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Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006–10
Author(s) -
Evans Elizabeth,
Li Libo,
Min Jeong,
Huang David,
Urada Darren,
Liu Lei,
Hser YihIng,
Nosyk Bohdan
Publication year - 2015
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12863
Subject(s) - medicine , interquartile range , hazard ratio , standardized mortality ratio , confidence interval , population , mortality rate , opioid , cohort , demography , cohort study , proportional hazards model , environmental health , receptor , sociology
Aims To estimate mortality rates among treated opioid‐dependent individuals by cause and in relation to the general population, and to estimate the instantaneous effects of opioid detoxification and maintenance treatment (MMT) on the hazard of all‐cause and cause‐specific mortality. Design Population‐based treatment cohort study. Setting Linked mortality data on all individuals first enrolled in publicly funded pharmacological treatment for opioid dependence in California, USA from 2006 to 2010. Participants A total of 32 322 individuals, among whom there were 1031 deaths (3.2%) over a median follow‐up of 2.6 years (interquartile range = 1.4–3.7). Measurements The primary outcome was mortality, indicated by time to death, crude mortality rates (CMR) and standardized mortality ratios (SMR). Findings Individuals being treated for opioid dependence had a more than fourfold increase of mortality risk compared with the general population [SMR = 4.5, 95% confidence interval (CI) = 4.2, 4.8]. Mortality risk was higher (1) when individuals were out‐of‐treatment (SMR = 6.1, 95% CI = 5.7, 6.5) than in‐treatment (SMR = 1.8, 95% CI = 1.6, 2.1) and (2) during detoxification (SMR = 2.4, 95% CI = 1.5, 3.8) than during MMT (SMR = 1.8, 95% CI = 1.5, 2.1), especially in the 2 weeks post‐treatment entry (SMR = 5.5, 95% CI = 2.7, 9.8 versus SMR = 2.5, 95% CI = 1.7, 4.9). Detoxification and MMT both independently reduced the instantaneous hazard of all‐cause and drug‐related mortality. MMT preceded by detoxification was associated with lower all‐cause and other cause‐specific mortality than MMT alone. Conclusions In people with opiate dependence, detoxification and methadone maintenance treatment both independently reduce the instantaneous hazard of all‐cause and drug‐related mortality.