Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England

Matthias Pierce; Sheila M Bird; Matthew Hickman; John Marsden; Graham Dunn; Andrew Jones; Tim Millar

doi:10.1111/add.13193

Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England

Matthias Pierce, Sheila M Bird, Matthew Hickman, John Marsden, Graham Dunn, Andrew Jones, Tim Millar

Research output: Contribution to journal › Article › peer-review

Abstract

AIMS: To compare the change in illicit opioid users' risk of fatal drug-related poisoning (DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support, and investigate the modifying effect of patient characteristics, criminal justice system (CJS) referral and treatment completion.

DESIGN: National data linkage cohort study of the English National Drug Treatment Monitoring System and the Office for National Statistics national mortality database. Data were analysed using survival methods.

SETTING: All services in England that provide publicly funded, structured treatment for illicit opioid users.

PARTICIPANTS: Adults treated for opioid dependence during April 2005 to March 2009: 151,983 individuals; 69% male; median age 32.6 with 442,950 person-years of observation.

MEASUREMENTS: The outcome was fatal DRP occurring during periods in or out of treatment, with adjustment for age, gender, substances used, injecting status and CJS referral.

FINDINGS: There were 1499 DRP deaths [3.4 per 1000 person-years, 95% confidence interval (CI) = 3.2-3.6]. DRP risk increased while patients were not enrolled in any treatment [adjusted hazard ratio (aHR) = 1.73, 95% CI = 1.55-1.92]. Risk when enrolled only in a psychological intervention was double that during OAP (aHR = 2.07, 95% CI = 1.75-2.46). The increased risk when out of treatment was greater for men (aHR = 1.88, 95% CI = 1.67-2.12), illicit drug injectors (aHR = 2.27, 95% CI = 1.97-2.62) and those reporting problematic alcohol use (aHR = 2.37, 95% CI = 1.90-2.98).

CONCLUSIONS: Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.

Original language	English
Pages (from-to)	298-308
Number of pages	11
Journal	Addiction
Volume	111
Issue number	2
Early online date	Nov 2015
DOIs	https://doi.org/10.1111/add.13193
Publication status	Published - Feb 2016

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10.1111/add.13193Licence: CC BY

Stimulating debate, changing practice and influencing policy in tackling drug-related deaths in the UK, Europe and USA
Millar, T. (Participant), Pierce, M. (Participant), (Participant) & Jones, A. (Participant)
Impact: Health and wellbeing, Policy

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@article{b95758cd96e442efb49c7a919dc481e8,

title = "Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England",

abstract = "AIMS: To compare the change in illicit opioid users' risk of fatal drug-related poisoning (DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support, and investigate the modifying effect of patient characteristics, criminal justice system (CJS) referral and treatment completion.DESIGN: National data linkage cohort study of the English National Drug Treatment Monitoring System and the Office for National Statistics national mortality database. Data were analysed using survival methods.SETTING: All services in England that provide publicly funded, structured treatment for illicit opioid users.PARTICIPANTS: Adults treated for opioid dependence during April 2005 to March 2009: 151,983 individuals; 69% male; median age 32.6 with 442,950 person-years of observation.MEASUREMENTS: The outcome was fatal DRP occurring during periods in or out of treatment, with adjustment for age, gender, substances used, injecting status and CJS referral.FINDINGS: There were 1499 DRP deaths [3.4 per 1000 person-years, 95% confidence interval (CI) = 3.2-3.6]. DRP risk increased while patients were not enrolled in any treatment [adjusted hazard ratio (aHR) = 1.73, 95% CI = 1.55-1.92]. Risk when enrolled only in a psychological intervention was double that during OAP (aHR = 2.07, 95% CI = 1.75-2.46). The increased risk when out of treatment was greater for men (aHR = 1.88, 95% CI = 1.67-2.12), illicit drug injectors (aHR = 2.27, 95% CI = 1.97-2.62) and those reporting problematic alcohol use (aHR = 2.37, 95% CI = 1.90-2.98).CONCLUSIONS: Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.",

author = "Matthias Pierce and Bird, {Sheila M} and Matthew Hickman and John Marsden and Graham Dunn and Andrew Jones and Tim Millar",

note = "{\textcopyright} 2015 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.",

year = "2016",

month = feb,

doi = "10.1111/add.13193",

language = "English",

volume = "111",

pages = "298--308",

journal = "Addiction",

issn = "0965-2140",

publisher = "John Wiley & Sons Ltd",

number = "2",

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T1 - Impact of treatment for opioid dependence on fatal drug-related poisoning

