Department of Social Medicine, University of Bristol, Bristol BS8 2PS.
BMJ. 2010 Jul 1;341:c3172. doi: 10.1136/bmj.c3172.
To examine survival and long term cessation of injecting in a cohort of drug users and to assess the influence of opiate substitution treatment on these outcomes.
Prospective open cohort study.
A single primary care facility in Edinburgh.
794 patients with a history of injecting drug use presenting between 1980 and 2007; 655 (82%) were followed up by interview or linkage to primary care records and mortality register, or both, and contributed 10,390 person years at risk; 557 (85%) had received opiate substitution treatment.
Duration of injecting: years from first injection to long term cessation, defined as last injection before period of five years of non-injecting; mortality before cessation; overall survival.
In the entire cohort 277 participants achieved long term cessation of injecting, and 228 died. Half of the survivors had poor health related quality of life. Median duration from first injection to death was 24 years for participants with HIV and 41 years for those without HIV. For each additional year of opiate substitution treatment the hazard of death before long term cessation fell 13% (95% confidence interval 17% to 9%) after adjustment for HIV, sex, calendar period, age at first injection, and history of prison and overdose. Conversely exposure to opiate substitution treatment was inversely related to the chances of achieving long term cessation.
Opiate substitution treatment in injecting drug users in primary care reduces this risk of mortality, with survival benefits increasing with cumulative exposure to treatment. Treatment does not reduce the overall duration of injecting.
在一组吸毒者中研究生存和长期停止注射的情况，并评估阿片类药物替代治疗对这些结果的影响。
前瞻性开放队列研究。
爱丁堡的一个单一初级保健机构。
1980 年至 2007 年间有注射吸毒史的 794 名患者；655 名（82%）通过访谈或与初级保健记录和死亡率登记处的联系进行了随访，或两者都有，并为风险 10390 人年做出了贡献；557 名（85%）接受了阿片类药物替代治疗。
注射持续时间：从第一次注射到长期停止的时间，定义为五年非注射期间前的最后一次注射；停止前的死亡率；总生存率。
在整个队列中，277 名参与者实现了长期停止注射，228 名参与者死亡。一半的幸存者健康相关生活质量较差。有 HIV 的参与者从第一次注射到死亡的中位时间为 24 年，无 HIV 的参与者为 41 年。在调整了 HIV、性别、日历期、第一次注射年龄和监狱和过量使用史后，每增加一年阿片类药物替代治疗，长期停止前死亡的风险就会降低 13%（95%置信区间为 17%至 9%）。相反，接触阿片类药物替代治疗与实现长期停止的机会呈反比。
初级保健中的阿片类药物替代治疗可降低吸毒者的死亡风险，随着治疗累积暴露量的增加，生存获益也会增加。治疗并不能减少总体注射时间。
