Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-10
Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-10
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DOI：
10.1111/add.12863
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发表时间：
2015-06-01
期刊：
影响因子：
6
通讯作者：
Nosyk, Bohdan
中科院分区：
文献类型：
--
作者：
Evans, Elizabeth;Li, Libo;Nosyk, Bohdan
AimsTo estimate mortality rates among treated opioid-dependent individuals by cause and relation to the general population，and to estimate the instantaneous effects of opioid detoxification and maintenance treatment（MMT）on the hazard of all cause and cause-specific mortality. DesignationPopulation-based treatment cohort study.SettingLinked mortality data on all individuals first enrolled in public funded pharmacological treatment for opioid dependence in加州州，美国2006 - 2010年共发生32322例，其中死亡1031例（3.2%），中位随访2.6年（四分位数间距=1.4-3.7）。测量主要结果是死亡率，由死亡时间表示，粗死亡率（CMR）和标准化死亡率（SMR）。结果：与普通人群相比，接受阿片类药物依赖治疗的个体的死亡风险增加了四倍以上[SMR= 1.5%]。4.5，95%置信区间（CI）=4.2，4.8]。死亡率风险较高（1），当个人停止治疗（SMR=6.1，95% CI=5.7，6.5）（SMR=1.8，95% CI=1.6，2.1）和（2）脱毒期间（SMR=2.4，95%CI =1.5，3.8），尤其是在治疗后2周（SMR=5.5，95%CI =2.7，9.8 vs SMR=2.5，95%CI =1.7，4.9）。去甲肾上腺素和MMT均能独立降低全因死亡率和药物相关死亡率的瞬时风险。MMT戒毒前与较低的全因和其他原因特异性死亡率比MMT单独。ConclusionsIn人与阿片类药物依赖，戒毒和美沙酮维持治疗都独立地降低了瞬时的风险，全因和药物相关的死亡率。
AimsTo estimate mortality rates among treated opioid-dependent individuals by cause and in relation to the general population, and to estimate the instantaneous effects of opioid detoxification and maintenance treatment (MMT) on the hazard of all-cause and cause-specific mortality.DesignPopulation-based treatment cohort study.SettingLinked mortality data on all individuals first enrolled in publicly funded pharmacological treatment for opioid dependence in California, USA from 2006 to 2010.ParticipantsA total of 32322 individuals, among whom there were 1031 deaths (3.2%) over a median follow-up of 2.6 years (interquartile range=1.4-3.7).MeasurementsThe primary outcome was mortality, indicated by time to death, crude mortality rates (CMR) and standardized mortality ratios (SMR).FindingsIndividuals being treated for opioid dependence had a more than fourfold increase of mortality risk compared with the general population [SMR=4.5, 95% confidence interval (CI)=4.2, 4.8]. Mortality risk was higher (1) when individuals were out-of-treatment (SMR=6.1, 95% CI=5.7, 6.5) than in-treatment (SMR=1.8, 95% CI=1.6, 2.1) and (2) during detoxification (SMR=2.4, 95% CI=1.5, 3.8) than during MMT (SMR=1.8, 95% CI=1.5, 2.1), especially in the 2weeks post-treatment entry (SMR=5.5, 95% CI=2.7, 9.8 versus SMR=2.5, 95% CI=1.7, 4.9). Detoxification and MMT both independently reduced the instantaneous hazard of all-cause and drug-related mortality. MMT preceded by detoxification was associated with lower all-cause and other cause-specific mortality than MMT alone.ConclusionsIn people with opiate dependence, detoxification and methadone maintenance treatment both independently reduce the instantaneous hazard of all-cause and drug-related mortality.