Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study

Frontiers in Public Health

Public Health

Abdu Kedir Seid¹  Morten Hesse¹  Birgitte Thylstrup¹  Viktor Mravčík²  Roman Gabrhelík²  Blanka Nechanská²  Christian Tjagvad³  Anne Bukten³  Thomas Clausen³  Svetlana Skurtveit⁴  Marte Handal⁴ 

[1] Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark;First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czechia;Department of Addictology, General University Hospital in Prague, Prague, Czechia;Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway;Norwegian Institute of Public Health, Oslo, Norway;Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway;

关键词: opioid agonist treatment;    opioid maintenance treatment;    methadone;    buprenorphine;    buprenorphine with naloxone;    treatment outcomes;    mortality;    registry-based study;   

DOI  :  10.3389/fpubh.2023.1179763

 received in 2023-03-04, accepted in 2023-09-05,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundOpioid maintenance treatment (OMT) has the potential to reduce mortality rates substantially. We aimed to compare all-cause and overdose mortality among OMT patients while in or out of OMT in two different countries with different approaches to OMT.MethodsTwo nation-wide, registry-based cohorts were linked by using similar analytical strategies. These included 3,637 male and 1,580 female patients enrolled in OMT in Czechia (years 2000–2019), and 6,387 male and 2,078 female patients enrolled in OMT in Denmark (years 2007–2018). The direct standardization method using the European (EU-27 plus EFTA 2011–2030) Standard was employed to calculate age-standardized rate to weight for age. All-cause and overdose crude mortality rates (CMR) as number of deaths per 1,000 person years (PY) in and out of OMT were calculated for all patients. CMRs were stratified by sex and OMT medication modality (methadone, buprenorphine, and buprenorphine with naloxone).ResultsAge-standardized rate for OMT patients in Czechia and Denmark was 9.7/1,000 PY and 29.8/1,000 PY, respectively. In Czechia, the all-cause CMR was 4.3/1,000 PY in treatment and 10.8/1,000 PY out of treatment. The overdose CMR was 0.5/1,000 PY in treatment and 1.2/1,000 PY out of treatment. In Denmark, the all-cause CMR was 26.6/1,000 PY in treatment and 28.2/1,000 PY out of treatment and the overdose CMR was 7.3/1,000 PY in treatment and 7.0/1,000 PY out of treatment.ConclusionCountry-specific differences in mortality while in and out of OMT in Czechia and Denmark may be partly explained by different patient characteristics and treatment systems in the two countries. The findings contribute to the public health debate about OMT management and may be of interest to practitioners, policy and decision makers when balancing the safety and accessibility of OMT.

【 授权许可】

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Copyright © 2023 Gabrhelík, Hesse, Nechanská, Handal, Mravčík, Tjagvad, Thylstrup, Seid, Bukten, Clausen and Skurtveit.