Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment.
Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment.
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DOI：
10.1136/bmj.c3172
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发表时间：
2010-07-01
期刊：
影响因子：
--
通讯作者：
Robertson JR
中科院分区：
文献类型：
--
作者：
Kimber J;Copeland L;Hickman M;Macleod J;McKenzie J;De Angelis D;Robertson JR
目的研究一组吸毒者的生存和长期停止注射，并评估阿片类药物替代治疗对这些结果的影响。设计前瞻性开放队列研究。设置在爱丁堡的一个单一的初级保健设施。参与者794例患者的注射吸毒史在1980年和2007年之间提出; 655（82%）进行了随访的采访或链接到初级保健记录和死亡登记，或两者兼而有之，并贡献了10 390人年的风险; 557（85%）已接受阿片类药物替代治疗。主要结果测量：注射持续时间：从第一次注射到长期停止的年数，定义为五年非注射期之前的最后一次注射;停止前的死亡率;总生存率。结果277例长期停药，228例死亡。一半的幸存者有健康相关的生活质量差。从第一次注射到死亡的中位持续时间为24年，对于那些没有艾滋病毒的参与者为41年。对于每增加一年的阿片类药物替代治疗，在调整艾滋病毒、性别、日历周期、首次注射时的年龄以及监狱和过量用药史后，长期停药前的死亡风险下降13%（95%置信区间为17%至9%）。相反，暴露于阿片替代治疗与实现长期戒烟的机会呈负相关。结论：在初级保健中对注射毒品使用者进行阿片类替代治疗可降低死亡风险，生存获益随着治疗累积而增加。治疗不会减少注射的总持续时间。
Objectives To examine survival and long term cessation of injecting in a cohort of drug users and to assess the influence of opiate substitution treatment on these outcomes. Design Prospective open cohort study. Setting A single primary care facility in Edinburgh. Participants 794 patients with a history of injecting drug use presenting between 1980 and 2007; 655 (82%) were followed up by interview or linkage to primary care records and mortality register, or both, and contributed 10 390 person years at risk; 557 (85%) had received opiate substitution treatment. Main outcome measures Duration of injecting: years from first injection to long term cessation, defined as last injection before period of five years of non-injecting; mortality before cessation; overall survival. Results In the entire cohort 277 participants achieved long term cessation of injecting, and 228 died. Half of the survivors had poor health related quality of life. Median duration from first injection to death was 24 years for participants with HIV and 41 years for those without HIV. For each additional year of opiate substitution treatment the hazard of death before long term cessation fell 13% (95% confidence interval 17% to 9%) after adjustment for HIV, sex, calendar period, age at first injection, and history of prison and overdose. Conversely exposure to opiate substitution treatment was inversely related to the chances of achieving long term cessation. Conclusions Opiate substitution treatment in injecting drug users in primary care reduces this risk of mortality, with survival benefits increasing with cumulative exposure to treatment. Treatment does not reduce the overall duration of injecting.
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