Mortality among individuals prescribed opioid-agonist therapy in Scotland, UK, 2011–20: a national retrospective cohort study

McAuley, Andrew; Fraser, Rosalyn; Glancy, Megan; Yeung, Alan; Jones, Hayley E; Vickerman, Peter; Fraser, Hannah; Allen, Larissa; McDonald, Scott; Stone, Jack; Liddell, Douglas; Barnsdale, Lee; Priyadarshi, Saket; Markoulidakis, Andreas; Hickman, Matthew; Hutchinson, Sharon

doi:10.1016/s2468-2667(23)00082-8

Cited by 21 publications

(14 citation statements)

References 20 publications

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“…Other potential limitations of our analysis concern unmeasured time‐varying confounders. The observed calendar year effect showed clear evidence of variation over time in Scotland, which is consistent with studies showing increasing DRM risk (since at least 2010 [2, 29]) and changes in environmental risk (e.g. polydrug and benzodiazepine use [2]).…”

Section: Discussionsupporting

confidence: 87%

A transient positive association between direct‐acting antiviral therapy for hepatitis C infection and drug‐related hospitalization among people who inject drugs: Self‐controlled case‐series analysis of national data

McDonald,

Hickman,

Dillon

et al. 2023

Addiction

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Background and aimsDirect‐acting antiviral (DAA) treatment has an established positive effect on liver outcomes in people with hepatitis C infection; however, there is insufficient evidence regarding its effects on the ‘extra‐hepatic’ outcomes of drug‐related hospitalization and mortality (DRM) among people who inject drugs (PWID). We investigated associations between these outcomes and DAA treatment by comparing post‐treatment to baseline periods using a within‐subjects design to minimize selection bias concerns with cohort or case–control designs.DesignThis was a self‐controlled case‐series study.SettingScotland, 1 January 2015–30 November 2020.ParticipantsThe study population of non‐cirrhotic, DAA‐treated PWID was identified using a data set linking Scotland's hepatitis C diagnosis, HCV clinical databases, national inpatient/day‐case hospital records and the national deaths register. Three principal outcomes (drug overdose admission, non‐viral injecting related admission and drug‐related mortality) were defined using ICD codes.MeasurementsSelf‐controlled case‐series methodology was used to estimate the relative incidence (RI) of each outcome associated with time on treatment and up to six 90‐day exposure risk periods thereafter.FindingsA total of 6050 PWID were treated with DAAs in the sampling time‐frame. Compared with the baseline period, there was a significantly lowered risk of a drug overdose hospital admission in the second to fifth exposure risk periods only [relative incidence (RI) = 0.86, 95% confidence interval (CI) = 0.80–0.99; 0.89, 95% CI = 0.80–0.99; 0.86, 95% CI = 0.77–0.96; 0.88, 95% CI = 0.78–0.99, respectively]. For non‐viral injecting‐related admission, there was a reduced risk in the first, third and fourth exposure risk periods (RI = 0.76, 95% CI = 0.64–0.90; 0.75, 95% CI = 0.62–0.90; 0.79, 95% CI = 0.66–0.96, respectively). There was no evidence for reduced DRM risk in any period following treatment end.ConclusionsAmong people who inject drugs in Scotland, direct‐acting antiviral treatment appears to be associated with a small, non‐durable reduction in the risk of drug‐related hospital admission, but not drug‐related mortality. Direct‐acting antiviral therapy, despite high effectiveness against liver disease, does not appear to offer a panacea for reducing other drug‐related health harms.

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Section: Discussionsupporting

confidence: 87%

A transient positive association between direct‐acting antiviral therapy for hepatitis C infection and drug‐related hospitalization among people who inject drugs: Self‐controlled case‐series analysis of national data

McDonald,

Hickman,

Dillon

et al. 2023

Addiction

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“…Unmet health needs have been linked to increased depression, with 29% (21-37%) of PWUD meeting the threshold for clinical depression diagnosis, and consequent self-harm and post-traumatic stress common [ 1 , 137 ]. There were also associations between experience of addictions treatment and overdose which were unexpected, given OAT is known to be protective against drug-related mortality [ 138 ]. This association may be explained by severity of dependence (and related suboptimal dosage); changes in tolerance whilst engaging with treatment; those who engaged with treatment having a higher likelihood of follow-up for overdose; those with past overdose experience being more likely to be referred for treatment; OAT discontinuity and re-entry; and transferring between OAT providers [ 139 , 140 ].…”

Section: Discussionmentioning

confidence: 99%

Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis

Byrne,

Sani,

Thain

et al. 2024

Harm Reduct J

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Background and aims Psychological and social status, and environmental context, may mediate the likelihood of experiencing overdose subsequent to illicit drug use. The aim of this systematic review was to identify and synthesise psychosocial factors associated with overdose among people who use drugs. Methods This review was registered on Prospero (CRD42021242495). Systematic record searches were undertaken in databases of peer-reviewed literature (Medline, Embase, PsycINFO, and Cinahl) and grey literature sources (Google Scholar) for work published up to and including 14 February 2023. Reference lists of selected full-text papers were searched for additional records. Studies were eligible if they included people who use drugs with a focus on relationships between psychosocial factors and overdose subsequent to illicit drug use. Results were tabulated and narratively synthesised. Results Twenty-six studies were included in the review, with 150,625 participants: of those 3,383–4072 (3%) experienced overdose. Twenty-one (81%) studies were conducted in North America and 23 (89%) reported polydrug use. Psychosocial factors associated with risk of overdose (n = 103) were identified and thematically organised into ten groups. These were: income; housing instability; incarceration; traumatic experiences; overdose risk perception and past experience; healthcare experiences; perception of own drug use and injecting skills; injecting setting; conditions with physical environment; and social network traits. Conclusions Global rates of overdose continue to increase, and many guidelines recommend psychosocial interventions for dependent drug use. The factors identified here provide useful targets for practitioners to focus on at the individual level, but many identified will require wider policy changes to affect positive change. Future research should seek to develop and trial interventions targeting factors identified, whilst advocacy for key policy reforms to reduce harm must continue.

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“…As part of public health initiatives, a number of countries now provide naloxone kits for use by first responders in an effort to tackle drug related deaths within communities (Speakman et al, 2023). For those who are opioid dependent 'take home naloxone' may be administered in the event of an accidental overdose, and prior to hospital admission (McAuley et al, 2023).…”

Section: Naloxone Hydrochloride For Acute Life Threating Opioid Eventsmentioning

confidence: 99%

Naloxone hydrochloride for acute opioid events: answers

MacVicar

2023

Journal of Prescribing Practice

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Mortality among individuals prescribed opioid-agonist therapy in Scotland, UK, 2011–20: a national retrospective cohort study

Cited by 21 publications

References 20 publications

A transient positive association between direct‐acting antiviral therapy for hepatitis C infection and drug‐related hospitalization among people who inject drugs: Self‐controlled case‐series analysis of national data

A transient positive association between direct‐acting antiviral therapy for hepatitis C infection and drug‐related hospitalization among people who inject drugs: Self‐controlled case‐series analysis of national data

Psychosocial factors associated with overdose subsequent to Illicit Drug use: a systematic review and narrative synthesis

Naloxone hydrochloride for acute opioid events: answers

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