Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database.
Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database.
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DOI：
10.1136/bmj.c5475
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发表时间：
2010-10-26
期刊：
影响因子：
--
通讯作者：
Hickman, Matt
中科院分区：
文献类型：
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作者：
Cornish, Rosie;Macleod, John;Hickman, Matt
目的：研究阿片类替代治疗在治疗开始和结束时以及治疗持续时间的效果。设计：前瞻性队列研究。设置英国全科医学研究数据库。参与者：1990 年至 2005 年间诊断为物质滥用的初级保健患者开出美沙酮或丁丙诺啡。对持有 267003 张鸦片替代治疗处方的 5577 名患者进行随访（17732 年），直至最后一张处方到期后一年、在此时间之前的死亡日期或离开诊所的日期。将阿片使用者死亡率与一般人群死亡率进行比较的标准化死亡率。结果：接受阿片替代治疗的粗死亡率为每 100 人年 0.7 人，未接受治疗的粗死亡率为每 100 人年 1.3 人；治疗时的标准化死亡率为 5.3（95% 置信区间 4.0 至 6.8），治疗后的标准化死亡率为 10.9（9.0 至 13.1）。使用阿片类药物的男性死亡风险大约是女性的两倍（死亡率比 2.0、1.4 至 2.9）。在阿片替代治疗的前两周，粗死亡率为每 100 人年 1.7 人：比治疗其余时间期间的死亡率高 3.1（1.5 至 6.6）倍（调整性别、年龄组、历期和合并症后）。治疗停止后第 1-2 周的粗死亡率为每 100 人年 4.8 人，第 3-4 周为每 100 人年 4.3 人，治疗结束后的其余时间内为 0.95 人年：比治疗期间死亡基线风险高 9 倍（5.4 至 14.9）、8（4.7 至 13.7）和 1.9（1.3 至 2.8）倍。如果平均持续时间接近或超过 12 个月，阿片替代治疗有超过 85% 的机会降低阿片使用者的总体死亡率。 结论：临床医生和患者应在阿片替代治疗开始时和停止治疗后立即意识到死亡风险增加。需要进一步研究来调查阿片替代治疗的平均持续时间对药物相关死亡率的影响。
OBJECTIVE: To investigate the effect of opiate substitution treatment at the beginning and end of treatment and according to duration of treatment.DESIGN: Prospective cohort study. Setting UK General Practice Research Database.PARTICIPANTS: Primary care patients with a diagnosis of substance misuse prescribed methadone or buprenorphine during 1990-2005. 5577 patients with 267003 prescriptions for opiate substitution treatment followed-up (17732 years) until one year after the expiry of their last prescription, the date of death before this time had elapsed, or the date of transfer away from the practice.MAIN OUTCOME MEASURES: Mortality rates and rate ratios comparing periods in and out of treatment adjusted for sex, age, calendar year, and comorbidity; standardised mortality ratios comparing opiate users' mortality with general population mortality rates.RESULTS: Crude mortality rates were 0.7 per 100 person years on opiate substitution treatment and 1.3 per 100 person years off treatment; standardised mortality ratios were 5.3 (95% confidence interval 4.0 to 6.8) on treatment and 10.9 (9.0 to 13.1) off treatment. Men using opiates had approximately twice the risk of death of women (morality rate ratio 2.0, 1.4 to 2.9). In the first two weeks of opiate substitution treatment the crude mortality rate was 1.7 per 100 person years: 3.1 (1.5 to 6.6) times higher (after adjustment for sex, age group, calendar period, and comorbidity) than the rate during the rest of time on treatment. The crude mortality rate was 4.8 per 100 person years in weeks 1-2 after treatment stopped, 4.3 in weeks 3-4, and 0.95 during the rest of time off treatment: 9 (5.4 to 14.9), 8 (4.7 to 13.7), and 1.9 (1.3 to 2.8) times higher than the baseline risk of mortality during treatment. Opiate substitution treatment has a greater than 85% chance of reducing overall mortality among opiate users if the average duration approaches or exceeds 12 months.CONCLUSIONS: Clinicians and patients should be aware of the increased mortality risk at the start of opiate substitution treatment and immediately after stopping treatment. Further research is needed to investigate the effect of average duration of opiate substitution treatment on drug related mortality.