T2 - a national cohort study in England

AU - Pierce, Matthias

AU - Bird, Sheila M

AU - Hickman, Matthew

AU - Marsden, John

AU - Dunn, Graham

AU - Jones, Andrew

AU - Millar, Tim

PY - 2016/2

Y1 - 2016/2

N2 - AIMS: To compare the change in illicit opioid users' risk of fatal drug-related poisoning (DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support, and investigate the modifying effect of patient characteristics, criminal justice system (CJS) referral and treatment completion.DESIGN: National data linkage cohort study of the English National Drug Treatment Monitoring System and the Office for National Statistics national mortality database. Data were analysed using survival methods.SETTING: All services in England that provide publicly funded, structured treatment for illicit opioid users.PARTICIPANTS: Adults treated for opioid dependence during April 2005 to March 2009: 151,983 individuals; 69% male; median age 32.6 with 442,950 person-years of observation.MEASUREMENTS: The outcome was fatal DRP occurring during periods in or out of treatment, with adjustment for age, gender, substances used, injecting status and CJS referral.FINDINGS: There were 1499 DRP deaths [3.4 per 1000 person-years, 95% confidence interval (CI) = 3.2-3.6]. DRP risk increased while patients were not enrolled in any treatment [adjusted hazard ratio (aHR) = 1.73, 95% CI = 1.55-1.92]. Risk when enrolled only in a psychological intervention was double that during OAP (aHR = 2.07, 95% CI = 1.75-2.46). The increased risk when out of treatment was greater for men (aHR = 1.88, 95% CI = 1.67-2.12), illicit drug injectors (aHR = 2.27, 95% CI = 1.97-2.62) and those reporting problematic alcohol use (aHR = 2.37, 95% CI = 1.90-2.98).CONCLUSIONS: Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.

AB - AIMS: To compare the change in illicit opioid users' risk of fatal drug-related poisoning (DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support, and investigate the modifying effect of patient characteristics, criminal justice system (CJS) referral and treatment completion.DESIGN: National data linkage cohort study of the English National Drug Treatment Monitoring System and the Office for National Statistics national mortality database. Data were analysed using survival methods.SETTING: All services in England that provide publicly funded, structured treatment for illicit opioid users.PARTICIPANTS: Adults treated for opioid dependence during April 2005 to March 2009: 151,983 individuals; 69% male; median age 32.6 with 442,950 person-years of observation.MEASUREMENTS: The outcome was fatal DRP occurring during periods in or out of treatment, with adjustment for age, gender, substances used, injecting status and CJS referral.FINDINGS: There were 1499 DRP deaths [3.4 per 1000 person-years, 95% confidence interval (CI) = 3.2-3.6]. DRP risk increased while patients were not enrolled in any treatment [adjusted hazard ratio (aHR) = 1.73, 95% CI = 1.55-1.92]. Risk when enrolled only in a psychological intervention was double that during OAP (aHR = 2.07, 95% CI = 1.75-2.46). The increased risk when out of treatment was greater for men (aHR = 1.88, 95% CI = 1.67-2.12), illicit drug injectors (aHR = 2.27, 95% CI = 1.97-2.62) and those reporting problematic alcohol use (aHR = 2.37, 95% CI = 1.90-2.98).CONCLUSIONS: Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.

U2 - 10.1111/add.13193

DO - 10.1111/add.13193

M3 - Article

C2 - 26452239

SN - 0965-2140

VL - 111

SP - 298

EP - 308

JO - Addiction

JF - Addiction

IS - 2

ER -

Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England

Abstract

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Impacts

Stimulating debate, changing practice and influencing policy in tackling drug-related deaths in the UK, Europe and USA

Cite this