Opioid Agonist Therapy Reduces Risk of Death in People Addicted to Opioids
A new global review has found that receiving opioid agonist (OAT) therapy is associated with a lower risk of multiple causes of death in people addicted to opioids.
The review, published in JAMA today [2 June], found that people addicted to opioids were less likely to experience mortality from overdose, suicide, alcohol, cancer and cardiovascular disease while taking OAT.
Researchers from the National Drug and Alcohol Research Center (NDARC) at UNSW Sydney, the University of Bristol and several other global institutions examined the relationship between OAT and mortality by drug type, setting and Participant groups of over 700,000 participants, which is six times the number of any previous exam.
The review found that the risk of death was lower in people receiving treatment with buprenorphine or methadone, the two most common forms of OAT in people addicted to opioids.
Lead author Thomas Santo Jr, doctoral student at NDARC, said: “People addicted to opiates who receive OAT are not only less at risk of overdose than those who do not, but also at less risk. suicide and several other common causes of death. “
“This review provides additional rationale for expanding access to OAT to help reduce the risk of death among people addicted to opioids,” Santo said.
“It is important to note that the benefits of OAT were consistent by region, age, gender, and comorbid status. The few studies that have examined the impact of OAT after release from prison have found that time spent in OAT reduced the risk of death.
The examination confirmed that there was a greater risk of death during the first month after stopping OAT. For patients on methadone, there was a greater risk of mortality at the start of treatment which was not observed in patients on buprenorphine.
“The first four weeks after stopping treatment are associated with particularly high rates of suicide and overdose-related mortality,” Santo said.
“These results underscore the importance of retention in treatment for opioid dependent people who begin treatment with OAT. There is also a need for more detailed investigations and interventions to minimize the risk of mortality during OAT induction. “
The review shows that randomized controlled trials (RCTs) of OAT are undernourished (do not have a large enough sample size) to examine the risk of mortality.
“We looked at the evidence from the trials, but so few studies were designed to look at mortality, so we have to rely on cohort studies of people in treatment around the world,” Santo said.
Professor Matt Hickman, NIHR’s Health Protection Research Unit in Behavioral Sciences and Assessment at the University of Bristol, said: ‘The research evidence is clear – OAT reduces risk mortality – but the benefits to the population of OAT may not be realized if community treatment periods are too short and inmates with opioid use disorders are not released on OAT after discharge from prison. Countries – like the UK – with ongoing public health crises in drug-related deaths – need to review both access to OAT and how it is provided to ensure that the more deaths are avoided.
“A clinical decision support system, stratifying the risk of client abandonment in real time, can help identify those who need service improvements to increase engagement and prevent abandonment.
“Work to increase access and retention could have significant benefits at the population level. “
“The impact of opioid agonist therapy administered in different settings on all-cause mortality and specific causes of death: a systematic review and meta-analysis” by Thomas Santo Jr. et al. to JAMA