Fatal and non-fatal opioid overdose in opioid dependent patients treated with methadone, buprenorphine or implant naltrexone
Fatal and non-fatal opioid overdose in opioid dependent patients treated with methadone, buprenorphine or implant naltrexone
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DOI：
10.1016/j.drugpo.2017.05.039
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发表时间：
2017-08-01
影响因子：
4.4
通讯作者：
Hulse, Gary
中科院分区：
文献类型：
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作者：
Kelty, Erin;Hulse, Gary
背景：非法使用阿片类药物与致死性和非致死性阿片类药物过量的高发生率相关。本研究旨在比较接受美沙酮、丁丙诺啡或植入纳洛酮治疗的阿片类药物依赖患者中致命性和严重但非致命性阿片类药物过量的发生率，并确定致命性阿片类药物过量的风险因素。方法：接受美沙酮治疗的阿片类药物依赖患者（n=3515），丁丙诺啡（n=3250）或植入纳洛酮（n=1461）在西澳大利亚州2001年至2010年期间首次使用，与州死亡率和医院数据相匹配。计算并比较三种治疗的致死性和非致死性严重阿片类药物过量的发生率。使用多变量考克斯比例风险模型检查了与致命性阿片类药物过量相关的风险因素。结果：三组之间致命性或非致命性阿片类药物过量的粗发生率无显着差异。在治疗的前28天内，所有三组中非致命性阿片类药物过量的发生率都很高，美沙酮治疗患者的致命性阿片类药物过量也很高。然而，在此期间，在丁丙诺啡或纳洛酮患者中未观察到致死性阿片类药物过量。在前28天之后，丁丙诺啡被证明具有保护作用，特别是在非致命性阿片类药物过量方面。停止治疗后，两组之间的致死性和非致死性阿片类药物过量的发生率相似，但纳洛酮治疗患者的非致死性阿片类药物过量发生率低于美沙酮治疗患者。治疗开始后，性别，并诊断为阿片类药物中毒，心血管或精神健康问题的住院治疗是随后的致命性阿片类药物过量的显着predictors.Conclusions：致命性和非致命性阿片类药物过量的比率没有显着不同的美沙酮，丁丙诺啡或植入纳洛酮治疗的患者。性别和既往因特定原因住院治疗可用于识别具有致死性阿片类药物过量高风险的患者。(C)2017爱思唯尔B.V.保留所有权利。
Background: Illicit opioid use is associated with high rates of fatal and non-fatal opioid overdose. This study aims to compare rates of fatal and serious but non-fatal opioid overdose in opioid dependent patients treated with methadone, buprenorphine or implant naltrexone, and to identify risk factors for fatal opioid overdose.Methods: Opioid dependent patients treated with methadone (n=3515), buprenorphine (n=3250) or implant naltrexone (n=1461) in Western Australia for the first time between 2001 and 2010, were matched against state mortality and hospital data. Rates of fatal and non-fatal serious opioid overdoses were calculated and compared for the three treatments. Risk factors associated with fatal opioid overdose were examined using multivariate cox proportional hazard models.Results: No significant difference was observed between the three groups in terms of crude rates of fatal or non-fatal opioid overdoses. During the first 28 days of treatment, rates of non-fatal opioid overdose were high in all three groups, as were fatal opioid overdoses in patients treated with methadone. However, no fatal opioid overdoses were observed in buprenorphine or naltrexone patients during this period. Following the first 28 days, buprenorphine was shown to be protective, particularly in terms of non-fatal opioid overdoses. After the cessation of treatment, rates of fatal and non-fatal opioid overdoses were similar between the groups, with the exception of lower rates of non-fatal opioid overdose in the naltrexone treated patients compared with the methadone treated patients. After the commencement of treatment, gender, and hospitalisations with a diagnosis of opioid poisoning, cardiovascular or mental health problems were significant predictors of subsequent fatal opioid overdose.Conclusions: Rates of fatal and non-fatal opioid overdose were not significantly different in patients treated with methadone, buprenorphine or implant naltrexone. Gender and prior cause-specific hospitalisations can be used to identify patients at a high risk of fatal opioid overdose. (C) 2017 Elsevier B.V. All rights reserved.