阿片类激动剂治疗是否降低老年或合并躯体疾病人群的过量死亡风险？澳大利亚新南威尔士州 2002-17 年基于行政健康数据的队列研究。

Does opioid agonist treatment reduce overdose mortality risk in people who are older or have physical comorbidities? Cohort study using linked administrative health data in New South Wales, Australia, 2002-17.

机构信息

Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada.

Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, Canada.

出版信息

Addiction. 2023 Aug;118(8):1527-1539. doi: 10.1111/add.16178. Epub 2023 Mar 20.

DOI:10.1111/add.16178

PMID:36843415

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10330006/

Abstract

AIMS

To quantify the association between opioid agonist treatment (OAT) and overdose death by age group; test the hypothesis that across different age groups, opioid overdose mortality is lowest during OAT with buprenorphine compared with time out of treatment or OAT with methadone; and test associations between OAT and opioid overdose mortality in the presence of chronic circulatory, respiratory, liver and kidney diseases.

DESIGN

Retrospective observational cohort study using linked administrative data.

SETTING

New South Wales, Australia.

PARTICIPANTS

A total of 37 764 people prescribed OAT, 1 August 2002 and 31 December 2017.

MEASUREMENTS

OAT exposure, opioid overdose mortality and key confounders were measured using linked population data sets on OAT entry and exit, hospitalization, mental health care, incarceration and mortality. ICD-10 codes were used to define opioid overdose mortality and chronic disease groups of interest.

FINDINGS

Relative to time out of treatment, time in OAT was associated with a lower risk of opioid overdose death across all age groups and chronic diseases. Among people aged 50 years and older, there was weak evidence that buprenorphine may be associated with greater protection against opioid overdose death than methadone [generalized estimating equation (GEE) adjusted incident rate ratio (aIRR) = 0.47; 95% confidence interval (CI) = 0.21, 1.02; marginal structural models (MSM) aIRR = 0.49; 95% CI = 0.17, 1.41]. Buprenorphine was associated with greater protection against overdose death than methadone for clients with circulatory (MSM aIRR = 0.27; 95% CI = 0.11, 0.67) or respiratory (MSM aIRR = 0.26; 95% CI = 0.07, 0.94) diseases, but not liver (MSM aIRR = 0.59; 95% CI = 0.14, 2.43) or kidney (MSM aIRR = 1.16; 95% CI = 0.31, 4.36) diseases.

CONCLUSIONS

Opioid agonist treatment (OAT) appears to reduce mortality risk in people with opioid use disorder who are older or who have physical comorbidities. Opioid overdose mortality during OAT with buprenorphine appears to be lower and reduced in clients with circulatory and respiratory diseases compared with OAT with methadone.

摘要

目的

按年龄组量化阿片类激动剂治疗 (OAT) 与过量死亡之间的关联；检验假设，即在不同年龄组中，与停止治疗或美沙酮 OAT 相比，接受丁丙诺啡 OAT 治疗的阿片类药物过量死亡率最低；并在存在慢性循环、呼吸、肝脏和肾脏疾病的情况下，检验 OAT 与阿片类药物过量死亡率之间的关联。

设计

使用链接行政数据的回顾性观察性队列研究。

地点

澳大利亚新南威尔士州。

参与者

2002 年 8 月 1 日至 2017 年 12 月 31 日，共 37764 名接受 OAT 治疗的人。

测量方法

使用 OAT 进入和退出、住院、心理健康护理、监禁和死亡率的链接人口数据集来衡量 OAT 暴露、阿片类药物过量死亡率和关键混杂因素。ICD-10 代码用于定义阿片类药物过量死亡率和感兴趣的慢性疾病组。

结果

与停止治疗相比，所有年龄组和患有慢性疾病的人接受 OAT 治疗的时间与较低的阿片类药物过量死亡风险相关。对于 50 岁及以上的人群，丁丙诺啡可能比美沙酮更能预防阿片类药物过量死亡的证据较弱[广义估计方程 (GEE) 调整后的发病率比(aIRR)=0.47；95%置信区间(CI)=0.21, 1.02；边际结构模型(MSM) aIRR=0.49；95%CI=0.17, 1.41]。丁丙诺啡与美沙酮相比，对患有循环系统（MSM aIRR=0.27；95%CI=0.11, 0.67）或呼吸系统疾病（MSM aIRR=0.26；95%CI=0.07, 0.94）的患者的过量死亡保护作用更大，但对肝脏（MSM aIRR=0.59；95%CI=0.14, 2.43）或肾脏疾病（MSM aIRR=1.16；95%CI=0.31, 4.36）则不然。