Association between mortality rates and medication and residential treatment after in-patient medically managed opioid withdrawal: a cohort analysis.
Adolescent
Adult
Buprenorphine
/ therapeutic use
Cohort Studies
Drug Overdose
/ mortality
Female
Humans
Male
Massachusetts
/ epidemiology
Methadone
/ therapeutic use
Middle Aged
Naltrexone
/ therapeutic use
Narcotic Antagonists
/ therapeutic use
Opiate Substitution Treatment
Opioid-Related Disorders
/ drug therapy
Proportional Hazards Models
Residential Treatment
/ statistics & numerical data
Retrospective Studies
Substance Withdrawal Syndrome
/ drug therapy
Young Adult
Detox
medically managed withdrawal
medication for opioid use disorders
mortality
overdose
residential treatment
Journal
Addiction (Abingdon, England)
ISSN: 1360-0443
Titre abrégé: Addiction
Pays: England
ID NLM: 9304118
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
06
07
2019
revised:
16
09
2019
accepted:
06
01
2020
pubmed:
26
2
2020
medline:
10
4
2021
entrez:
26
2
2020
Statut:
ppublish
Résumé
Medically managed opioid withdrawal (detox) can increase the risk of subsequent opioid overdose. We assessed the association between mortality following detox and receipt of medications for opioid use disorder (MOUD) and residential treatment after detox. Cohort study generated from individually linked public health data sets. Massachusetts, USA. A total of 30 681 opioid detox patients with 61 819 detox episodes between 2012 and 2014. Treatment categories included no post-detox treatment, MOUD, residential treatment or both MOUD and residential treatment identified at monthly intervals. We classified treatment exposures in two ways: (a) 'on-treatment' included any month where a treatment was received and (b) 'with-discontinuation' individuals were considered exposed through the month following treatment discontinuation. We conducted multivariable Cox proportional hazards analyses and extended Kaplan-Meier estimator cumulative incidence for all-cause and opioid-related mortality for the treatment categories as monthly time-varying exposure variables. Twelve months after detox, 41% received MOUD for a median of 3 months, 35% received residential treatment for a median of 2 months and 13% received both for a median of 5 months. In on-treatment analyses for all-cause mortality compared with no treatment, adjusted hazard ratios (AHR) were 0.34 [95% confidence interval (CI) = 0.27-0.43] for MOUD, 0.63 (95% CI = 0.47-0.84) for residential treatment and 0.11 (95% CI = 0.03-0.43) for both. In with-discontinuation analyses for all-cause mortality, compared with no treatment, AHRs were 0.52 (95% CI = 0.42-0.63) for MOUD, 0.76 (95% CI = 0.59-0.96) for residential treatment and 0.21 (95% CI = 0.08-0.55) for both. Results were similar for opioid-related overdose mortality. Among people who have undergone medically managed opioid withdrawal, receipt of medications for opioid use disorder, residential treatment or the combination of medications for opioid use disorder and residential treatment were associated with substantially reduced mortality compared with no treatment.
Sections du résumé
BACKGROUND AND AIM
Medically managed opioid withdrawal (detox) can increase the risk of subsequent opioid overdose. We assessed the association between mortality following detox and receipt of medications for opioid use disorder (MOUD) and residential treatment after detox.
DESIGN
Cohort study generated from individually linked public health data sets.
SETTING
Massachusetts, USA.
PARTICIPANTS
A total of 30 681 opioid detox patients with 61 819 detox episodes between 2012 and 2014.
MEASUREMENTS
Treatment categories included no post-detox treatment, MOUD, residential treatment or both MOUD and residential treatment identified at monthly intervals. We classified treatment exposures in two ways: (a) 'on-treatment' included any month where a treatment was received and (b) 'with-discontinuation' individuals were considered exposed through the month following treatment discontinuation. We conducted multivariable Cox proportional hazards analyses and extended Kaplan-Meier estimator cumulative incidence for all-cause and opioid-related mortality for the treatment categories as monthly time-varying exposure variables.
FINDINGS
Twelve months after detox, 41% received MOUD for a median of 3 months, 35% received residential treatment for a median of 2 months and 13% received both for a median of 5 months. In on-treatment analyses for all-cause mortality compared with no treatment, adjusted hazard ratios (AHR) were 0.34 [95% confidence interval (CI) = 0.27-0.43] for MOUD, 0.63 (95% CI = 0.47-0.84) for residential treatment and 0.11 (95% CI = 0.03-0.43) for both. In with-discontinuation analyses for all-cause mortality, compared with no treatment, AHRs were 0.52 (95% CI = 0.42-0.63) for MOUD, 0.76 (95% CI = 0.59-0.96) for residential treatment and 0.21 (95% CI = 0.08-0.55) for both. Results were similar for opioid-related overdose mortality.
CONCLUSIONS
Among people who have undergone medically managed opioid withdrawal, receipt of medications for opioid use disorder, residential treatment or the combination of medications for opioid use disorder and residential treatment were associated with substantially reduced mortality compared with no treatment.
Identifiants
pubmed: 32096908
doi: 10.1111/add.14964
pmc: PMC7854020
mid: NIHMS1069282
doi:
Substances chimiques
Narcotic Antagonists
0
Buprenorphine
40D3SCR4GZ
Naltrexone
5S6W795CQM
Methadone
UC6VBE7V1Z
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1496-1508Subventions
Organisme : NIDA NIH HHS
ID : K23 DA042168
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001430
Pays : United States
Informations de copyright
© 2020 Society for the Study of Addiction.
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