prescription of opioids at a primary care clinic that implemented a multifaceted opioid management program.Methods: A chart review of patients in a chronic opioid registry assessed prevalence of different types of PDB over 2 years, and whether opioids were prescribed during the last 3 months of the 2-year study period among patients with different levels of PDB.Results: Among 233 registry patients, 84.1% exhibited PDB; 45.5% exhibited >3 types of PDB. At the end of 2 years, most registry patients were still prescribed opioids, though patients with >3 types of PDB were less likely than those without PDB to be prescribed opioids (62.3% vs. 78.4%, P ‫؍‬ 0.016).Conclusions: PDB was pervasive in this population of patients on chronic opioid therapy. Those with the most PDB, and thus with the greatest likelihood of opioid use disorder and its social and medical consequences, were the least likely to be prescribed opioids by the clinic after 2 years. Given the rising rates of illicit opioid use in the U.S., it is important that clinics work closely with their patients who display PDB, systematically assess them for opioid use disorder, and offer evidence-based treatment.

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“…This method was developed by Millar et al (2008) and has been used successfully in other recent studies of offending and mortality in substance use disorder treatment cohorts (see Pierce et al 2015;White et al, 2015).…”

Section: Data Linkage Proceduresmentioning

confidence: 99%

Is treatment for alcohol use disorder associated with reductions in criminal offending? A national data linkage cohort study in England

Willey

Eastwood

Gee

et al. 2016

Drug and Alcohol Dependence

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

Cited by 136 publications

References 27 publications

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

Problem Drug-related Behavior and Discontinuation of Opioids Following the Introduction of an Opioid Management Program

Is treatment for alcohol use disorder associated with reductions in criminal offending? A national data linkage cohort study in England

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