Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study
Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study
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DOI：
10.1136/bmj.m772
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发表时间：
2020-03-31
影响因子：
105.7
通讯作者：
Nosyk, Bohdan
中科院分区：
文献类型：
--
作者：
Pearce, Lindsay A.;Min, Jeong Eun;Nosyk, Bohdan
目的-在非法制造的芬太尼和其他强效合成阿片类药物在非法药物供应中的高流行率的情况下，比较阿片类药物使用障碍患者在阿片类激动剂治疗（OAT）和非阿片类激动剂治疗（OAT）期间的死亡风险。设计-基于人群的回顾性队列研究。设置-五个卫生行政数据集的个体水平联系，医生账单记录，门诊护理报告，以及不列颠哥伦比亚省的死亡，加拿大。参与者-1996年1月1日至2018年9月30日期间接受OAT的55 347名阿片类药物使用障碍患者。主要结局指标-全因和特定原因粗死亡率（每1000人年），以确定死亡的绝对风险和所有原因的年龄和性别标准化死亡率比率，以确定与一般人群相比的相对死亡风险。根据治疗状态（使用OAT、停用OAT）、开始和停止治疗的时间（1、2、3-4、5-12、>12周）和药物类型（美沙酮、丁丙诺啡/纳洛酮）计算死亡风险。调整后的风险比相比，随着时间的推移，芬太尼成为更普遍的非法药物supply.Results- 7030（12.7%）的55 347 OAT收件人死亡的相对风险OAT。OAT组的全因标准化死亡率（4.6，95%置信区间4.4 - 4.8）显著低于非OAT组（9.7，9.5 - 10.0）。在芬太尼流行率增加的时期，OAT死亡率的相对风险为2.1（95%置信区间为1.8至2.4）倍，高于引入芬太尼前的OAT，增加到3.4（2.8至4.3）研究期结束时结论：阿片类药物使用障碍患者，保留OAT与死亡风险的大幅降低相关。随着芬太尼和其他合成阿片类药物在非法药物供应中变得普遍，OAT对死亡率的保护作用增加，而OAT的死亡风险仍然很高。随着芬太尼在全球范围内变得更加普遍，这些发现凸显了改善阿片类激动剂治疗保留并防止接受者停止治疗的干预措施的重要性。
Objective - To compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply.Design - Population based retrospective cohort study.Setting - Individual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada.Participants - 55 347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018.Main outcome measures - All cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply.Results- 7030 (12.7%) of 55 347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk).Conclusions - Retention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.