Non-fatal overdose risk during and after opioid agonist treatment: A primary care cohort study with linked hospitalisation and mortality records

Domzaridou, Eleni; Carr, Matthew; Webb, Roger; Millar, Tim; Ashcroft, Darren M.

doi:10.1016/j.lanepe.2022.100489

Cited by 10 publications

(12 citation statements)

References 28 publications

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“…When aligning the interventions, target populations and outcome definitions across cohorts and therefore, applying a target trial approach to infer causality from observational data[39], we demonstrated that comprehensive NSP/OAT led to a substantial reduction of HIV and HCV acquisition compared to no/partial participation in different settings of high-income countries. Coupled with the fact that OAT has been previously associated with reductions in injection drug use, mortality, nonfatal overdoses requiring hospitalization, engagement in care and reductions in criminal activity[2,53], our findings reinforce the crucial role of access to HRP. Given that most countries lack access to comprehensive NSP/OAT, and global HCV and HIV elimination is unlikely to be reached by 2030[54,55], increased coverage of these key interventions will be vital to preventing new infections.…”

supporting

confidence: 77%

Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials

et al. 2023

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Background and Aims Although the Netherlands, Canada and Australia were early adopters of harm reduction for people who inject drugs (PWID), their respective HIV and hepatitis C (HCV) epidemics differ. We measured the pooled effect of needle and syringe program (NSP) and opioid agonist therapy (OAT) participation on HIV and HCV incidence in these settings. Design For each cohort, we emulated the design and statistical analysis of a target trial using observational data. Setting and Participants We included PWID at risk of HIV or HCV infection from the Amsterdam Cohort Studies (1985–2013), Vancouver Injection Drug Users Study (1997–2009) and Melbourne Injecting Drug User Cohort Study (SuperMIX) (2010–2021). Measurements Separately for each infection and cohort (only HCV in SuperMIX), marginal structural models were used to compare the effect of comprehensive (on OAT and 100% NSP coverage or on OAT only if no recent injection drug use) versus no/partial NSP/OAT (no OAT and/or <100% NSP coverage) participation. Pooled hazard ratios (HR) and 95% CI were calculated using random‐effects meta‐analysis. Findings We observed 94 HIV seroconversions and 81 HCV seroconversions among 2023 and 430 participants, respectively. Comprehensive NSP/OAT led to a 41% lower risk of HIV acquisition (pooled HR = 0.59, 95% CI = 0.36–0.96) and a 76% lower risk of HCV acquisition (pooled HR = 0.24, 95% CI = 0.11–0.51), compared with no/partial NSP/OAT, with little heterogeneity between studies for both infections (I2 = 0%). Conclusions In the Netherlands, Canada and Australia, comprehensive needle and syringe program and opioid agonist therapy participation appears to substantially reduce HIV and hepatitis C acquisition compared with no or partial needle and syringe program/opioid agonist therapy participation. These findings from an emulated trial design reinforce the critical role of comprehensive access to harm reduction in optimizing infection prevention for people who inject drugs.

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supporting

confidence: 77%

Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials

et al. 2023

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“…14 This, in turn, reduces illicit substance use and likely the risky behavior associated with that, and the effect would be expected to begin even shortly after treatment. 15 Protective factors, though, are more difficult to address and likely require more time than just 1 month of treatment. Protective factor questions on the BAM ask about religion/spirituality, time spent at work, school and volunteering, income to pay for necessities, and support from family members and friends.…”

Section: Discussionmentioning

confidence: 99%

An Assessment of the One-Month Effectiveness of Telehealth Treatment for Opioid Use Disorder Using the Brief Addiction Monitor

