Risk of fatal overdose during and after specialist drug treatment: the VEdeTTE study, a national multi‐site prospective cohort study

Davoli, Marina; Bargagli, Anna Maria; Perucci, Carlo A.; Schifano, Patrizia; Belleudi, Valeria; Hickman, Matthew; Salamina, Giuseppe; Diecidue, Roberto; Vigna‐Taglianti, Federica; Faggiano, Fabrizio

doi:10.1111/j.1360-0443.2007.02025.x

Cited by 190 publications

(148 citation statements)

References 27 publications

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“…The only study we found that examines the risk of premature deaths shortly after leaving treatment used a four-week window (Davoli et al, 2007). In the prison literature, the time window for a high risk of death varies between studies, ranging from one to four weeks or even longer (Ødegård et al, 2009).…”

Section: Definition Of the Time Windowmentioning

confidence: 99%

“…It is well documented that there is a high mortality rate among drug users, and that death by overdose is common cause of death in that group (Clausen et al, 2008;Darke and Degenhardt, 2007;Davoli et al, 2007;Bargagli et al, 2006;Johnson et al, 2005;Gossop et al, 2002). Actually, deaths from opiate overdose comprise the vast majority of all drugrelated deaths (Strang et al, 2008;Darke and Zador, 1996).…”

Section: Introductionmentioning

confidence: 99%

“…However, these studies have not analysed the length of time elapsed between leaving treatment and death (Quaglio et al, 2001;Preti et al, 2002). Except for one study by Davoli et al (2007), hardly any research on MFIT/TCs has looked into this phenomenon. Davoli et al (2007) show that retention in both in-and outpatient treatment for opiate users helps to protect against overdose mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Except for one study by Davoli et al (2007), hardly any research on MFIT/TCs has looked into this phenomenon. Davoli et al (2007) show that retention in both in-and outpatient treatment for opiate users helps to protect against overdose mortality. They also demonstrate that the hazard ratio of overdose death was 26.6 during the month immediately following treatment, as against 7.3 in the subsequent period.…”

Section: Introductionmentioning

confidence: 99%

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Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Ravndal

Amundsen²

2010

Drug and Alcohol Dependence

106

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Background:Drug users who are leaving/completing inpatient medication-free treatment may, like drug users released from prison, have an elevated risk of dying from fatal overdoses. This is mainly explained by their low drug tolerance. Methods:Two hundred and seventy-six drug users who had been admitted to eleven inpatient facilities in Norway, were followed prospectively after discharge from treatment during an eight year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). The following instruments were used: EuropASI, SCL-25 and MCMI-II.Information on deaths and causes of death were obtained from the National Death Register. Results:A total of 36 deaths were registered after discharge from treatment during the observation period, of which 24 were classified as overdose deaths. During the first 4 weeks after discharge six persons died, yielding an unadjusted excess mortality of 15.7 (rate ratio) in this period (CI 5.3-38.3). All were dropouts and all deaths were classified as opiate overdoses.There was no significant association between time in index treatment and mortality after discharge, nor did any background characteristics correlate significantly with elevated mortality shortly after discharge. Conclusions:The elevated risk of dying from overdose within the first four weeks of leaving medicationfree inpatient treatment is so dramatic that preventive measures should be taken. More studies from similar inpatient programmes are needed in order to obtain systematic knowledge about determinants of overdose deaths shortly after leaving treatment, and possible preventive measures..

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Section: Definition Of the Time Windowmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Ravndal

Amundsen²

2010

Drug and Alcohol Dependence

106

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“…OST is highly cost‐effective, whether delivered in the community or prison 17, 18, 19. Prolonged OST is associated with improved survival 5; however, recent studies highlight very high mortality risk in the month after treatment cessation 20, 21, 22, 23. There have also been reports of an elevated risk of mortality during the first month of OST 20, 21, 24, 25.…”

Section: Introductionmentioning

confidence: 99%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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AimsTo estimate whether opioid substitution treatment (OST) with buprenorphine or methadone is associated with a greater reduction in the risk of all‐cause mortality (ACM) and opioid drug‐related poisoning (DRP) mortality.DesignCohort study with linkage between clinical records from Clinical Practice Research Datalink and mortality register.SettingUK primary care.ParticipantsA total of 11 033 opioid‐dependent patients who received OST from 1998 to 2014, followed‐up for 30 410 person‐years.MeasurementsExposure to methadone (17 373, 61%) OST episodes or buprenorphine (9173, 39%) OST episodes. ACM was available for all patients; information on cause of death and DRP was available for 5935 patients (54%) followed‐up for 16 363 person‐years. Poisson regression modelled mortality by treatment period with an interaction between OST type and treatment period (first 4 weeks on OST, rest of time off OST, first 4 weeks off OST, rest of time out of OST censored at 12 months) to test whether ACM or DRP differed between methadone and buprenorphine. Inverse probability weights were included to adjust for confounding and balance characteristics of patients prescribed methadone or buprenorphine.FindingsACM and DRP rates were 1.93 and 0.53 per 100 person‐years, respectively. DRP was elevated during the first 4 weeks of OST [incidence rate ratio (IRR) = 1.93 95% confidence interval (CI) = 0.97–3.82], the first 4 weeks off OST (IRR = 8.15, 95% CI = 5.45–12.19) and the rest of time out of OST (IRR = 2.13, 95% CI = 1.47–3.09) compared with mortality risk from 4 weeks to end of treatment. Patients on buprenorphine compared with methadone had lower ACM rates in each treatment period. After adjustment, there was evidence of a lower DRP risk for patients on buprenorphine compared with methadone at treatment initiation (IRR = 0.08, 95% CI = 0.01–0.48) and rest of time on treatment (IRR = 0.37, 95% CI = 0.17–0.79). Treatment duration (mean and median) was shorter on buprenorphine than methadone (173 and 40 versus 363 and 111, respectively). Model estimates suggest that there was a low probability that methadone or buprenorphine reduced the number of DRP in the population: 28 and 21%, respectively.ConclusionsIn UK general medical practice, opioid substitution treatment with buprenorphine is associated with a lower risk of all‐cause and drug‐related poisoning mortality than methadone. In the population, buprenorphine is unlikely to give greater overall protection because of the relatively shorter duration of treatment.

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Association of Opioid Agonist Therapy With Lower Incidence of Hepatitis C Virus Infection in Young Adult Injection Drug Users

et al. 2014

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use is the primary mode of transmission for hepatitis C virus (HCV) infection. Prior studies suggest opioid agonist therapy may reduce the incidence of HCV infection among injection drug users; however, little is known about the effects of this therapy in younger users.OBJECTIVE To evaluate whether opioid agonist therapy was associated with a lower incidence of HCV infection in a cohort of young adult injection drug users.

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Risk of fatal overdose during and after specialist drug treatment: the VEdeTTE study, a national multi‐site prospective cohort study

Cited by 190 publications

References 27 publications

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

Association of Opioid Agonist Therapy With Lower Incidence of Hepatitis C Virus Infection in Young Adult Injection Drug Users

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