Changes in opioid mortality following increased access to opioid substitution treatment

Abstract Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing mortality represent an important area of study. In Skåne County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related mortality. Methods Detailed data on all opioid-induced deaths in Skåne during the two years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skåne and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related mortalities in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skåne and the rest of Sweden before and after the intervention.Results There was a non-significant increase in the number of deaths in Skåne between the data collection periods (RR: 1.18 95% CI:0.89-1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12-6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51-1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug intoxications in Skåne compared to the rest of Sweden following the onset of the reform (0.90, 0.84-0,97, p= 0.004). Conclusions Opioid-related mortality, as assessed using forensic data, has not changed significantly in Skåne following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased opioid mortality. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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Changes in opioid-related deaths following increased access to opioid substitution treatment

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-021-00351-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lisa Andersson ◽

Anders Håkansson ◽

Jonas Berge ◽

Björn Johnson

Keyword(s):

Policy Change ◽

National Level ◽

Patient Choice ◽

Mortality Data ◽

Substitution Treatment ◽

Opioid Substitution Treatment ◽

Level Data ◽

The Impact ◽

Overdose Deaths ◽

Opioid Substitution

Abstract Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing opioid-related deaths represent an important area of study. In Skåne County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related deaths. Methods Detailed data on opioid-related deaths in Skåne during the 2 years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skåne and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related deaths in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skåne and the rest of Sweden before and after the intervention. Results There was no significant difference in the number of deaths in Skåne between the data collection periods (RR: 1.18 95% CI:0.89–1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12–6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51–1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug deaths in Skåne compared to the rest of Sweden following the onset of the reform (0.90, 0.84–0,97, p= 0.004). Conclusions Opioid-related deaths, as assessed using forensic data, has not changed significantly in Skåne following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased overdose deaths. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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Patients on Opioid Substitution Treatment in the Republic of Macedonia: What Do Treatment Demand Data Tell Us?

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2014.058 ◽

2014 ◽

Vol 2 (2) ◽

pp. 335-343

Author(s):

Tatjana Petrushevska ◽

Vesna Velik Stefanovska

Keyword(s):

Medical Records ◽

National Level ◽

Treatment Protocol ◽

Cross Sectional Study ◽

Age Group ◽

Substitution Treatment ◽

Cross Sectional ◽

Opioid Substitution Treatment ◽

Treatment Facilities ◽

Opioid Substitution

AIM: The aim of the survey is to analyze national data from opioid substitution treatment (OST) medical records and to compare it with the data from EU countries.MATERIAL AND METHODS: The survey is quantitative analytical cross-sectional study conducted in the period September - December 2013. Medical records from all patients on OST at national level during the year 2012 were analyzed. EMCDDA questionnaire from treatment protocol 3.0 was used. Data for OST patients on MMT was take from all 12 public treatment facilities, three private centers and 3 prisons. Data for OST patients on buprenorphine was taken from public clinic as the only one responsible for this type of treatment.RESULTS: A comprehensive network, diverse models of treatment intervention exists in the MKD. Total number of OST patients in 2012 in all treatment facilities was 1857 (1356 are in public, 141 in private, 360 in prison settings) 10% are on Buprenorphine and 90% are on Methadone, 52% in age group 20-34. Ratio of male to female heroin clients is 9:1; 162 are female (9 %); 107(66%) are in treatment in the age group 20-34. Average number of OST patients is 0.1% of the total population in each of the 10 cities analyzed. The mean age at first heroin use is 18 years. 40% of patients haven’t high school. With their family lives 65% of OST patients; 487 patients (36%) have children; 80% of patients use of benzodiazepines.CONCLUSION: Although treatment network of drug addiction is quite developed, perceived need for further capacity building and increase the quality of medical care implies increasing the availability, diversification in terms of sensitivity to cultural differences, gender, age, ethnicity, as well as the treatment of dependence of different types of psychoactive substances.

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