Aggression towards clinicians within Opiate Substitution Treatment (OST) services: A survey of service providers

Background: Co-prescribing benzodiazepines to patients in opiate substitution treatment is controversial and often alleged to increase mortality. In an inner-London general practice, patients with problematic benzodiazepine co-dependence were allowed benzodiazepine maintenance treatment (BMT) since 1994, providing an opportunity for analysis. Method: 1) Case-note review of all 278 opiate substitution treatment patients, accruing 1289 patient treatment years; 46% had concurrent BMT. 2) National Health Service database search for patients who died after leaving accrued a further 883 years of information; only patients who left the UK were unaccounted for (4%). Three groups were studied: 1) never obtained benzodiazepine prescription (NOB): n=80); 2) briefly/occasionally prescribed benzodiazepines (BOP): n=71; 3) BMT: n=127. Outcomes measured: Treatment retention (months); deaths/100 patient treatment years; deaths after leaving the service/100 years of information. Results: Treatment retention: NOB: 34 months; BOP: 51 months; BMT: 72 months. In-treatment mortality: NOB: 1.79/100 patient treatment years; BOP: 0.33/100 patient treatment years; BMT: 1.31/100 patient treatment years. Deaths after leaving service: NOB: 2.24/100 years of information, BOP: 0.63/100 years of information. However, mortality for previously BMT-patients increased by 450% to 5.90/100 years of information. Discussion: BMT patients had longer treatment retention than NOB or BOP and lower mortality than NOB patients. It is unlikely that patients had access to prescribed benzodiazepines on leaving the service because of restrictions in the national guidelines but co-dependent patients are a high-risk group who may stand to gain most benefit from opiate substitution treatment if combined with benzodiazepine-maintenance.

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An overview of opiate substitution treatment in the European Union and Norway

International Journal of Drug Policy ◽

10.1016/s0955-3959(02)00067-1 ◽

2002 ◽

Vol 13 (6) ◽

pp. 477-484 ◽

Cited By ~ 12

Author(s):

Ulrik Solberg ◽

Gregor Burkhart ◽

Margareta Nilson

Keyword(s):

European Union ◽

Substitution Treatment ◽

The European Union ◽

Opiate Substitution Treatment

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Incidence of hepatitis C in drug injectors: the role of homelessness, opiate substitution treatment, equipment sharing, and community size

Epidemiology and Infection ◽

10.1017/s095026880900212x ◽

2009 ◽

Vol 137 (9) ◽

pp. 1255-1265 ◽

Cited By ~ 55

Author(s):

N. CRAINE ◽

M. HICKMAN ◽

J. V. PARRY ◽

J. SMITH ◽

A. M. WALKER ◽

...

Keyword(s):

Hepatitis C ◽

Substitution Treatment ◽

Switching Regression ◽

Community Size ◽

Opiate Substitution Treatment ◽

South Wales ◽

Drug Injectors ◽

Treatment Equipment ◽

Incident Rate

SUMMARYA prospective cohort study estimated the incidence of hepatitis C virus (HCV) in drug injectors in South Wales (UK). In total, 286/481 eligible seronegative individuals were followed up after approximately 12 months. Dried blood spot samples were collected and tested for anti-HCV antibody and behavioural data were collected at baseline and follow-up. HCV incidence was 5·9/100 person-years [95% confidence interval (CI) 3·4–9·5]. HCV incidence was predicted by community size [incident rate ratio (IRR) 6·6, 95% CI 2·11–20·51,P=0·001], homelessness (IRR 2·9, 95% CI 1·02–8·28,P=0·047) and sharing injecting equipment (IRR 12·7, 95% CI 1·62–99·6,P=0·015). HCV incidence was reduced in individuals in opiate substitution treatment (IRR 0·34, 95% CI 0·12–0·99,P=0·047). In order to reduce follow-up bias we used multiple imputation of missing data using switching regression; after imputation estimated HCV incidence was 8·5/100 person-years (95% CI 5·4–12·7). HCV incidence varies with community size, equipment sharing and homelessness are associated with increased HCV incidence and opiate substitution treatment may be protective against HCV.

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