Organ pathologies detected post‐mortem in patients receiving opioid agonist treatment for opioid use disorder: a nation‐wide 2‐year cross‐sectional study

Abstract

Aims To document organ pathologies detected post‐mortem in patients receiving opioid agonist treatment for opioid use disorder and estimate the extent to which individual characteristics are associated with pulmonary, cardiovascular, hepatic or renal pathologies. Design Two‐year cross‐sectional nation‐wide study. Setting Norway. Participants Among all 200 patients who died during opioid agonist treatment between 1 January 2014 and 31 December 2015, 125 patients (63%) were autopsied. Among these, 122 patients (75% men) had available autopsy reports and were included. The mean age at the time of death was 48 years. Measurements Information on pulmonary, cardiovascular, hepatic and renal pathologies were retrieved from forensic or medical autopsy reports, with no (0) and yes (1) as outcome variables and age, sex and body mass index as covariates in logistic regression analyses. Findings Pathologies in several organs were common. Two‐thirds (65%) of the decedents had more than two organ system diseases. The most common organ pathologies were chronic liver disease (84%), cardiovascular disease (68%) and pulmonary emphysema (41%). In bivariate analyses, only older age was associated with any pulmonary pathology [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.01–1.10], cardiovascular pathology (OR = 1.11; 95% CI = 1.05–1.17) and renal pathology (OR = 1.05; 95% CI = 1.00–1.11). Older age remained independently associated with cardiovascular pathology (OR = 1.10; 95% CI = 1.04–1.16) and renal pathology (OR = 1.06; 95% CI = 1.01–1.12) adjusted for body mass index and sex. Conclusions Among autopsied Norwegians who died during opioid agonist treatment in 2014 and 2015, two‐thirds had more than two organ system diseases, despite their mean age of 48 years at the time of death. Older age was independently associated with at least one cardiovascular or renal pathology after adjusting for sex and body mass index.

Liver stiffness and associated risk factors among people with a history of injecting drugs: a prospective cohort study

“…For persons with OUD, opioid agonist therapy (OAT) is an essential treatment approach, which almost halves mortality in this population, yet the mortality remains high within this group [ 8 , 9 ]. Diseases of the digestive system, such as chronic liver disease, significantly contribute to the morbidity and mortality of persons with OUD or injecting substance use [ 10 , 11 ]. In a systematic review, the standard mortality rate related to diseases of the digestive system was estimated to be 3.4 for males and 7.9 for females [ 10 ].…”

“…In a systematic review, the standard mortality rate related to diseases of the digestive system was estimated to be 3.4 for males and 7.9 for females [ 10 ]. In an autopsy study from Norway of 122 patients who died during OAT treatment, at least one liver disease was identified in 84% of the decedents [ 11 ]. Amidst a growing global prevalence of liver cirrhosis, there is a need to improve the understanding of the risk factors for liver disease and their progression among persons with OUD or injecting substance use [ 12 , 13 ] to achieve timely detection and prevent disease progression [ 14 ].…”

A qualitative study on people with opioid use disorders’ perspectives on smoking and smoking cessation interventions

“…Patients with opioid dependence have a markedly lower life expectancy than the general population ( 1 , 2 ). Opioid agonist therapy (OAT) substantially reduces mortality, but the morbidity and mortality rates remain higher than for the general population ( 3 – 5 ). An estimated 85% of patients receiving OAT smoke tobacco ( 6 ).…”

Integration of smoking cessation into standard treatment for patients receiving opioid agonist therapy who are smoking tobacco: protocol for a randomised controlled trial (ATLAS4LAR)

“…Among patients with opioid dependence receiving opioid agonist therapy (OAT), nearly 85% smoke tobacco [ 10 ]. The prevalence of lung diseases is as high as 63% in autopsy samples of OAT patients [ 11 ], whereas 21% of patients on methadone as OAT medication in a primary care setting had diagnosis of COPD, asthma, or both [ 12 ]. Thus, ceasing tobacco smoking is likely to provide a significant decrease in morbidity and mortality among opioid-dependent patients.…”