Kings College London, National Addiction Centre, Institute of Psychiatry, London SE5 8BB, UK.
BMJ. 2010 Sep 16;341:c4851. doi: 10.1136/bmj.c4851.
To evaluate the impact of introduction of supervision of methadone dosing on deaths related to overdose of methadone in Scotland and England between 1993 and 2008 while controlling for increased prescribing of methadone.
Analysis of annual trends in deaths related to overdose of methadone in relation to defined daily doses of methadone prescribed.
Scotland and England. Population Deaths in which methadone was coded as the only drug involved or as one of the drugs implicated.
Annual OD4-methadone index (number of deaths with methadone implicated per million defined daily doses of methadone prescribed in that year).
OD4-methadone declined substantially over the four epochs of four years between 1993 and 2008. It decreased significantly (P<0.05) in 10 of 12 epoch changes: in Scotland from 19.3 (95% confidence interval 15 to 24) to 4.1 (2.8 to 5.4) and finally to 3.0 (2.4 to 3.5) for methadone only deaths (and from 58 to 29 to 14 for deaths with any mention of methadone); in England from 27.1 (25 to 29) to 24.8 (23 to 27) and finally to 5.8 (5.3 to 6.3) for methadone only deaths (and from 46 to 42 to 12 for deaths with any mention of methadone). The decreases in OD4-methadone were closely related to the introduction of supervised dosing of methadone in both countries, first in Scotland (1995-2000) and later in England (1999-2005). These declines occurred over periods of substantial increases in prescribing of methadone (18-fold increase in defined daily doses per million population annually in Scotland and sevenfold increase in England).
Introduction of supervised methadone dosing was followed by substantial declines in deaths related to overdose of methadone in both Scotland and England. OD4-methadone index analyses, controlled for substantial increases in methadone prescribing in both countries, identified at least a fourfold reduction in deaths due to methadone related overdose per defined daily dose (OD4-methadone) over this period.
在控制美沙酮处方量增加的情况下，评估苏格兰和英格兰在 1993 年至 2008 年间引入美沙酮剂量监督对与美沙酮过量相关的死亡人数的影响。
分析与规定的美沙酮日剂量相关的与美沙酮过量相关的死亡人数的年度趋势。
苏格兰和英格兰。涉及美沙酮的编码为唯一药物或所涉及药物之一的人群死亡。
每年与美沙酮相关的 OD4-美沙酮指数（该年内规定的美沙酮日剂量为百万分之一的死亡人数）。
OD4-美沙酮在 1993 年至 2008 年的四个四年时期的四个时期内大幅下降。在 10 次 epoch 变化中有 10 次显著下降（P<0.05）：苏格兰从 19.3（95%置信区间 15 至 24）降至 4.1（2.8 至 5.4），最后降至 3.0（2.4 至 3.5）（仅涉及美沙酮的死亡）（从 58 降至 29 至 14 与美沙酮有关的死亡）；英格兰从 27.1（25 至 29）降至 24.8（23 至 27），最后降至 5.8（5.3 至 6.3）（仅涉及美沙酮的死亡）（从 46 降至 42 至 12 与美沙酮有关的死亡）。OD4-美沙酮的下降与两国美沙酮剂量监督的引入密切相关，首先是在苏格兰（1995-2000 年），然后是在英格兰（1999-2005 年）。这些下降发生在美沙酮处方量大幅增加的时期（苏格兰每年每百万人口的规定日剂量增加 18 倍，英格兰增加 7 倍）。
在苏格兰和英格兰，引入美沙酮剂量监督后，与美沙酮过量相关的死亡人数大幅下降。OD4-美沙酮指数分析，控制了两国美沙酮处方量的大幅增加，确定在此期间，每规定日剂量（OD4-美沙酮）因美沙酮相关过量导致的死亡人数减少了至少四倍。
