Long‐term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11‐year findings from the Australian Treatment Outcome Study

Teesson, Maree; Marel, Christina; Darke, Shane; Ross, Joanne; Slade, Tim; Burns, Lucy; Lynskey, Michael T.; Memedovic, Sonja; White, Joanne; Mills, Katherine L.

doi:10.1111/add.12860

Cited by 98 publications

(75 citation statements)

References 27 publications

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“…The current findings regarding depressive status are consistent with somewhat paradoxical findings that major depression increases the likelihood for heroin relapse (Havard, et al, 2006; Teesson et al, 2015), even though depressive symptoms are associated with a greater interest in achieving abstinence and receiving treatment, such as MAT (Avants, Margolin, & McKee, 2000; Mukherjee et al, 2016). Our finding that persons with depressed mood, relative to those with non-depressed mood, were more likely to prefer MAT after detoxification—68% of those preferring MAT met criteria for depressed mood—indicates that depressive symptoms may influence patients’ interest in treatment, and perhaps their recognition of heightened risk.…”

Section: Discussionsupporting

confidence: 83%

“…Major depression and heroin use are highly comorbid (Havard, Teesson, Darke, & Ross, 2006; Teesson et al, 2015), depressive symptoms are associated with lower levels of perceived refusal self-efficacy (Senbanjo et al, 2009) and greater compulsion to use heroin (Lee, Lin, Wang, & Yen, 2016), and major depression is a risk factor for heroin relapse (Hasin et al, 2002; Samet et al, 2013). Therefore, our analysis controlled for depressed mood as well as demographic and drug use factors that are prevalent among heroin users and MAT patients, including unemployment status (Becker, Fiellin, Merrill, Schulman, Finklestein, Olsen, & Busch, 2008; Fischer, Nakamura, Rush, Rehm, & Urbanoski, 2010) and criminal justice involvement (Hakansson & Berglund, 2012; Rastegar, Kawasaki, King, Harris, & Brooner, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification

Kenney

Bailey

Anderson

et al. 2017

Addictive Behaviors

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Objective An individual’s self-efficacy to refuse using heroin in high-risk situations is believed to minimize the likelihood for relapse. However, among individuals completing inpatient heroin detoxification, perceived refusal self-efficacy may also reduce one’s perceived need for medication-assisted treatment (MAT), an effective and recommended treatment for opioid use disorder. In the current study, we examined the relationship between heroin refusal self-efficacy and preference for MAT following inpatient detoxification. Method Participants (N = 397) were interviewed at the start of brief inpatient opioid detoxification. Multiple logistic regression was used to estimate the adjusted association of background characteristics, depressed mood, and perceived heroin refusal self-efficacy with preference for MAT. Results Controlling for other covariates, depressed mood and lower perceived refusal self-efficacy were associated with a significantly greater likelihood of expressing preference for MAT (versus no MAT). Conclusions Perceived ability to refuse heroin after leaving detox is inversely associated with a heroin user’s desire for MAT. An effective continuum of care model may benefit from greater attention to patient’s perceived refusal self-efficacy during detoxification which may impact preference for MAT and long-term recovery.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification

Kenney

Bailey

Anderson

et al. 2017

Addictive Behaviors

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“…Many studies were excluded due to their sampling criteria. For example, many papers from the Australian Treatment Outcome Study included individuals attending needle exchange services who were not treated for their opiate problem (Darke, 2011;Darke et al, 2011;Darke et al, 2009;Teesson et al, 2015;Teesson et al, 2007). There is substantial variation in what the term "older" or "ageing" encompasses and, therefore, the body of evidence for the target population is small, and the majority of studies do not give their reasoning for their choice of age cut-offs.…”

Section: Discussionmentioning

confidence: 99%

“…The burden of disease due to drug use is highest for heroin and other opiates compared to any other illicit drugs (Darke, 2011;Degenhardt and Hall, 2015), and the use of heroin has emerged as an international public health concern within the past decade (Teesson et al, 2015). Long term heroin users have the highest risk of mortality with the average age of death in the early thirties (Darke et al, 2006a) and heroin overdose deaths have been reported among older people in their 50's and 60's (Darke et al, 2006b).…”

Section: Introductionmentioning

confidence: 99%

Treatment for opioid use and outcomes in older adults: a systematic literature review

