Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: A cohort study.

Young Adult Male Humans Analgesics, Opioid / adverse effects South Africa / epidemiology Cohort Studies Private Sector Opioid-Related Disorders / drug therapy Buprenorphine / therapeutic use Methadone / therapeutic use Insurance
Mortality Opioid agonist therapy Opioid substitution therapy Opioid use disorders Private sector South Africa

Journal

The International journal on drug policy
ISSN: 1873-4758
Titre abrégé: Int J Drug Policy
Pays: Netherlands
ID NLM: 9014759

Informations de publication

Date de publication:
11 2022
Historique:
received: 04 05 2022
revised: 26 08 2022
accepted: 05 09 2022
pubmed: 7 10 2022
medline: 26 10 2022
entrez: 6 10 2022
Statut: ppublish

Résumé

The use of opioids is increasing globally, but data from low- and middle-income countries on opioid-related mental and behavioural disorders (hereafter referred to as opioid-related disorders) are scarce. This study examines the incidence of opioid-related disorders, opioid agonist use, and excess mortality among persons with opioid-related disorders in South Africa's private healthcare sector. We analysed longitudinal data of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having an opioid-related disorder if they received an opioid agonist (buprenorphine or methadone) or an ICD-10 diagnosis for harmful opioid use (F11.1), opioid dependence or withdrawal (F11.2-4), or an unspecified or other opioid-related disorder (F11.0, F11.5-9). We calculated adjusted hazard ratios (aHR) for factors associated with opioid-related disorders, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 diagnosis for opioid dependence or withdrawal, and examined excess mortality among beneficiaries with opioid-related disorders. Of 1,251,458 beneficiaries, 1286 (0.1%) had opioid-related disorders. Between 2011 and 2020, the incidence of opioid-related disorders increased by 12% (95% CI 9%-15%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of opioid-related disorders. The cumulative incidence of opioid agonist use among beneficiaries who received an ICD-10 diagnosis for opioid dependence or withdrawal was 18.0% (95% CI 14.0-22.4) 3 years after diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, opioid-related disorders were associated with an increased risk of mortality (aHR 2.28, 95% CI 1.84-2.82). Opioid-related disorders were associated with a 7.8-year shorter life expectancy. The incidence of people diagnosed with or treated for an opioid-related disorder in the private sector is increasing rapidly. People with opioid-related disorders are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of opioid-related disorders is urgently needed to improve the health outcomes of people with opioid-related disorders.

Sections du résumé

BACKGROUND
The use of opioids is increasing globally, but data from low- and middle-income countries on opioid-related mental and behavioural disorders (hereafter referred to as opioid-related disorders) are scarce. This study examines the incidence of opioid-related disorders, opioid agonist use, and excess mortality among persons with opioid-related disorders in South Africa's private healthcare sector.
METHODS
We analysed longitudinal data of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having an opioid-related disorder if they received an opioid agonist (buprenorphine or methadone) or an ICD-10 diagnosis for harmful opioid use (F11.1), opioid dependence or withdrawal (F11.2-4), or an unspecified or other opioid-related disorder (F11.0, F11.5-9). We calculated adjusted hazard ratios (aHR) for factors associated with opioid-related disorders, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 diagnosis for opioid dependence or withdrawal, and examined excess mortality among beneficiaries with opioid-related disorders.
RESULTS
Of 1,251,458 beneficiaries, 1286 (0.1%) had opioid-related disorders. Between 2011 and 2020, the incidence of opioid-related disorders increased by 12% (95% CI 9%-15%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of opioid-related disorders. The cumulative incidence of opioid agonist use among beneficiaries who received an ICD-10 diagnosis for opioid dependence or withdrawal was 18.0% (95% CI 14.0-22.4) 3 years after diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, opioid-related disorders were associated with an increased risk of mortality (aHR 2.28, 95% CI 1.84-2.82). Opioid-related disorders were associated with a 7.8-year shorter life expectancy.
CONCLUSIONS
The incidence of people diagnosed with or treated for an opioid-related disorder in the private sector is increasing rapidly. People with opioid-related disorders are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of opioid-related disorders is urgently needed to improve the health outcomes of people with opioid-related disorders.

Identifiants

DOI: 10.1016/j.drugpo.2022.103853 PMID: 36202041 PMC: PMC9884995
pubmed: 36202041
pii: S0955-3959(22)00269-9
doi: 10.1016/j.drugpo.2022.103853
pmc: PMC9884995
mid: NIHMS1867734
pii:
doi:

Substances chimiques

Analgesics, Opioid 0
Buprenorphine 40D3SCR4GZ
Methadone UC6VBE7V1Z

Types de publication

Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

103853

Subventions

Organisme : NIAID NIH HHS
ID : U01 AI069924
Pays : United States

Informations de copyright

Copyright © 2022. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper

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Auteurs

Mpho Tlali (M)

Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: mpho.tlali@uct.ac.za.

Andrew Scheibe (A)

Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa; TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa; Community Oriented Primary Care Research Unit, Department of Family Medicine, University of Pretoria, Pretoria, South Africa.

Yann Ruffieux (Y)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

Morna Cornell (M)

Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Anja E Wettstein (AE)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School of Health Sciences, University of Bern, Bern, Switzerland.

Matthias Egger (M)

Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

Mary-Ann Davies (MA)

Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Gary Maartens (G)

Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.

Leigh F Johnson (LF)

Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Andreas D Haas (AD)

Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

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