Impact of Treatment for Opioid Dependence on Fatal Drug-Related Poisoning: A National Cohort Study in England

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 1,499 DRP deaths (3.4 per 1,000 person-years). DRP risk increased while patients were not enrolled in any treatment. Risk when enrolled only in a psychological intervention was double that during OAP. The increased risk when out of treatment was greater for men, illicit drug injectors, and those reporting problematic alcohol use.

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.

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By:  Pierce M1,2, Bird SM3, Hickman M4, Marsden J5, Dunn G2, Jones A2, Millar T1.

• 1Institute of Brain Behaviour and Mental Health, Faculty of Medical and Human Sciences, University of Manchester, UK.
• 2Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, UK.
• 3MRC Biostatistics Unit, Cambridge, UK.
• 4School of Social and Community Medicine, University of Bristol, UK.
• 5Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. 

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