Carew

Comiskey

2018

Drug and Alcohol Dependence

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A B S T R A C TBackground: Historically, issues relating to problem substance use among older people have received little attention, and have only recently been recognised. Methods: A literature review of relevant material was conducted in November 2015 to assess current outcome research among older adults treated for opioid dependence. Multiple electronic databases were searched and results were supplemented by grey literature, library and online searches, and relevant references within selected articles. Retrieved articles were assessed for relevance against the inclusion and exclusion criteria. Results were reviewed to identify major findings and recommendations. Results: A total of 76 titles were included in the review. Most research conducted on older adults involves alcohol and prescription medications. Older drug users are growing in number and have a unique profile, with many presenting for treatment for the first time aged 50-70 years. Findings reveal (1) opioid treatment numbers are decreasing, however the average age of treatment admissions is increasing, (2) there is no consensus on what old is (3) two distinct types of older opioid substance users exist (early/late onset), (4) older clients achieve better treatment outcomes than younger counterparts, and (5) older women achieve better treatment outcomes than men. Conclusions: Findings suggest that little is known about treatment outcomes among older people. Problematic drug use (of which opioids make up the largest proportion) had been incorrectly assumed to end as patients age. Defining an age limit for 'older' is important. Addiction and healthcare services must anticipate and prepare for increased demand by this group.

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“…Moreover, within periods of methadone treatment there is a swift decline in risk from first to fourth week, followed by a stable trend, whereas after cessation there is a high but quite stable risk during the first four weeks and a progressive decline afterward. This is important because some patients cycle in and out of opioid substitution treatment [46][47][48][49][50] and are therefore exposed to repeated periods of high risk for mortality. Such changes probably mainly reflect changes in risk of fatal overdose, 6 32 but this has not been accurately assessed because only two cohorts reported overdose data specifically.…”

Section: Mortality Risk During Specific Periods In and Out Of Methadomentioning

confidence: 99%

Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies

Sordo

Barrio

Bravo

et al. 2017

BMJ

1,286

1,016

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Objective To compare the risk for all cause and overdose mortality in people with opioid dependence during and after substitution treatment with methadone or buprenorphine and to characterise trends in risk of mortality after initiation and cessation of treatment. Design Systematic review and meta-analysis. Data sources Medline, Embase, PsycINFO, and LILACS to September 2016. Study selection Prospective or retrospective cohort studies in people with opioid dependence that reported deaths from all causes or overdose during follow-up periods in and out of opioid substitution treatment with methadone or buprenorphine. Data extraction and synthesis Two independent reviewers performed data extraction and assessed study quality. Mortality rates in and out of treatment were jointly combined across methadone or buprenorphine cohorts by using multivariate random effects meta-analysis. Results There were 19 eligible cohorts, following 122 885 people treated with methadone over 1.3-13.9 years and 15 831 people treated with buprenorphine over 1.1-4.5 years. Pooled all cause mortality rates were 11.3 and 36.1 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 3.20, 95% confidence interval 2.65 to 3.86) and reduced to 4.3 and 9.5 in and out of buprenorphine treatment (2.20, 1.34 to 3.61). In pooled trend analysis, all cause mortality dropped sharply over the first four weeks of methadone treatment and decreased gradually two weeks after leaving treatment. All cause mortality remained stable during induction and remaining time on buprenorphine treatment. Overdose mortality evolved similarly, with pooled overdose mortality rates of 2.6 and 12.7 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 4.80, 2.90 to 7.96) and 1.4 and 4.6 in and out of buprenorphine treatment. Conclusions Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids. The induction phase onto methadone treatment and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk. These findings are potentially important, but further research must be conducted to properly account for potential confounding and selection bias in comparisons of mortality risk between opioid substitution treatments, as well as throughout periods in and out of each treatment.

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Long‐term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11‐year findings from the Australian Treatment Outcome Study

Abstract: In an 11-year follow-up of patients undergoing treatment for heroin dependence, 10.2% had died and almost half were still in treatment; the proportion still using heroin fell to a quarter, with major depression being a significant predictor of continued use.

Cited by 98 publications

References 27 publications

Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification

Heroin refusal self-efficacy and preference for medication-assisted treatment after inpatient detoxification

Treatment for opioid use and outcomes in older adults: a systematic literature review

Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies

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