Mortality Risk Can Be Reduced in Opioid Dependent People

Receiving Opioid Agonist Therapy (OAT) is associated with a lower risk of multiple causes of death like overdose-related, suicide, alcohol-related, cancer, and cardiovascular-related mortality among people with opioid dependence, as per a review from the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney, University of Bristol and several other global institutions. The relationship between OAT and mortality across type of drug, setting and participant groups was examined in over 700,000 participants, which is six times the number of any other previous review.

It was found that mortality risk was lower for those receiving either buprenorphine or methadone treatment, the two most common forms of OAT for people with opioid dependence.

"People with opioid dependence who receive OAT are not only at lower risk of overdose than those who do not but also at lower risk of suicide and several other common causes of death. This review provides further justification for expanding access to OAT to help lower the risk of mortality among people with opioid dependence. Importantly, the benefits of OAT were consistent across the region, age, sex, and comorbidity status. The few studies that examined the impact of OAT after release from prison, found that time in OAT lowered risk of mortality," says Lead author, Thomas Santo Jr, Ph.D. candidate at NDARC.

Mortality Risk and OAT

The review confirmed that there was a greater risk of death in the first month after OAT is stopped. For patients on methadone, there was a greater risk of mortality at the beginning of treatment which was not seen for patients on buprenorphine. It was also seen that first four weeks that followed the treatment cessation were associated with particularly high rates of suicide and overdose-related mortality.

The study thereby highlights the importance of retention in treatment for those with opioid dependence who start treatment on OAT along with detailed investigation and intervention development to minimize mortality risk.

"The research evidence is clear - OAT reduces mortality risk - but the population benefits of OAT may not be realised if treatment periods in the community are too short and prisoners with opioid use disorders are not released on OAT after leaving prison. Countries - like the UK - with on-going public health crises in drug related deaths - need to review both access to OAT and the way it is delivered to ensure the greatest number of deaths are averted. A clinical decision support system, stratifying clients' risk of dropout in real time, may facilitate the identification of those in need of service enhancements to increase engagement and prevent dropout. Work to scale up access and retention could have important population-level benefits," says Professor Matt Hickman, at the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol.

Source-Medindia