Kevin J Li1,2,3, Diane L Smedberg1, Lynn E DeLisi1,2. 1. Department of Veterans Affairs, Brockton Campus, Brockton, Massachusetts. 2. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. 3. Department of Psychiatry, Harvard South Shore Psychiatry Residency Training Program, Brockton, Massachusetts.
Abstract
BACKGROUND AND OBJECTIVES: With 47 600 opioid-related deaths in 2017, the yearly deaths have surpassed the HIV/AIDS peak yearly death rates. Residential rehabilitation (RR) and medication-assisted treatments (MAT) are commonly utilized treatments for opioid use disorder (OUD). METHODS: All patients (n = 182) who were admitted to the Boston Veterans Health Administration for inpatient admission for medically supervised opioid withdrawal in 2015 were included. Deceased patients were matched 1:1, based on age and sex to living patients from the 182-patient cohort. Nationwide electronic medical records were analyzed from 2015 through 2018. Via multilinear regression, risk factor correlation to all-cause mortality (the dependent variable) was our main outcome. Primary risk factors included recurrent admissions for medically supervised withdrawals and exposure to RR or MAT. Secondary risk factors were opioid use traits, nonopioid drug use, partner support, education level, homelessness, and employment. RESULTS: 18.4% (n = 34) were deceased by the time of follow-up-equivalent to 4760 deaths per 100 000 person-years. A total of 61.8% (n = 21) of these deaths were directly related to opioid use. Completion of RR correlated with lower predicted mortality (β = -8.21, P = 0.03). In contrast, attending RR but not completing correlated with higher predicted mortality rate (β = 6.51, P = 0.046). Concurrent benzodiazepine use (β = 8.99, P = 0.047), generalized anxiety disorder (β = 7.13, P = 0.03) and major depressive disorder (β = 5.44, P = 0.04) increased risk of death. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: OUD carries a shockingly high lethality in Veterans requiring inpatient admission for opioid withdrawal, particularly when there are untreated comorbid psychiatric conditions. RR and MAT are correlated to lower all-cause mortality in this population and should be highly utilized. Given the extremely high mortality, intensive system-wide interventions are needed for the care of Veterans with OUD. On the basis of the reduced predicted mortality with RR and MAT, further research into novel MATs as well as refining RR programs should be a major focus. (Am J Addict 2019;28:318-323).
BACKGROUND AND OBJECTIVES: With 47 600 opioid-related deaths in 2017, the yearly deaths have surpassed the HIV/AIDS peak yearly death rates. Residential rehabilitation (RR) and medication-assisted treatments (MAT) are commonly utilized treatments for opioid use disorder (OUD). METHODS: All patients (n = 182) who were admitted to the Boston Veterans Health Administration for inpatient admission for medically supervised opioid withdrawal in 2015 were included. Deceased patients were matched 1:1, based on age and sex to living patients from the 182-patient cohort. Nationwide electronic medical records were analyzed from 2015 through 2018. Via multilinear regression, risk factor correlation to all-cause mortality (the dependent variable) was our main outcome. Primary risk factors included recurrent admissions for medically supervised withdrawals and exposure to RR or MAT. Secondary risk factors were opioid use traits, nonopioid drug use, partner support, education level, homelessness, and employment. RESULTS: 18.4% (n = 34) were deceased by the time of follow-up-equivalent to 4760 deaths per 100 000 person-years. A total of 61.8% (n = 21) of these deaths were directly related to opioid use. Completion of RR correlated with lower predicted mortality (β = -8.21, P = 0.03). In contrast, attending RR but not completing correlated with higher predicted mortality rate (β = 6.51, P = 0.046). Concurrent benzodiazepine use (β = 8.99, P = 0.047), generalized anxiety disorder (β = 7.13, P = 0.03) and major depressive disorder (β = 5.44, P = 0.04) increased risk of death. CONCLUSION AND SCIENTIFIC SIGNIFICANCE: OUD carries a shockingly high lethality in Veterans requiring inpatient admission for opioid withdrawal, particularly when there are untreated comorbid psychiatric conditions. RR and MAT are correlated to lower all-cause mortality in this population and should be highly utilized. Given the extremely high mortality, intensive system-wide interventions are needed for the care of Veterans with OUD. On the basis of the reduced predicted mortality with RR and MAT, further research into novel MATs as well as refining RR programs should be a major focus. (Am J Addict 2019;28:318-323).
Authors: Nikhil Seval; Cynthia A Frank; Alain H Litwin; Prerana Roth; Meredith A Schade; Martina Pavlicova; Frances R Levin; Kathleen T Brady; Edward V Nunes; Sandra A Springer Journal: Contemp Clin Trials Date: 2021-04-07 Impact factor: 2.261
Authors: Stephanie A Hooker; Michelle D Sherman; Mary Lonergan-Cullum; Adam Sattler; Bruce S Liese; Kathryn Justesen; Tanner Nissly; Robert Levy Journal: J Prim Care Community Health Date: 2020 Jan-Dec