Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study

Strang, John; McCambridge, Jim; Best, David; Beswick, T. S. L.; Bearn, Jenny; Rees, Siân; Gossop, Michael

doi:10.1136/bmj.326.7396.959

Cited by 287 publications

(175 citation statements)

References 5 publications

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“…This clearly indicates that successful completion of treatment at one point in time does not prevent subsequent relapse and possible death later on (Strang et al, 2003). However, all deaths in the four-week period after discharge were among the dropouts.…”

Section: Discussionmentioning

confidence: 96%

“…A one year follow-up study investigated opiate clients receiving detoxification as part of a 28 day inpatient treatment programme. The main finding showed a clustering of deaths from overdose in the group of patients characterized by loss of tolerance, who had successfully completed treatment (Strang et al, 2003). Most treatment studies show that the longer clients stay in treatment, the better the outcome (Simpson et al, 1997;Hser et al, 1988).…”

Section: Introductionmentioning

confidence: 99%

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Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Ravndal

Amundsen²

2010

Drug and Alcohol Dependence

109

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Background:Drug users who are leaving/completing inpatient medication-free treatment may, like drug users released from prison, have an elevated risk of dying from fatal overdoses. This is mainly explained by their low drug tolerance. Methods:Two hundred and seventy-six drug users who had been admitted to eleven inpatient facilities in Norway, were followed prospectively after discharge from treatment during an eight year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). The following instruments were used: EuropASI, SCL-25 and MCMI-II.Information on deaths and causes of death were obtained from the National Death Register. Results:A total of 36 deaths were registered after discharge from treatment during the observation period, of which 24 were classified as overdose deaths. During the first 4 weeks after discharge six persons died, yielding an unadjusted excess mortality of 15.7 (rate ratio) in this period (CI 5.3-38.3). All were dropouts and all deaths were classified as opiate overdoses.There was no significant association between time in index treatment and mortality after discharge, nor did any background characteristics correlate significantly with elevated mortality shortly after discharge. Conclusions:The elevated risk of dying from overdose within the first four weeks of leaving medicationfree inpatient treatment is so dramatic that preventive measures should be taken. More studies from similar inpatient programmes are needed in order to obtain systematic knowledge about determinants of overdose deaths shortly after leaving treatment, and possible preventive measures..

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Ravndal

Amundsen²

2010

Drug and Alcohol Dependence

109

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“…However, these effects are usually at the brink of overdose. Tolerance to respiratory depression in people who inject heroin can develop quickly with chronic use, but can be lost quickly in withdrawal, making the judgement of lethal doses hard to predict (Mars, et al, 2015;Strang, et al, 2003). Street heroin with variable purity levels and price due to the variances of supply, make it harder to identify a lethal dosage, particularly after heroin shortages when the 'normal' quality resumes (Darke, Hall, Weatherburn, & Lind, 1999;Travis, 2011;Unick, Rosenblum, Mars, & Ciccarone, 2014).…”

Section: Proportion Reporting Overdosementioning

confidence: 99%

The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland

O’Halloran

Cullen

Njoroge

et al. 2017

International Journal of Drug Policy

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The extent of and factors associated with self-reported overdose and selfreported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland.http://researchonline.ljmu.ac.uk/6768/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. LJMU Research OnlineThe extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs in England, Wales and Northern Ireland AbstractThe extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs in England, Wales and Northern Ireland

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“…Due to the chronicity of opioid dependence, current treatment guidelines favor the open-end nature of MAT, sometimes required to continue lifelong (APA, 2006; Swiss Society of Addiction Medicine (SSAM), 2013). In some countries, legal regulations still call for complete abstinence (including opioid substitutes) as mandatory treatment goal, but abstinence-oriented therapy is often unsuccessful due to high relapse rates with the risk of deteriorating psychosocial conditions or even death due to overdose after lost tolerance to opioids (Caplehorn et al, 1994;Merrall et al, 2010;Strang, 2003). The rate of spontaneous or professionally assisted remission remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of medication-assisted treatment of opioid dependence—The physicians’ perspective

Vogel

Nordt

Dürsteler

et al. 2016

Drug and Alcohol Dependence

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BACKGROUND: There is controversy about which outcome parameters should be employed to assess substance use treatment. Subjective measures of medication-assisted treatment (MAT) of opioid dependence are increasingly important. However, while patients' perspectives have been examined, the caregivers' views remain largely unknown. Here, we explore how physicians evaluate MAT, and which predictors are most relevant. METHODS: We conducted a retrospective cohort study of all MAT episodes with oral opioid agonists in the canton of Zurich between 1998 and 2013 using a case register. Termination forms of the register include a physician-completed assessment on the course of the treatment episode. Mixed model analysis was applied to determine relevant predictors. RESULTS: The analysis was based on 17,234 episodes from 7432 patients. Mean global assessment of the course of MAT was 'moderate'. The most important predictors for treatment evaluation by physicians were treatment break off as reason for termination (p<0.0001), psychological improvement throughout treatment (p<0.0001), wish for abstinence from the substitute (p<0.0001), social integration index at termination (p<0.0001), and social (p<0.0001) as well as medical (p<0.0001) improvement. The negative association of treatment break off with MAT assessment was more pronounced in semi-rural than urban areas (p<0.0001). CONCLUSION: Predictors relating to the well-being and functioning of the patient as well as the reasons underlying treatment termination appear to be more important for the treating physician's evaluation of medication-assisted treatment episodes than on-going substance use. Coming off the opioid medication plays a central role, independent of ongoing illicit substance use. Predictors relating to the well-being and functioning of the patient as well as the reasons underlying treatment termination appear to be more important for the treating physician's evaluation of medication-assisted treatment episodes than on-going substance use. Coming off the opioid medication plays a central role, independent of ongoing illicit substance use.

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Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study

Cited by 287 publications

References 5 publications

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland

Evaluation of medication-assisted treatment of opioid dependence—The physicians’ perspective

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