Boston University School of Medicine-Boston Medical Center, Boston, MA, USA.
Massachusetts Department of Public Health, Boston, MA, USA.
Addiction. 2020 Aug;115(8):1496-1508. doi: 10.1111/add.14964. Epub 2020 Feb 25.
Medically managed opioid withdrawal (detox) can increase the risk of subsequent opioid overdose. We assessed the association between mortality following detox and receipt of medications for opioid use disorder (MOUD) and residential treatment after detox.
Cohort study generated from individually linked public health data sets.
Massachusetts, USA.
A total of 30 681 opioid detox patients with 61 819 detox episodes between 2012 and 2014.
Treatment categories included no post-detox treatment, MOUD, residential treatment or both MOUD and residential treatment identified at monthly intervals. We classified treatment exposures in two ways: (a) 'on-treatment' included any month where a treatment was received and (b) 'with-discontinuation' individuals were considered exposed through the month following treatment discontinuation. We conducted multivariable Cox proportional hazards analyses and extended Kaplan-Meier estimator cumulative incidence for all-cause and opioid-related mortality for the treatment categories as monthly time-varying exposure variables.
Twelve months after detox, 41% received MOUD for a median of 3 months, 35% received residential treatment for a median of 2 months and 13% received both for a median of 5 months. In on-treatment analyses for all-cause mortality compared with no treatment, adjusted hazard ratios (AHR) were 0.34 [95% confidence interval (CI) = 0.27-0.43] for MOUD, 0.63 (95% CI = 0.47-0.84) for residential treatment and 0.11 (95% CI = 0.03-0.43) for both. In with-discontinuation analyses for all-cause mortality, compared with no treatment, AHRs were 0.52 (95% CI = 0.42-0.63) for MOUD, 0.76 (95% CI = 0.59-0.96) for residential treatment and 0.21 (95% CI = 0.08-0.55) for both. Results were similar for opioid-related overdose mortality.
Among people who have undergone medically managed opioid withdrawal, receipt of medications for opioid use disorder, residential treatment or the combination of medications for opioid use disorder and residential treatment were associated with substantially reduced mortality compared with no treatment.
医学管理的阿片类药物戒断（戒毒）会增加随后阿片类药物过量的风险。我们评估了戒毒后的死亡率与阿片类药物使用障碍（OUD）治疗药物和戒毒后的住院治疗之间的关系。
从个体关联的公共卫生数据集生成的队列研究。
美国马萨诸塞州。
共有 30681 名阿片类药物戒毒患者，2012 年至 2014 年间共有 61819 次戒毒发作。
治疗类别包括戒毒后无治疗、OUD 治疗、住院治疗或 OUD 治疗和住院治疗两者。我们以两种方式对治疗暴露进行分类：（a）“治疗中”包括接受任何一个月的治疗，（b）“停药后”个体在停药后的一个月内被认为有暴露。我们对所有原因和阿片类药物相关死亡率进行了多变量 Cox 比例风险分析和扩展 Kaplan-Meier 估计累积发生率，将治疗类别作为每月随时间变化的暴露变量。
戒毒后 12 个月，41%的患者接受了 OUD 治疗，中位数为 3 个月，35%的患者接受了住院治疗，中位数为 2 个月，13%的患者同时接受了 OUD 治疗和住院治疗，中位数为 5 个月。与未治疗相比，在全因死亡率的治疗中分析中，与未治疗相比，OUD 的调整后危险比（AHR）为 0.34 [95%置信区间（CI）= 0.27-0.43]，住院治疗为 0.63（95%CI=0.47-0.84），两者均为 0.11（95%CI=0.03-0.43）。在全因死亡率的停药后分析中，与未治疗相比，OUD 的 AHR 为 0.52（95%CI=0.42-0.63），住院治疗为 0.76（95%CI=0.59-0.96），两者均为 0.21（95%CI=0.08-0.55）。阿片类药物相关过量死亡的结果相似。
在接受医学管理的阿片类药物戒断的人群中，与未治疗相比，接受 OUD 治疗药物、住院治疗或 OUD 治疗药物和住院治疗的联合治疗与死亡率显著降低相关。
