Geisel School of Medicine at Dartmouth College, Hanover, N.H. (Watts, Riblet, Shiner, Gui); White River Junction VA Medical Center, White River Junction, Vt. (all authors).
Am J Psychiatry. 2022 Apr;179(4):298-304. doi: 10.1176/appi.ajp.2021.21070700.
Understanding the effectiveness of medication treatment for opioid use disorder to decrease the risk of suicide mortality may inform clinical and policy decisions. The authors sought to describe the effect of medications for opioid use disorder (MOUD) on risk of suicide mortality.
This was a retrospective cohort study in Department of Veterans Affairs (VA) patients from 2003 to 2017. The authors linked three data sources: the VA Corporate Data Warehouse, Centers for Medicare and Medicaid Services Claims Data, and the VA-Department of Defense Mortality Data Repository. The exposure of interest was MOUD, including starting periods (first 14 days on treatment), stopping periods (first 14 days off treatment), stable time on treatment, and stable time off treatment (reference category). The main outcome measures included suicide mortality, external-cause mortality, and all-cause mortality in the 5 years following initiation of MOUD.
Over 60,000 VA patients received MOUD. Patients were typically male (92.8%) and their mean age was 46.5 years (SD=13.1). After adjusting for demographic characteristics, mental health and physical health conditions, and health care utilization, the adjusted hazard ratio during stable MOUD was 0.45 (95% CI=0.32, 0.63) for suicide mortality, 0.35 (95% CI=0.31, 0.40) for external-cause mortality, and 0.34 (95% CI=0.31, 0.37) for all-cause mortality. MOUD starting periods were associated with an adjusted hazard ratio for suicide mortality of 0.55 (95% CI=0.25, 1.21), and MOUD stopping periods were associated with an adjusted hazard ratio for suicide mortality of 1.38 (95% CI=0.82, 2.34).
Treatment with MOUD was associated with a substantial reduction in suicide mortality as well external causes of mortality and all-cause mortality.
了解治疗阿片类药物使用障碍的药物（MOUD）降低自杀死亡率的效果，可能为临床和政策决策提供信息。作者旨在描述 MOUD 对自杀死亡率风险的影响。
这是一项 2003 年至 2017 年在退伍军人事务部（VA）患者中进行的回顾性队列研究。作者将三个数据源进行了关联：VA 公司数据仓库、医疗保险和医疗补助服务索赔数据以及 VA-国防部死亡率数据存储库。感兴趣的暴露因素是 MOUD，包括起始期（治疗的最初 14 天）、停药期（治疗结束的最初 14 天）、治疗稳定期和治疗停药稳定期（参考类别）。主要结局指标包括 MOUD 启动后 5 年内的自杀死亡率、外部原因死亡率和全因死亡率。
超过 60000 名 VA 患者接受了 MOUD。患者通常为男性（92.8%），平均年龄为 46.5 岁（标准差=13.1）。在调整人口统计学特征、心理健康和身体健康状况以及医疗保健利用情况后，稳定 MOUD 期间自杀死亡率的调整后的危险比为 0.45（95%置信区间=0.32，0.63），外部原因死亡率为 0.35（95%置信区间=0.31，0.40），全因死亡率为 0.34（95%置信区间=0.31，0.37）。MOUD 起始期与自杀死亡率的调整后的危险比为 0.55（95%置信区间=0.25，1.21），MOUD 停药期与自杀死亡率的调整后的危险比为 1.38（95%置信区间=0.82，2.34）。
MOUD 治疗与自杀死亡率以及外部原因死亡率和全因死亡率的显著降低相关。
