Theme: Epidemiology and Public Health Research Year: 2021
Background: Mortality among people with opioid dependence is higher than that of the general population. Opioid agonist treatment (OAT) is an effective treatment for opioid dependence; however, there has not yet been a systematic review on the relationship between OAT and specific causes of mortality. Methods: We searched Embase, MEDLINE, and PsycINFO databases for observational studies that collected data on mortality among people with opioid dependence while receiving and not receiving OAT. Data on study, participant, and treatment characteristics were extracted; person-years, all-cause mortality, and cause-specific mortality were calculated. Crude mortality rates and rate ratios (RRs) were pooled using random-effects meta-analyses. Results: We included data from 36 cohort studies with 749,634 participants. The rate of all-cause mortality during OAT was more than half of the rate seen during time out of OAT (RR, 0.47; 95%CI, 0.42-0.53). This association between receiving OAT and all-cause mortality was consistent regardless of patient sex, age, geographic location, HIV status, hepatitis C virus status, and history of injecting drug use. There was lower risk of suicide (RR, 0.48; 95%CI, 0.37-0.61), cancer (RR, 0.72; 95%CI, 0.52-0.98), drug-related (RR, 0.41; 95%CI, 0.33-0.52), alcohol-related (RR, 0.59; 95%CI, 0.49-0.72), and cardiovascular-related (RR, 0.69; 95%CI, 0.60-0.79) mortality during OAT. All-cause mortality was 6 times higher in the 4 weeks after OAT cessation (RR, 6.01; 95%CI, 4.32-8.36), remaining double the rate for the remainder of time not receiving OAT (RR, 1.81; 95%CI, 1.50-2.18). OAT was associated with a lower risk of mortality during incarceration (RR, 0.06; 95%CI, 0.01-0.46) and after release from incarceration (RR, 0.09; 95%CI, 0.02-0.56). Conclusion: OAT was associated with lower rates of mortality. However, access to OAT remains limited, and coverage remains low. Work to improve access globally may have important population-level benefits. Disclosure of Interest Statement: Mr Santo reported receiving the Australian Government Research Training Program Fee Offset scholarship and Australian Federal Government Department of Health Grants National Centre Core Funding during the conduct of the study. Dr Hickman reported receiving grants from National Institute for Health Research & Medical Research Council for analysis of the data set included in this review during the conduct of the study and speaker honoraria from Merck Sharp & Dohme and Gilead in the past 3 years outside the submitted work. Dr Grebely reported receiving grants from AbbVie, Cepheid, Gilead Sciences, Hologic, Indivior, and Merck, and personal fees from AbbVie, Cepheid, Gilead Sciences, and Merck outside the submitted work. Dr Campbell reported receiving grants from Indivior and NHMRC Early Career Fellowship during the conduct of the study. Dr Bharat reported receiving the National Drug and Alcohol Research Centre and University of New South Wales Scientia PhD Scholarships outside the submitted work. Dr Dupouy reported being a member of a working group for and writing a recommendation on the proper use of prescribed opioid analgesics for the French High Authority of Health. Dr Farrell reported receiving grants from the Australian Federal Government Department of Health National Centre Core Funding, an untied grant from Indivior to evaluate new opioid medications in Australia, and grants from Seqirus United to evaluate new opioid medications in Australia outside the submitted work. Dr Degenhardt reported receiving grants from NHMRC Fellowship, project funding and grants from the National Institutes of Health Project funding, grants from Indivior Untied to evaluate new opioid medications in Australia, and grants from Seqirus United to evaluate new
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