Burke,

Clear,

Rollston

et al. 2023

Substance Use & Addiction Journal

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Objectives: Telehealth treatment with medication for opioid use disorder (teleMOUD) was made possible with regulations following the COVID-19 pandemic that permitted prescribing buprenorphine without an in-person visit. This study evaluates the self-reported outcomes of patients treated by teleMOUD using the Brief Addiction Monitor (BAM), a 17-question tool that assesses drug use, cravings, physical and psychological health, and psychosocial factors to produce 3 subset scores: substance use, risk factors, and protective factors. Methods: Patients treated by a teleMOUD provider group operating in >30 states were asked to complete an app-based version of BAM at enrollment and at 1 month. Patients who completed both assessments between June 2022 and March 2023 were included. Results: A total of 2556 patients completed an enrollment BAM and 1447 completed both assessments. Mean number of days from baseline BAM to follow-up was 26.7 days. Changes were significantly different across most questions. The substance use subscale decreased from mean 2.6 to 0.8 ( P < .001), the risk factors subscale decreased from mean 10.3 to 7.5 ( P < .001), and the protective factors subscale increased from mean 14.3 to 15.0. ( P < .001). Substance use and risk factor subscale changes were significant across all sex and age groups, while protective factors subscale did not improve for those <25 and >54 years. Patient reports of at least 1 day of illegal use or misuse decreased, including marijuana (28.1% vs 9.0%), cocaine/crack (3.9% vs 2.6%), and opioids (49.8% vs 10.5%). Conclusions: Among patients treated by teleMOUD who completed assessments at enrollment and 1 month, there was improvement in drug use, risk factor, and protective factor scores.

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“…Electronic records are adopted across all primary care practices, and data are collected daily from voluntarily enrolled practices by CPRD, which is then integrated with existing records and subjected to multiple quality checks . The data are nationally representative in terms of age, sex, and race and ethnicity, collated from more than 2200 primary care practices and including 18 million active patients across the United Kingdom, approximately 25% of the UK population . The patient-level data include detailed information on demographics, clinical events, prescriptions, and specialist referrals.…”

Section: Methodsmentioning

confidence: 99%

Risk of Falls and Fractures in Individuals With Cataract, Age-Related Macular Degeneration, or Glaucoma

Tsang,

Wright,

Carr

et al. 2024

JAMA Ophthalmol

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ImportanceThree leading disease causes of age-related visual loss are cataract, age-related macular degeneration (AMD), and glaucoma. Although all 3 eye diseases have been implicated with falls and fracture risk, evidence is mixed, with the contribution of different eye diseases being uncertain.ObjectiveTo examine whether people with cataract, AMD, or glaucoma have higher risks of falls or fractures than those without.Design, Setting, and ParticipantsThis cohort study was a population-based study in England using routinely collected electronic health records from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum primary care databases with linked hospitalization and mortality records from 2007 to 2020. Participants were people with cataract, AMD, or glaucoma matched to comparators (1:5) by age, sex, and general practice. Data were analyzed from May 2021 to June 2023.ExposuresFor each eye disease, we estimated the risk of falls or fractures using separate multivariable Cox proportional hazards regression models.Main OutcomesTwo primary outcomes were incident falls and incident fractures derived from general practice, hospital, and mortality records. Secondary outcomes were incident fractures of specific body sites.ResultsA total of 410 476 people with cataract, 75 622 with AMD, and 90 177 with glaucoma were matched (1:5) to 2 034 194 (no cataract), 375 548 (no AMD), and 448 179 (no glaucoma) comparators. The mean (SD) age was 73.8 (11.0) years, 79.4 (9.4) years, and 69.8 (13.1) years for participants with cataract, AMD, or glaucoma, respectively. Compared with comparators, there was an increased risk of falls in those with cataract (adjusted hazard ratio [HR], 1.36; 95% CI, 1.35-1.38), AMD (HR, 1.25; 95% CI, 1.23-1.27), and glaucoma (HR, 1.38; 95% CI, 1.35-1.41). Likewise for fractures, there were increased risks in all eye diseases, with an HR of 1.28 (95% CI, 1.27-1.30) in the cataract cohort, an HR of 1.18 (95% CI, 1.15-1.21) for AMD, and an HR of 1.31 (95% CI, 1.27-1.35) for glaucoma. Site-specific fracture analyses revealed increases in almost all body sites (including hip, spine, forearm, skull or facial bones, pelvis, ribs or sternum, and lower leg fractures) compared with matched comparators.Conclusions and RelevanceThe results of this study support recognition that people with 1 or more of these eye diseases are at increased risk of both falls and fractures. They may benefit from improved advice, access, and referrals to falls prevention services.

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Non-fatal overdose risk during and after opioid agonist treatment: A primary care cohort study with linked hospitalisation and mortality records

Cited by 10 publications

References 28 publications

Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials

Comprehensive needle and syringe program and opioid agonist therapy reduce HIV and hepatitis c virus acquisition among people who inject drugs in different settings: A pooled analysis of emulated trials

An Assessment of the One-Month Effectiveness of Telehealth Treatment for Opioid Use Disorder Using the Brief Addiction Monitor

Risk of Falls and Fractures in Individuals With Cataract, Age-Related Macular Degeneration, or Glaucoma

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