Ragnar Frisch Centre for Economic Research, Oslo, Norway.
Department of Alcohol, Tobacco and Drugs, Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.
Addiction. 2022 May;117(5):1363-1371. doi: 10.1111/add.15739. Epub 2021 Nov 30.
Effective policies to reduce drug-related overdoses remain a public health priority. We aimed to estimate the causal effects of a national opioid agonist treatment (OAT) program on population level drug fatalities.
Population-based prospective cohort study exploiting supply driven variation in treatment uptake across cohort-age groups generated by the introduction and scale-up of a national OAT program. A Poisson difference-in-differences model with an intention-to-treat design was used to assess how treatment uptake altered the age profile of risks and infer treatment effects on drug fatalities.
Norway, from 1996 through 2016.
The data include a total of 5634 drug-related overdose deaths and cover the introduction of the Norwegian OAT program in 1998 and its initial growth period, reaching 12 286 ever-treated recipients by 2016.
Fatal opioid-related overdoses were defined as deaths with a primary cause assigned an International Classification of Diseases 10th Revision (ICD-10) code F11, or X42, X44, X62 or X64 in combination with T40.0-T40.4. Other non-opioid related fatal overdoses were defined by a primary cause registered as F12, F14, F15, F16 or F19, or X42, X44, X62 or 64 in combination with T40.5-T40.9.
An additional 887 deaths (95% credibility interval [CI] = 265-1563) would have been expected in the absence of OAT, which implies one death avoided per 111 (95% CI = 61-342) treatment-exposed person-years. At scale, the program reduced annual overdose mortality by 27% in 2016 (95% CI = 10%-41%) relative to a no-OAT counterfactual, corresponding to 99 fewer expected fatal overdoses (95% CI = 28-180) in 2016. Analysing fatal opioid-related and other drug overdoses separately found similar numbers for avoided opioid-related fatalities (921, with 95% CI = 373-1526) and no treatment effects on non-opioid related fatalities (-38, with 95% CI = -193-154).
The introduction and rapid scale-up of a national opioid agonist treatment program in Norway was associated with substantial and plausibly causal reductions in drug fatalities.
减少与药物相关的过量用药的有效政策仍然是公共卫生的重点。我们旨在估计全国阿片类药物激动剂治疗（OAT）计划对人群水平药物死亡的因果影响。
利用全国 OAT 计划的引入和扩大在队列年龄组中产生的治疗使用率的供应驱动变化，进行基于人群的前瞻性队列研究。采用意向治疗设计的泊松差差异模型，评估治疗使用率如何改变风险的年龄分布，并推断治疗对药物死亡的影响。
挪威，1996 年至 2016 年。
数据包括 5634 例与药物相关的过量用药死亡，涵盖了挪威 OAT 计划的引入及其初始增长期，到 2016 年，已有 12286 名接受过治疗的患者。
致命的阿片类药物相关过量用药被定义为主要原因被分配国际疾病分类第 10 版（ICD-10）代码 F11 或 X42、X44、X62 或 X64 与 T40.0-T40.4 相结合的死亡。其他非阿片类药物相关的致命过量用药被定义为主要原因被登记为 F12、F14、F15、F16 或 F19 或 X42、X44、X62 或 X64 与 T40.5-T40.9 相结合的死亡。
如果没有 OAT，预计会有 887 例额外死亡（95%置信区间[CI] = 265-1563），这意味着每 111 人（95% CI = 61-342）治疗暴露人年就会避免 1 例死亡。在规模上，该计划与无 OAT 的情况相比，2016 年过量用药死亡率降低了 27%（95% CI = 10%-41%），这相当于 2016 年预计减少 99 例致命过量用药（95% CI = 28-180）。分别分析致命的阿片类药物相关和其他药物过量用药，发现避免的阿片类药物相关致命用药数量相似（921，95% CI = 373-1526），而对非阿片类药物相关致命用药没有治疗效果（-38，95% CI = -193-154）。
挪威全国阿片类药物激动剂治疗计划的引入和快速扩大与药物死亡人数的大量且可能具有因果关系的减少有关。
