Opioid maintenance treatment in the Czech Republic, Norway and Denmark: a study protocol of a comparative registry linkage study

Gabrhelík, Roman; Handal, Marte; Mravčík, Viktor; Nechanská, Blanka; Tjagvad, Christian; Thylstrup, Birgitte; Hesse, Morten; Minařík, Jakub; Jarkovský, Jiří; Bukten, Anne; Clausen, Thomas

doi:10.1136/bmjopen-2020-047028

Cited by 8 publications

(5 citation statements)

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“…This was a registry-linkage study on the national samples of OAT patients from Czechia and Norway in 2010-2019. The protocols for the overall comparative registry linkage studies [32,33] and previous findings on somatic comorbidity and mortality in the same cohort of OAT patients can be found elsewhere [34,35].…”

Section: Methodsmentioning

confidence: 99%

Exploring dual diagnosis in opioid agonist treatment patients: a registry-linkage study in Czechia and Norway

Rolová,

Skurtveit,

Gabrhelík

et al. 2024

Addict Sci Clin Pract

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Background Knowledge of co-occurring mental disorders (termed ‘dual diagnosis’) among patients receiving opioid agonist treatment (OAT) is scarce. This study aimed (1) to estimate the prevalence and structure of dual diagnoses in two national cohorts of OAT patients and (2) to compare mental disorders between OAT patients and the general populations stratified on sex and standardized by age. Methods A registry-linkage study of OAT patients from Czechia (N = 4,280) and Norway (N = 11,389) during 2010–2019 was conducted. Data on mental disorders (F00-F99; ICD-10) recorded in nationwide health registers were linked to the individuals registered in OAT. Dual diagnoses were defined as any mental disorder excluding substance use disorders (SUDs, F10-F19; ICD-10). Sex-specific age-standardized morbidity ratios (SMR) were calculated for 2019 to compare OAT patients and the general populations. Results The prevalence of dual diagnosis was 57.3% for Czechia and 78.3% for Norway. In Czechia, anxiety (31.1%) and personality disorders (25.7%) were the most prevalent, whereas anxiety (33.8%) and depression (20.8%) were the most prevalent in Norway. Large country-specific variations were observed, e.g., in ADHD (0.5% in Czechia, 15.8% in Norway), implying differences in screening and diagnostic practices. The SMR estimates for any mental disorders were 3.1 (females) and 5.1 (males) in Czechia and 5.6 (females) and 8.2 (males) in Norway. OAT females had a significantly higher prevalence of co-occurring mental disorders, whereas SMRs were higher in OAT males. In addition to opioid use disorder (OUD), other substance use disorders (SUDs) were frequently recorded in both countries. Conclusions Results indicate an excess of mental health problems in OAT patients compared to the general population of the same sex and age in both countries, requiring appropriate clinical attention. Country-specific differences may stem from variations in diagnostics and care, reporting to registers, OAT provision, or substance use patterns.

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Section: Methodsmentioning

confidence: 99%

Exploring dual diagnosis in opioid agonist treatment patients: a registry-linkage study in Czechia and Norway

Rolová,

Skurtveit,

Gabrhelík

et al. 2024

Addict Sci Clin Pract

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“…In each country, physicians are legally required to report data to these registries. The protocol for the overall comparative registry linkage study can be found elsewhere [[24]]. All three cohorts have been analysed separately.…”

Section: Methodsmentioning

confidence: 99%

Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study

et al. 2023

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Introduction: Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender. Methods: This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000–2019), Denmark (2000–2018), and Norway (2010–2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality. Results: In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark). Conclusion: This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.

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“…We used a prospective cohort approach linking the data sources by using the unique civil registration number assigned to all residents in both countries ( 21 ).…”

Section: Methodsmentioning

confidence: 99%

“…Nation-wide OMT registers with detailed information on an individual level about time of enrolment in treatment, discontinuation, re-entry, and termination of OMT medication exist in Czechia and Denmark ( 21 ), and may be linked to information on time of death and causes of death obtained from nation-wide mortality registries. Furthermore, these two countries represent distinct treatment settings.…”

Section: Introductionmentioning

confidence: 99%

Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study

Gabrhelík,

Hesse,

Nechanská

et al. 2023

Front. Public Health

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BackgroundOpioid maintenance treatment (OMT) has the potential to reduce mortality rates substantially. We aimed to compare all-cause and overdose mortality among OMT patients while in or out of OMT in two different countries with different approaches to OMT.MethodsTwo nation-wide, registry-based cohorts were linked by using similar analytical strategies. These included 3,637 male and 1,580 female patients enrolled in OMT in Czechia (years 2000–2019), and 6,387 male and 2,078 female patients enrolled in OMT in Denmark (years 2007–2018). The direct standardization method using the European (EU-27 plus EFTA 2011–2030) Standard was employed to calculate age-standardized rate to weight for age. All-cause and overdose crude mortality rates (CMR) as number of deaths per 1,000 person years (PY) in and out of OMT were calculated for all patients. CMRs were stratified by sex and OMT medication modality (methadone, buprenorphine, and buprenorphine with naloxone).ResultsAge-standardized rate for OMT patients in Czechia and Denmark was 9.7/1,000 PY and 29.8/1,000 PY, respectively. In Czechia, the all-cause CMR was 4.3/1,000 PY in treatment and 10.8/1,000 PY out of treatment. The overdose CMR was 0.5/1,000 PY in treatment and 1.2/1,000 PY out of treatment. In Denmark, the all-cause CMR was 26.6/1,000 PY in treatment and 28.2/1,000 PY out of treatment and the overdose CMR was 7.3/1,000 PY in treatment and 7.0/1,000 PY out of treatment.ConclusionCountry-specific differences in mortality while in and out of OMT in Czechia and Denmark may be partly explained by different patient characteristics and treatment systems in the two countries. The findings contribute to the public health debate about OMT management and may be of interest to practitioners, policy and decision makers when balancing the safety and accessibility of OMT.

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Opioid maintenance treatment in the Czech Republic, Norway and Denmark: a study protocol of a comparative registry linkage study

Cited by 8 publications

References 44 publications

Exploring dual diagnosis in opioid agonist treatment patients: a registry-linkage study in Czechia and Norway

Exploring dual diagnosis in opioid agonist treatment patients: a registry-linkage study in Czechia and Norway

Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study

Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study

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