Opioid overdose risk during and after drug treatment for heroin dependence: An incidence density case-control study nested in the VEdeTTE cohort.
drug treatment
heroin dependence
methadone maintenance
opioid agonist treatment
overdose mortality
Journal
Drug and alcohol review
ISSN: 1465-3362
Titre abrégé: Drug Alcohol Rev
Pays: Australia
ID NLM: 9015440
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
15
01
2020
revised:
10
08
2020
accepted:
12
08
2020
pubmed:
25
9
2020
medline:
20
11
2021
entrez:
24
9
2020
Statut:
ppublish
Résumé
To corroborate protective effects of a range of drug treatment modalities against overdose mortality risk. Nested case-control study, with incidence density sampling, selecting controls retrospectively at each case event. Cases and controls came from a sub-cohort of opioid-dependent patients (n = 4444) from two Italian regions (Lazio and Piedmont). From 1998 to 2005, there were 91 overdose deaths (cases) matched to 352 controls. The primary outcome was overdose mortality and the primary exposure was drug treatment: opioid agonist treatment (OAT), opioid detoxification, residential community, psychosocial and other pharmacological treatment. Conditional logistic regression models generated intervention effects comparing mortality risk in and out of treatment, adjusting for confounding variables. Overall, drug treatment reduced overdose mortality risk by 80% [adjusted odds ratio (AOR) 0.18, 95% confidence interval (CI) 0.10-0.33, P < 0.001] compared to being out of treatment. There was a particularly strong protective effect of OAT on overdose mortality (AOR 0.08, 95% CI 0.03-0.23, P < 0.001) compared to being out of treatment. There was evidence of a substantially elevated risk of overdose in the first month of leaving treatment (AOR 23.50, 95% CI 7.84-70.19, P < 0.001) compared to being in treatment. The nested case-control design strengthened earlier findings that OAT in Italy has strong protective effects on overdose mortality risk, much stronger than has been previously seen in other Western European settings.
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
281-286Subventions
Organisme : Department of Health
ID : RP-PG-0616-20008
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/N00616X/1
Pays : United Kingdom
Organisme : Ministry of Health Italy
Organisme : Regional Fund for Drug Addiction of Piedmont Region
Organisme : Department of Health
ID : 12/136/105
Pays : United Kingdom
Informations de copyright
© 2020 Australasian Professional Society on Alcohol and other Drugs.
Références
Larney S, Tran L, Santo T et al. All-cause and cause-specific mortality among people using extramedical opioids: a systematic review and meta-analysis. JAMA Psychiat 2019;77:1-10.
Bargagli AM, Hickman M, Davoli M et al. Drug-related mortality and its impact on adult mortality in eight European countries. Eur J Public Health 2006;16:198-202.
Degenhardt L, Bucello C, Mathers B et al. Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Addiction 2011;106:32-51.
European Monitoring Centre for Drugs and Drug Addiction (2019). European Drug Report 2019: Trends and developments. Publications Office of the European Union, Luxembourg.
World Health Organization. Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: WHO, 2009.
Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UKgeneral practice research database. BMJ 2010;341:c5475.
Davoli M, Bargagli AM, Perucci CA et al. Risk of fatal overdose during and after specialist drug treatment: the VEdeTTE study, a national multi-site prospective cohort study. Addiction 2007;102:1954-9.
Kimber J, Copeland L, Hickman M et al. Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment. BMJ 2010;341:c3172.
Sordo L, Barrio G, Bravo MJ et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ 2017;357:j1550.
Pierce M, Bird SM, Hickman M et al. Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction 2016;111:298-308.
Degenhardt L, Randall D, Hall W, Law M, Butler T, Burns L. Mortality among clients of a state-wide opioid pharmacotherapy program over 20 years: risk factors and lives saved. Drug Alcohol Depend 2009;105:9-15.
Kimber J, Larney S, Hickman M, Randall D, Degenhardt L. Mortality risk of opioid substitution therapy with methadone versus buprenorphine: a retrospective cohort study. Lancet Psychiatry 2015;2:901-8.
Ernster VL. Nested case-control studies. Prev Med 1994;23:587-90.
Bargagli AM, Faggiano F, Amato L et al. VEdeTTE, a longitudinal study on effectiveness of treatments for heroin addiction in Italy: study protocol and characteristics of study population. Subst Use Misuse 2006;41:1861-79.
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The DRD-standard version 3.0. EMCDDA standard protocol for the EU Member States to collect data and report figures for the key indicator drug-related deaths by the Standard Reitox tables. Luxembourg: Publications Office of the European Union; 2002.
Ferri M, Bargagli AM, Faggiano F et al. Mortality of drug users attending public treatment centers in Italy 1998-2001: a cohort study. Epidemiol Prev 2007;31:276-82.
Hickman M, Vickerman P, Robertson R, Macleod J, Strang J. Promoting recovery and preventing drug-related mortality: competing risks? J Public Health (Oxf) 2011;33:332-4.
Dipartimento Politiche Antidroga. Relazione al Parlamento 2017 sullo stato delle tossicodipendenze in Italia. Roma: Presidenza del Consiglio dei Ministri, 2017.