Do interruptions to the continuity of methadone maintenance treatment in specialist addiction settings increase the risk of drug-related poisoning deaths? A retrospective cohort study

Autor: Benedict K. Ryan, Gráinne Cousins, Kathleen Bennett, Denis O'Driscoll, Louise Durand, Tom Fahey, Eamon Keenan, Fiona Boland, Joseph Barry
Rok vydání: 2019
Předmět:
Adult
Male
Narcotics
Patient Transfer
Research Report
medicine.medical_specialty
Methadone maintenance
Population
030508 substance abuse
Medicine (miscellaneous)
opioid substitution treatment
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Risk Factors
drug‐related poisoning mortality
Internal medicine
Cause of Death
medicine
Risk of mortality
Opiate Substitution Treatment
Humans
030212 general & internal medicine
education
Retrospective Studies
education.field_of_study
business.industry
All‐cause mortality
Mortality rate
Retrospective cohort study
Opioid use disorder
Research Reports
Middle Aged
medicine.disease
Opioid-Related Disorders
Psychiatry and Mental health
methadone maintenance treatment
Relative risk
Female
opioid‐use disorder
Drug Overdose
0305 other medical science
business
heroin
Ireland
transfer
Methadone
medicine.drug
Zdroj: Addiction (Abingdon, England)
ISSN: 1360-0443
Popis: Aims To examine the risk of mortality associated with interruptions to the continuity of methadone maintenance treatment (MMT), including transfers between services, in opioid‐dependent individuals attending specialist addiction services. Design Retrospective cohort study using addiction services and primary care dispensing records, the National Methadone Register and National Drug‐Related Death Index (NDRDI). Setting Geographically defined population in Dublin, Ireland. Participants A total of 2899 people prescribed and dispensed methadone in specialist addiction services between January 2010 and December 2015. There were five exposure groups: weeks 1–4 following transfer between treatment providers; weeks 1–4 out of treatment; weeks 5–52 out of treatment; weeks 1–4 of treatment initiation; and weeks 5+ of continuous treatment (reference category). Measurements Primary outcome: drug‐related poisoning (DRP) deaths. Secondary outcome: all‐cause mortality (ACM). Mortality rates calculated by dividing number of deaths (DRP; ACM) in exposure groups by person‐years exposure. Unadjusted and adjusted Poisson regression (covariates age, sex, incarceration, methadone dose and comorbidities) estimated differences in mortality rates. Findings There were 154 ACM deaths, 55 (35.7%) identified as DRP deaths. No deaths were observed in the first month following transfer between treatment providers. The risk of DRP mortality was highest in weeks 1–4 out of treatment [adjusted relative risk (aRR = 4.04, 95% confidence interval (CI) = 1.43–11.43, P = 0.009] and weeks 1–4 of treatment initiation (ARR = 3.4, 95% CI = 1.2–9.64, P = 0.02). Similarly, risk of ACM was highest in weeks 1–4 out of treatment (ARR = 11.78, 95% CI = 7.73–17.94, P
Databáze: OpenAIRE
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