Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-24T04:30:31.842Z Has data issue: false hasContentIssue false
  • English
  • Français

Reduced mortality in patients with extended duration of methadone maintenance treatment: a five-year retrospective nationwide study

Published online by Cambridge University Press:  20 May 2021

Chieh-Liang Huang Open the ORCID record for Chieh-Liang Huang [Opens in a new window] ,
I-Ju Tsai Open the ORCID record for I-Ju Tsai [Opens in a new window] ,
Wen-Chi Lin Open the ORCID record for Wen-Chi Lin [Opens in a new window] ,
Cheng-Li Lin ,
Ing-Kang Ho ,
Ruey-Yun Wang Open the ORCID record for Ruey-Yun Wang [Opens in a new window]  and
Cynthia Wei-Sheng Lee Open the ORCID record for Cynthia Wei-Sheng Lee [Opens in a new window]
Chieh-Liang Huang
Affiliation:
Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan School of Medicine, China Medical University, Taichung, Taiwan Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
I-Ju Tsai
Affiliation:
Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung, Taiwan
Wen-Chi Lin
Affiliation:
Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
Cheng-Li Lin
Affiliation:
Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung, Taiwan
Ing-Kang Ho
Affiliation:
Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan School of Medicine, China Medical University, Taichung, Taiwan Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
Ruey-Yun Wang
Affiliation:
Department of Public Health, China Medical University, Taichung, Taiwan
Cynthia Wei-Sheng Lee*
Affiliation:
Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
*
Author for correspondence: Cynthia Wei-Sheng Lee, E-mail: T22529@mail.cmuh.org.tw; cindywslee@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The retention of patients under methadone maintenance treatment (MMT) is an indication for the effectiveness of the therapy. We aimed to explore the relation between mortality and the cumulative MMT duration.

Methods

A retrospective cohort analysis was performed using Taiwan Illicit Drug Issue Database (TIDID) and National Health Insurance Research Database (NHIRD) during 2012–2016. We included 9149 and 11 112 MMT patients as the short and long groups according to the length of their cumulative MMT duration, 1–364 and ⩾365 days, respectively. The risk of mortality was calculated by Cox proportional hazards regression model with time-dependent exposure to MMT, and the survival probability was plotted with the Kaplan-Meier curve.

Results

The mortality rates were 2.51 and 1.51 per 100 person-years in the short and long cumulative MMT duration groups, respectively. After adjusting for on or off MMT, age, sex, marital status, education level, maximum methadone dose, and comorbidities (human immunodeficiency virus, depression, hepatitis C virus, hepatitis B virus, alcoholic liver disease, and cardiovascular disease), the long group had a lower risk of death (hazard ratio = 0.67; 95% confidence interval 0.60–0.75) than the short group. Increased risk was observed in patients with advanced age, being male, unmarried, infected by HIV, HCV, and HBV, and diagnosed with depression, ALD, and CVD. Causes of death were frequently related to drug and injury.

Conclusions

Longer cumulative MMT duration is associated with lower all-cause and drug-related mortality rate.

Keywords

Alcoholic liver diseasecardiovascular disease (CVD)cohort studydepressionhepatitis C virushuman immunodeficiency virusmethadone maintenance treatmentmortality
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 3 , February 2023 , pp. 722 - 730
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Previous presentation: Cynthia Wei-Sheng Lee, Ruey-Yun Wang, Wen-Chi Lin, I-Ju Tsai, Ing-Kang Ho, Chieh-Liang Huang (2019). Association of Mortality and Duration of Methadone Maintenance Treatment: a Retrospective Nationwide Study in Taiwan. In: 2019 Annual Conference of Taiwanese Society of Addiction; 27 October 2019; Taoyuan Psychiatric Center, Taoyuan, Taiwan. Abstract nr P12.

