Opioid‐related mortality and filled prescriptions for buprenorphine and methadone

Wikner, Birgitta Norstedt; Öhman, Inger; Seldén, Tor; Druid, Henrik; Brandt, Lena; Kieler, Helle

doi:10.1111/dar.12143

Cited by 42 publications

(40 citation statements)

References 35 publications

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“…However, about 70% of the decedents in our study were enrolled in a drug treatment facility at the time of death and more than 60% were receiving MMT. These results differ from the findings of other studies where the majority of those with methadone-related deaths were not receiving MMT at time of death [4,19,20,33,34] . Although elevated mortality risk in MMT is usually observed during the induction period, only about 5% of MMT deaths took place during the first 4 weeks of treatment in the current study [35,36] .…”

Section: Discussioncontrasting

confidence: 99%

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

et al. 2016

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Background/Aims: Increasing rates of overdose deaths involving opioid maintenance treatment (OMT) medications and particularly methadone have been observed concurrently with the implementation of liberal OMT strategies (i.e. minimum of control and high doses prescribed). This study examined methadone-related overdose deaths in a liberal OMT programme. Methods: Drug-overdose deaths (n = 130) with detection of methadone in Copenhagen, Aarhus, and Odense Municipality, Denmark, during the period 2008-2011 were identified from a registry. Cases with and without prescribed methadone as OMT were compared. Treatment delivery strategy among OMT-prescribed methadone cases was investigated. Results: Methadone was detected in 130 overdose deaths (71.4% of all overdose deaths). Among these, 63.1% were receiving methadone maintenance treatment. Of these, 79.3% had co-detection of benzodiazepines. Concomitant detection of heroin, non-prescribed benzodiazepines, and younger age were associated with having non-prescribed methadone in the toxicological findings (adjusted OR 3.1, 4.0 and 9.5, respectively). Of the decedents, 43.8% were prescribed a higher methadone dose than recommended (>120 mg daily), of which 80.0% did not have supervised intake of methadone. Conclusions: Liberal OMT access does not necessarily prevent overdose deaths overall. Prescription of higher doses of methadone combined with benzodiazepines may result in an increased risk of overdose for individuals in as well as outside OMT.

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Section: Discussioncontrasting

confidence: 99%

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

et al. 2016

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“…Previous studies have primarily investigated psychoactive prescription drugs as a group (Hall et al, 2008;Rönkä el al., 2015), or focused on a separate drug class, such as opioids (Fischer et al, 2014;Häkkinen et al, 2014;Paulozzi et al, 2009;Wikner et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Tjäderborn

Jönsson

Sandström

et al. 2016

Drug and Alcohol Dependence

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Aims: To determine the prevalence of non-prescribed drug use among subjects suspected of drug-impaired driving with a confirmed intake of a psychoactive prescription drug, and to identify associated factors. Methods:Subjects investigated for drug-impaired driving in Sweden during 2006-2009 with a confirmed intake of diazepam, flunitrazepam, tramadol, zolpidem or zopiclone were identified using the Swedish Forensic Toxicology Database. Information on dispensed prescription drugs was retrieved from the Swedish Prescribed Drug Register. Non-prescribed use was defined as a confirmed use of a psychoactive prescription drug intake confirmed by toxicological analysis in a subject by whom it was not dispensed in the 12 months preceding the sampling. Prevalence proportions were calculated for each drug and logistic regression was used to identify associated factors. Results: In total, 2225 subjects were included. The median age (range) was 34 (15-80) years and 1864 (83.8%) subjects were male. Non-prescribed use was found in 1513 subjects (58.7%); for flunitrazepam 103 (76.3%), diazepam 1098 (74.1%), tramadol 192 (40.3%), zopiclone 60 (29.7%), and zolpidem 60 (21.2%) subjects, respectively. Younger age and multiple-substance use were associated with nonprescribed use, whereas ongoing treatment with other psychoactive drugs was negatively associated with nonprescribed use. Conclusions: Non-prescribed use of psychoactive prescription drugs was common in subjects suspected of drug-impaired driving and was more frequent for benzodiazepines and tramadol compared to zolpidem and zopiclone. The young and multi-substance users were more likely, whereas subjects with ongoing prescribed treatment with other psychoactive drugs were less likely, to use non-prescribed drugs.

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“…The second strand of research is looking at the negative consequences of illicit use, mainly in the form of methadoneand buprenorphine-related mortality among users not in treatment (Auriacombe, Fatseas, Dubernet, Daulouede, & Tignol, 2004;Fugelstad, Johansson, & Thiblin, 2010;Madden & Shapiro, 2011;Mégarbane et al, 2006;Morgan, Griffiths, & Hickman, 2006;Seldén, Ahlner, Druid, & Kronstrand, 2012;Seymour et al, 2003;Strang et al, 2010;Wikner et al, 2014). The majority of such fatalities are caused by polyintoxication involving a broad array of different substances, often sedatives and alcohol (Fugelstad et al, 2010;Mégarbane et al, 2006;Seldén et al, 2012;Wikner et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…The majority of such fatalities are caused by polyintoxication involving a broad array of different substances, often sedatives and alcohol (Fugelstad et al, 2010;Mégarbane et al, 2006;Seldén et al, 2012;Wikner et al, 2014). Such deaths have made up a significant percentage of the opioidrelated mortality in some countries, not least Sweden; since 2011 the combined number of methadone-and buprenorphine-related fatalities have exceeded heroin-related deaths.…”

Section: Introductionmentioning

confidence: 99%

Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors

Johnson

Richert

2015

International Journal of Drug Policy

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Opioid‐related mortality and filled prescriptions for buprenorphine and methadone

Cited by 42 publications

References 35 publications

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

Non-prescribed use of psychoactive prescription drugs among drug-impaired drivers in Sweden

Diversion of methadone and buprenorphine by patients in opioid substitution treatment in Sweden: Prevalence estimates and risk factors

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