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Mol Psychiatry. 2018 Jun 22. doi: 10.1038/s41380-018-0094-5. [Epub ahead of print]

Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis.

Ma J1,2, Bao YP3,4, Wang RJ1,2, Su MF1,2, Liu MX1,2, Li JQ1,2, Degenhardt L5, Farrell M5, Blow FC6,7, Ilgen M6,7, Shi J8, Lu L9,10.

Author information

1
National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, 100191, Beijing, China.
2
School of Public Health, Peking University, 100191, Beijing, China.
3
National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, 100191, Beijing, China. baoyp@bjmu.edu.cn.
4
National Drug and Alcohol Research Centre, University of New South Wales Australia, Sydney, NSW, 2052, Australia. baoyp@bjmu.edu.cn.
5
National Drug and Alcohol Research Centre, University of New South Wales Australia, Sydney, NSW, 2052, Australia.
6
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, 48109-2700, USA.
7
Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, 48109-2700, USA.
8
National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, 100191, Beijing, China. shijie@bjmu.edu.cn.
9
Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, 100191, Beijing, China. linlu@bjmu.edu.cn.
10
Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, 100191, Beijing, China. linlu@bjmu.edu.cn.

Abstract

Opioid use disorder (OUD) is associated with a high risk of premature death. Medication-assisted treatment (MAT) is the primary treatment for opioid dependence. We comprehensively assessed the effects of different MAT-related characteristics on mortality among those with OUD by a systematic review and meta-analysis. The all-cause and overdose crude mortality rates (CMRs) and relative risks (RRs) by treatment status, different type, period, and dose of medication, and retention time were pooled using random effects, subgroup analysis, and meta-regression. Thirty cohort studies involving 370,611 participants (1,378,815 person-years) were eligible in the meta-analysis. From 21 studies, the pooled all-cause CMRs were 0.92 per 100 person-years (95% CI: 0.79-1.04) while receiving MAT, 1.69 (1.47-1.91) after cessation, and 4.89 (3.54-6.23) for untreated period. Based on 16 studies, the pooled overdose CMRs were 0.24 (0.20-0.28) while receiving MAT, 0.68 (0.55-0.80) after cessation of MAT, and 2.43 (1.72-3.15) for untreated period. Compared with patients receiving MAT, untreated participants had higher risk of all-cause mortality (RR 2.56 [95% CI: 1.72-3.80]) and overdose mortality (8.10 [4.48-14.66]), and discharged participants had higher risk of all-cause death (2.33 [2.02-2.67]) and overdose death (3.09 [2.37-4.01]). The all-cause CMRs during and after opioid substitution treatment with methadone or buprenorphine were 0.93 (0.76-1.10) and 1.79 (1.47-2.10), and corresponding estimate for antagonist naltrexone treatment were 0.26 (0-0.59) and 1.97 (0-5.18), respectively. Retention in MAT of over 1-year was associated with a lower mortality rate than that with retention ≤1 year (1.62, 1.31-1.93 vs. 5.31, -0.09-10.71). Improved coverage and adherence to MAT and post-treatment follow-up are crucial to reduce the mortality. Long-acting naltrexone showed positive advantage on prevention of premature death among persons with OUD.

PMID:
29934549
DOI:
10.1038/s41380-018-0094-5

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