Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

Tjagvad, Christian; Línnet, Kristían; Andersen, Ljubica Vukelic; Christoffersen, Dorte; Clausen, Thomas

doi:10.1159/000446429

Cited by 31 publications

(36 citation statements)

References 39 publications

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“…Prior to the introduction of the patient choice reform, a concern was raised that an expansion of the number of patients in treatment, and thus an increase in individuals receiving medication in the form of methadone and buprenorphine, could lead to increased diversion of these medications to people not in OST. This is something that has been observed in other studies where access to OST has increased [17,18,27,30,50,51]. The analyses in this study show that there was no signi cant increase in deaths caused by methadone or buprenorphine in general in Skåne between periods examined.…”

Section: Discussionsupporting

confidence: 85%

Changes in opioid mortality following increased access to opioid substitution treatment

Andersson¹,

Håkansson²,

Berge³

et al. 2020

Preprint

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Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing mortality represent an important area of study. In Skåne County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related mortality. Methods Detailed data on all opioid-induced deaths in Skåne during the two years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skåne and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related mortalities in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skåne and the rest of Sweden before and after the intervention.Results There was a non-significant increase in the number of deaths in Skåne between the data collection periods (RR: 1.18 95% CI:0.89-1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12-6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51-1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug intoxications in Skåne compared to the rest of Sweden following the onset of the reform (0.90, 0.84-0,97, p= 0.004). Conclusions Opioid-related mortality, as assessed using forensic data, has not changed significantly in Skåne following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased opioid mortality. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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Section: Discussionsupporting

confidence: 85%

Changes in opioid mortality following increased access to opioid substitution treatment

Andersson¹,

Håkansson²,

Berge³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Pharmacotherapy for OUD is a well-established component of treatment (Ries et al, 2009) and many studies have shown an association between OUD pharmacotherapy and mortality (Cornish et al, 2010; Degenhardt et al, 2009; Pierce et al, 2016). The lack of association in this population may be due to differences between this and other populations studied, the nature of the services they were receiving, or because of the well-documented increased risk of mortality during times of pharmacotherapy treatment initiation and cessation (Buster et al, 2002; Cornish et al, 2010; Cousins et al, 2016; Degenhardt et al, 2009; Kimber et al, 2015; Pierce et al, 2016; Pierce et al, 2015; Tjagvad et al, 2016). This is also an observational study and causal inferences cannot be made.…”

Section: Discussionmentioning

confidence: 83%

Association between process measures and mortality in individuals with opioid use disorders

Watkins

Paddock

Hudson

et al. 2017

Drug and Alcohol Dependence

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Background Individuals with opioid use disorders have high rates of mortality relative to the general population. The relationship between treatment process and mortality is unknown. Aim To examine the association between 7 process measures and 12- and 24-month mortality. Methods Retrospective cohort study of patients with opioid use disorders who received care from the Veterans Administration between October 2006 and September 2007. Logistic regression models were used to examine the association between 12 and 24-month mortality and 7 patient-level process measures, while risk-adjusting for patient characteristics. Process measures included quarterly physician visits, any opioid use disorder pharmacotherapy, continuous pharmacotherapy, psychosocial treatment, Hepatitis B/C and HIV screening, and no prescriptions for benzodiazepines or opioids. We conducted sensitivity analyses to examine the robustness of our findings to an unobserved confounder. Results Among individuals with opioid use disorders, not being prescribed opioids or benzodiazepines, receipt of any psychosocial treatment and quarterly physician visits were significantly associated with lower mortality at both 12 and 24 months, but Hepatitis and HIV screening, and measures related to opioid use disorder pharmacotherapy were not. Sensitivity analyses indicated that the difference in the prevalence of an unobserved confounder would have to be unrealistically large given the observed data, or there would need to be a large effect of the confounder, to render these findings non-significant. Conclusions And Relevance This is the first study to show an association between process measures and mortality in patients with opioid use disorders and provides initial evidence for their use as quality measures.

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“…[43][44][45] Regarding adverse events, only a minor effect on corrected QT (QTc) interval duration has been reported with therapeutic doses of buprenorphine-naloxone, without proarrhythmic effects. 46,47 Conversely, methadone can increase the risk of a rare but fatal ventricular arrhythmia (torsades de pointes) because of its substantial QT-prolonging effects, especially at higher doses.…”

Section: Disadvantagesmentioning

confidence: 99%

Management of opioid use disorders: a national clinical practice guideline

Bruneau

Ahamad

Goyer

et al. 2018

CMAJ

327

392

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Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

Cited by 31 publications

References 39 publications

Changes in opioid mortality following increased access to opioid substitution treatment

Changes in opioid mortality following increased access to opioid substitution treatment

Association between process measures and mortality in individuals with opioid use disorders

Management of opioid use disorders: a national clinical practice guideline

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