References

Behzadi, M., Joukar, S., & Beik, A. (2018). Opioids and cardiac arrhythmia: A literature review. Medical Principles and Practice, 27(5), 401–414. doi:10.1159/000492616.CrossRefGoogle ScholarPubMed
Berg, J. M., Malte, C. A., Reger, M. A., & Hawkins, E. J. (2018). Medical records flag for suicide risk: Predictors and subsequent use of care among veterans with substance use disorders. Psychiatric Services, 69(9), 993–1000. doi:10.1176/appi.ps.201700545.CrossRefGoogle ScholarPubMed
Degenhardt, L., Bucello, C., Mathers, B., Briegleb, C., Ali, H., Hickman, M., & McLaren, J. (2011). Mortality among regular or dependent users of heroin and other opioids: A systematic review and meta-analysis of cohort studies. Addiction, 106(1), 32–51. doi:10.1111/j.1360-0443.2010.03140.x.CrossRefGoogle ScholarPubMed
Evans, E., Li, L., Min, J., Huang, D., Urada, D., Liu, L., … Nosyk, B. (2015). Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006–2010. Addiction, 110(6), 996–1005. doi:10.1111/add.12863.CrossRefGoogle Scholar
Fanucchi, L., Springer, S. A., & Korthuis, P. T. (2019). Medications for treatment of opioid use disorder among persons living with HIV. Current HIV/AIDS Reports, 16(1), 1–6. doi:10.1007/s11904-019-00436-7.CrossRefGoogle ScholarPubMed
Grebely, J., Dalgard, O., Conway, B., Cunningham, E. B., Bruggmann, P., Hajarizadeh, B., … Dore, G. J. (2018). Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): An open-label, single-arm, phase 4, multicentre trial. The Lancet Gastroenterology and Hepatology, 3(3), 153–161. doi:10.1016/s2468-1253(17)30404-1.CrossRefGoogle ScholarPubMed
Hser, Y. I., Evans, E., Huang, D., & Anglin, D. M. (2004). Relationship between drug treatment services, retention, and outcomes. Psychiatric Services, 55(7), 767–774. doi:10.1176/appi.ps.55.7.767.CrossRefGoogle ScholarPubMed
Hsieh, C. Y., Su, C. C., Shao, S. C., Sung, S. F., Lin, S. J., Kao Yang, Y. H., & Lai, E. C. (2019). Taiwan's national health insurance research database: Past and future. Clinical Epidemiology, 11, 349–358. doi:10.2147/CLEP.S196293.CrossRefGoogle ScholarPubMed
Huang, C. L., & Lee, C. W. (2013). Factors associated with mortality among heroin users after seeking treatment with methadone: A population-based cohort study in Taiwan. Journal of Substance Abuse Treatment, 44(3), 295–300. doi:10.1016/j.jsat.2012.08.003.CrossRefGoogle ScholarPubMed
Kresina, T. F., Eldred, L., Bruce, R. D., & Francis, H. (2005). Integration of pharmacotherapy for opioid addiction into HIV primary care for HIV/hepatitis C virus-co-infected patients. AIDS (London, England), 19(Suppl 3), S221–S226. doi:10.1097/01.aids.0000192093.46506.e5.CrossRefGoogle ScholarPubMed
Liao, D. L., Chen, P. C., Chen, C. H., Hsieh, C. J., Huang, Y. F., Shih, W. Y., & Cheng, J. J. (2013). Higher methadone doses are associated with lower mortality in patients of opioid dependence in Taiwan. Journal of Psychiatric Research, 47(10), 1530–1534. doi:10.1016/j.jpsychires.2013.07.001.CrossRefGoogle ScholarPubMed
Lucey, M. R., & Weinrieb, R. M. (2009). Alcohol and substance abuse. Seminars in Liver Disease, 29(1), 66–73. doi:10.1055/s-0029-1192056.CrossRefGoogle ScholarPubMed
Lyu, S.-Y., Su, L.-W., & Chen, Y.-M. A. (2012). Effects of education on harm-reduction programmes. The Lancet, 379(9814), e28–e30. doi:10.1016/s0140-6736(11)60786-1.CrossRefGoogle ScholarPubMed
