Predictors of Opioid-Related Death During Methadone Therapy

Abstract

We aimed to examine pharmacologic, demographic and medical comorbidity risk factors for opioid-related mortality among patients currently receiving methadone for an opioid use disorder. We conducted a population-based, nested case-control study linking healthcare and coroner's records in Ontario, Canada, from January 31, 1994 to December 31, 2010. We included social assistance recipients receiving methadone for an opioid use disorder. Within this group, cases were those who died of opioid-related causes. For each case, we identified up to 5 controls matched on calendar quarter. The primary analysis examined the association between use of psychotropic drugs (benzodiazepines, antidepressants or antipsychotics) and opioid-related mortality. Secondary analyses examined the associations between baseline characteristics, health service utilization, comorbidities and opioid-related mortality. Among 43,545 patients receiving methadone for an opioid use disorder, we identified 175 (0.4%) opioid-related deaths, along with 873 matched controls. Psychotropic drug use was associated with a two fold increased risk of opioid-related death (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.2 to 3.5). Specifically, benzodiazepines (adjusted OR 1.6; 95% CI 1.1 to 2.5) and antipsychotics (adjusted OR 2.3; 95% CI 1.5 to 3.5) were independently associated with opioid-related death. Other associated factors included chronic lung disease (adjusted OR 1.7; 95% CI 1.2 to 2.6), an alcohol use disorder (adjusted OR 1.9; 95% CI 1.2 to 3.2), mood disorders (adjusted OR 1.8; 95% CI 1.0 to 3.2), and a history of heart disease (adjusted OR 5.3; 95% CI 2.0 to 14.0). Psychotropic drug use is associated with opioid-related death in patients receiving methadone. Mindfulness of these factors may reduce the risk of death among methadone recipients.

Utilization of dating apps by men who have sex with men for persuading other men toward substance use

“…Short-term issues include increased heart rate, dizziness, tremors, and mode changes, whereas long-term impact includes mental and physical effects 23,24. As a consequence, deteriorated health of the people practicing substance use, associated criminal activities, and people with psychological disorders are all risks and challenges to a healthy society.…”

A Hazard Analysis of Risk Factors of Mortality in Individuals Who Inject Drugs in Denver CO

“…This lack of association could be due to a predominantly concurrent polydrug using cohort and the challenges of self-report. Concurrent and simultaneous polydrug use is a known risk factor for mortality [15, 16, 43] and combinations of heroin and cocaine [43], as well as opiates and benzodiazepines, [44] have been shown to be risk factors for acute-toxicity mortality. Perhaps polydrug users who use heroin predominantly as in cohort 3 (HR 1.75 vs. cohort 1, p = 0.08 not shown) or frequently use shared preparation equipment may harbor additional behavioral risks that would be important in all-cause mortality as well.…”

Treatment of Opioid-Use Disorders

“…Dangers associated with methadone include overdose if the dose is increased too quickly during the initial stages of treatment and a potential prolongation of the QT interval on electrocardiography that can contribute to cardiac arrhythmias with doses higher than 100 mg per day. [44][45][46] Patients must understand their roles and responsibilities as well as the benefits that the program can and cannot offer.…”

“…11,52,53 The effectiveness of methadone maintenance is well established, and this drug is listed among "essential medications" by the World Health Organization. 11,45 Maintenance programs decrease mortality by approximately 50% among persons with opioid-use disorders, decrease acquisition of HIV infection and hepatitis, decrease crime and illicit-substance use, improve social functioning, and increase the rate of retention in rehabilitation programs. 15,50,54,55 Buprenorphine Maintenance…”