Were the changes to Sweden's maintenance treatment policy 2000–06 related to changes in opiate‐related mortality and morbidity?

Romelsjö, Anders; Engdahl, Barbro; Stenbacka, Marlene; Fugelstad, Anna; Davstad, Ingrid; Leifman, Anders; Thiblin, Ingemar

doi:10.1111/j.1360-0443.2010.02999.x

Cited by 32 publications

(36 citation statements)

References 10 publications

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“…It also induces tolerance to opioids,19 20 and a corresponding decline in drug-related morbidity including overdoses should be expected. Some studies report improved somatic health during OMT based on interviews,17 clinical assessment21 and reduced consumption of inpatient care due to infections,22 23 but relatively few studies have investigated OMT-related somatic health effects and morbidity patterns. In a previous study we found reductions in somatic disease incidents treated in hospital or by general practitioners during OMT compared to ‘not in treatment’ 24.…”

Section: Introductionmentioning

confidence: 99%

Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study

et al. 2011

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ObjectivesTo examine the effect of opioid maintenance treatment (OMT) on somatic morbidity in a cohort of OMT patients.DesignRetrospective cohort study.SettingOMT programme in two Norwegian counties.Participants200 OMT patients, participation rate 71.2%.Main outcome measuresIncidence rates (IR) before, during and after OMT for acute/subacute hospital-treated somatic disease incidents (drug-related, non-drug-related, injuries) and rates for inpatient days and outpatient treatment contacts.ResultsIR for drug-related hospital treatment episodes were 76% lower during compared to before OMT (before versus during incidence rate ratio (IRR) 4.2 (95% CI 2.9 to 6.2), p<0.001) and 11 times higher after compared to during OMT (after versus during IRR 11.1 (6.6 to 18.5), p<0.001). For non-drug-related treatment episodes, IR were 35% higher during than before OMT (before versus during IRR 0.7 (0.6 to 1.0), p=0.02) and 32% higher after compared to during OMT (IRR 1.4 (0.9 to 2.2), p=0.15), while injuries showed little change according to OMT status. Although patients with on-going drug-taking during OMT showed less reduction in drug-related hospital-treated incidents during treatment than patients not using illicit drugs, the quartile with most drug-taking showed a significant reduction (before versus during IRR 3.6 (2.4 to 5.3)). Patients who had experienced cessation of OMT showed a significant reduction in drug-related treatment episodes during OMT (before versus during IRR 1.7 (1.0 to 2.9)), although less than patients without OMT interruptions (before versus during IRR 6.1 (3.6 to 10.6)), and a significant increase after OMT cessation compared with during OMT (IRR 5.4 (3.0 to 9.7)).ConclusionAcute/subacute drug-related somatic morbidity is reduced during compared to before OMT. This was also found for patients with on-going drug-taking during OMT. However, acute drug-related health problems show an increase after OMT cessation, and this is a matter of concern. Further studies on somatic morbidity after OMT cessation should be carried out.

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Section: Introductionmentioning

confidence: 99%

Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study

et al. 2011

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“…The powerful dependence liability of heroin and intense craving for the drug makes successful rehabilitation a difficult problem [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Heroin poisoning deaths with 6-acetylmorphine in blood: demographics of the victims, previous drug-related offences, polydrug use, and free morphine concentrations in femoral blood

2011

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This article discusses cases of drug-poisoning death in which 6-acetylmorphine (6-AM) was identified in blood as evidence for recent use of heroin. We report the demographics of the victims, previous drug-related offences, polydrug use, and the concentrations of free morphine in peripheral blood. After solid-phase extraction, morphine, codeine, and 6-AM were determined in blood samples by isotope-dilution gas chromatography-mass spectrometry (GC-MS) using limits of quantitation of 0.005 mg/l for each opiate. The victims of heroin poisoning were mainly men (88%), with a mean age of 35.4 ± 8.4 years (±SD) and no significant gender difference in age (men 35 ± 8.4 years; women 35 ± 8.6 years). The median concentration of free morphine in blood (n = 671) was 0.25 mg/l (66% [ 0.20 mg/l) and women had a higher concentration (0.30 mg/l) than men (0.24 mg/l) (P \ 0.05). No significant difference (P [ 0.05) was found for the concentration of free morphine in blood when heroin was the only drug taken (median 0.26 mg/l, n = 53) compared with multidrug deaths (median 0.24 mg/l, n = 618) (P [ 0.05). The coingested drugs most commonly identified in heroin-related deaths were ethanol (44%), diazepam (27%), cannabis (20%), and flunitrazepam (19%). We found that 61% of victims had previous drugrelated offences ranging from 1 to 48 times. The close agreement between the concentrations of free morphine in blood when heroin was the only drug taken and multidrug deaths suggests that differences in tolerance to opiates is more important in causing death than adverse drug-drug interactions.

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“…However, a significant increase in mortality specifically related to buprenorphine and methadone also occurred. 51 …”

Section: Misuse Abuse and Diversion Of Buprenorphinementioning

confidence: 99%

Buprenorphine Prescribing: To Expand or Not to Expand

Shorter

Kosten

2016

Journal of Psychiatric Practice

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As a result of the prescription opioid epidemic in the United States, there has been an increasing need for effective treatment interventions, both pharmacologic and non-pharmacologic. Buprenorphine has emerged as a critical component of the treatment of opioid use disorder, yet its adoption has not been without some concerns. This article first reviews the pharmacology, clinical use, and US legislative action related to buprenorphine, followed by a discussion of the misuse and diversion of buprenorphine in the United States as well as internationally. We then explore the impact of buprenorphine abuse as well as discussing strategies for its reduction, including changes in policy, prescription and pharmacy monitoring, and continuing medical education for guiding and improving clinical practice.

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Were the changes to Sweden's maintenance treatment policy 2000–06 related to changes in opiate‐related mortality and morbidity?

Abstract: The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.

Cited by 32 publications

References 10 publications

Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study

Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study

Heroin poisoning deaths with 6-acetylmorphine in blood: demographics of the victims, previous drug-related offences, polydrug use, and free morphine concentrations in femoral blood

Buprenorphine Prescribing: To Expand or Not to Expand

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