Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study
Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study
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DOI：
10.1111/add.13087
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发表时间：
2016-01-01
期刊：
影响因子：
6
通讯作者：
Fahey, Tom
中科院分区：
文献类型：
--
作者：
Cousins, Grainne;Boland, Fiona;Fahey, Tom
目的：评估在治疗转换期间死亡风险是否增加，并研究美沙酮监督服用对药物相关死亡率和全因死亡率的影响。
设计：爱尔兰全国队列研究。
环境：初级医疗保健。
参与者：2004年至2010年间，全国美沙酮治疗登记册上年龄在16 - 65岁的共6983名患者。
测量指标：药物相关（主要结局）和全因（次要结局）死亡率以及治疗期间和未治疗期间的比率；以及定期美沙酮监督服用的影响。
结果：未经调整的药物相关死亡率在治疗期间为每100人年0.24，未治疗期间为0.39，调整后的死亡率比率为1.63[95%置信区间（CI）=0.66 - 4.00]。未经调整的全因死亡率在治疗期间为每100人年0.51，未治疗期间为1.57，调整后的死亡率比率为3.64（95%CI = 2.11 - 6.30）。与治疗5周或更长时间相比，未治疗时的全因死亡率在最初2周高6.36倍（95%CI = 2.84 - 14.22），在第3 - 4周高9.12倍（95%CI = 3.17 - 26.28）。在接受定期监督的患者中全因死亡率较低（未经调整的死亡率为每100人年0.60，相比之下未接受监督的为0.81），然而，调整后，没有足够证据表明定期监督具有保护作用（死亡率比率 = 1.23，95%CI = 0.67 - 2.27）。
结论：在接受美沙酮治疗的初级医疗保健患者中，持续美沙酮治疗与死亡风险降低相关。患者在停止治疗后全因死亡风险增加，且在最初4周期间最高。
AimTo assess whether risk of death increases during periods of treatment transition, and investigate the impact of supervised methadone consumption on drug-related and all-cause mortality.DesignNational Irish cohort study.SettingPrimary care.ParticipantsA total of 6983 patients on a national methadone treatment register aged 16-65years between 2004 and 2010.MeasurementDrug-related (primary outcome) and all-cause (secondary outcome) mortality rates and rate ratios for periods on and off treatment; and the impact of regular supervised methadone consumption.ResultsCrude drug-related mortality rates were 0.24 per 100 person-years on treatment and 0.39 off treatment, adjusted mortality rate ratio 1.63 [95% confidence interval (CI)=0.66-4.00]. Crude all-cause mortality rate per 100 person-years was 0.51 on treatment versus 1.57 off treatment, adjusted mortality rate ratio 3.64 (95% CI=2.11-6.30). All-cause mortality off treatment was 6.36 (95% CI=2.84-14.22) times higher in the first 2weeks, 9.12 (95% CI=3.17-26.28) times higher in weeks 3-4, compared with being 5weeks or more in treatment. All-cause mortality was lower in those with regular supervision (crude mortality rate 0.60 versus 0.81 per 100 person-years) although, after adjustment, insufficient evidence exists to suggest that regular supervision is protective (mortality rate ratio=1.23, 95% CI=0.67-2.27).ConclusionsAmong primary care patients undergoing methadone treatment, continuing in methadone treatment is associated with a reduced risk of death. Patients' risk of all-cause mortality increases following treatment cessation, and is highest in the initial 4-week period.