Ma, J., Bao, Y.-P., Wang, R.-J., Su, M.-F., Liu, M.-X., Li, J.-Q., … Lu, L. (2019). Effects of medication-assisted treatment on mortality among opioids users: A systematic review and meta-analysis. Molecular Psychiatry, 24(12), 1868–1883. doi:10.1038/s41380-018-0094-5.CrossRefGoogle ScholarPubMed
Mbaba, M., Brown, S. E., Wooditch, A., Kiss, M., Murphy, A., Kumari, S., … Springer, S. A. (2018). Prevalence, diagnosis, and treatment rates of mood disorders among opioid users under criminal justice supervision. Substance Use & Misuse, 53(9), 1519–1528. doi:10.1080/10826084.2017.1416400.CrossRefGoogle ScholarPubMed
McCarty, D., Priest, K. C., & Korthuis, P. T. (2018). Treatment and prevention of opioid use disorder: Challenges and opportunities. Annual Review of Public Health, 39, 525–541. doi:10.1146/annurev-publhealth-040617-013526.CrossRefGoogle ScholarPubMed
Merrall, E. L., Kariminia, A., Binswanger, I. A., Hobbs, M. S., Farrell, M., Marsden, J., … Bird, S. M. (2010). Meta-analysis of drug-related deaths soon after release from prison. Addiction, 105(9), 1545–1554. doi:10.1111/j.1360-0443.2010.02990.x.CrossRefGoogle ScholarPubMed
Mumola, C. J. (2007). Medical causes of death in state prisons, 2001–2004. Washington, DC: Bureau of Justice Statistics.CrossRefGoogle Scholar
Nordstrom, D. L., Yokoi-Shelton, M. L., & Zosel, A. (2013). Using multiple cause-of-death data to improve surveillance of drug-related mortality. Journal of Public Health Management and Practice, 19(5), 402–411. doi:10.1097/PHH.0b013e318271c622.CrossRefGoogle ScholarPubMed
Ramakrishna, H., O'Hare, M., Mookadam, F., Gutsche, J. T., Shah, R., & Augoustides, J. G. (2015). Sudden cardiac death and disorders of the QT interval: Anesthetic implications and focus on perioperative management. Journal of Cardiothoracic and Vascular Anesthesia, 29(6), 1723–1733. doi:10.1053/j.jvca.2015.07.026.CrossRefGoogle Scholar
Seitz, H. K., Bataller, R., Cortez-Pinto, H., Gao, B., Gual, A., Lackner, C., … Tsukamoto, H. (2018). Alcoholic liver disease. Nature Reviews Disease Primers, 4(1), 16. doi:10.1038/s41572-018-0014-7.CrossRefGoogle ScholarPubMed
Shefer, G., Henderson, C., Howard, L. M., Murray, J., & Thornicroft, G. (2014). Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms – a qualitative study. PLoS One, 9(11), e111682. doi:10.1371/journal.pone.0111682.CrossRefGoogle ScholarPubMed
Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., … Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. British Medical Journal (Clinical Research Ed.), 357, j1550–j1550. doi:10.1136/bmj.j1550.CrossRefGoogle ScholarPubMed
Volkow, N. D., Jones, E. B., Einstein, E. B., & Wargo, E. M. (2019). Prevention and treatment of opioid misuse and addiction: A review. JAMA Psychiatry, 76(2), 208–216. doi:10.1001/jamapsychiatry.2018.3126.CrossRefGoogle ScholarPubMed
Watkins, K. E., Ober, A. J., Lamp, K., Lind, M., Setodji, C., Osilla, K. C., … Pincus, H. A. (2017). Collaborative care for opioid and alcohol use disorders in primary care: The SUMMIT randomized clinical trial. JAMA Internal Medicine, 177(10), 1480–1488. doi:10.1001/jamainternmed.2017.3947.CrossRefGoogle ScholarPubMed
Witkiewitz, K., & Vowles, K. E. (2018). Alcohol and opioid use, co-use, and chronic pain in the context of the opioid epidemic: A critical review. Alcoholism: Clinical and Experimental Research, 42(3), 478–488. doi:10.1111/acer.13594.CrossRefGoogle ScholarPubMed