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Addiction. 2016 Feb;111(2):298-308. doi: 10.1111/add.13193. Epub 2015 Nov 25.

Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England.

Author information

1
Institute of Brain Behaviour and Mental Health, Faculty of Medical and Human Sciences, University of Manchester, UK.
2
Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, UK.
3
MRC Biostatistics Unit, Cambridge, UK.
4
School of Social and Community Medicine, University of Bristol, UK.
5
Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.

Abstract

AIMS:

To compare the change in illicit opioid users' risk of fatal drug-related poisoning (DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support, and investigate the modifying effect of patient characteristics, criminal justice system (CJS) referral and treatment completion.

DESIGN:

National data linkage cohort study of the English National Drug Treatment Monitoring System and the Office for National Statistics national mortality database. Data were analysed using survival methods.

SETTING:

All services in England that provide publicly funded, structured treatment for illicit opioid users.

PARTICIPANTS:

Adults treated for opioid dependence during April 2005 to March 2009: 151,983 individuals; 69% male; median age 32.6 with 442,950 person-years of observation.

MEASUREMENTS:

The outcome was fatal DRP occurring during periods in or out of treatment, with adjustment for age, gender, substances used, injecting status and CJS referral.

FINDINGS:

There were 1499 DRP deaths [3.4 per 1000 person-years, 95% confidence interval (CI) = 3.2-3.6]. DRP risk increased while patients were not enrolled in any treatment [adjusted hazard ratio (aHR) = 1.73, 95% CI = 1.55-1.92]. Risk when enrolled only in a psychological intervention was double that during OAP (aHR = 2.07, 95% CI = 1.75-2.46). The increased risk when out of treatment was greater for men (aHR = 1.88, 95% CI = 1.67-2.12), illicit drug injectors (aHR = 2.27, 95% CI = 1.97-2.62) and those reporting problematic alcohol use (aHR = 2.37, 95% CI = 1.90-2.98).

CONCLUSIONS:

Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.

KEYWORDS:

Drug-related poisoning; opiate dependence; opioid agonist pharmacotherapy; overdose; psychosocial treatment; residential treatment

PMID:
26452239
PMCID:
PMC4950033
DOI:
10.1111/add.13193
[Indexed for MEDLINE]
Free PMC Article

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