Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study

C. McCowan, B. Kidd, T. Fahey

    Research output: Contribution to journalArticle

    56 Citations (Scopus)

    Abstract

    Objective To assess predictors of mortality in a population of people prescribed methadone.

    Design Retrospective cohort study.

    Setting Geographically defined population in Tayside, Scotland.

    Participants 2378 people prescribed and dispensed liquid methadone between January 1993 and February 2004.

    Main outcome measures All cause mortality (primary outcome) and drug dependent cause specific mortality (secondary outcome) by means of Cox proportional hazards models during 12 years of follow-up.

    Results Overall, 181 (8%) people died. Overuse of methadone (adjusted hazard ratio 1.67, 95% confidence interval 1.05 to 2.67), history of psychiatric admission (2.47, 1.67 to 3.66), and increasing comorbidity measured as Charlson index >= 3 (1.20, 1.15 to 1.26) were all associated with an increase in all cause mortality. Longer duration of use (adjusted hazard ratio 0.95, 0.94 to 0.96), history of having urine tested (0.33, 0.22 to 0.49), and increasing time since last filled prescription were protective in relation to all cause mortality. Drug dependence was identified as the principal cause of death in 60 (33%) people. History of psychiatric admission was significantly associated with drug dependent death (adjusted hazard ratio 2.41, 1.25 to 4.64), as was history of prescription of benzodiazepines (4.35, 1.32 to 14.30).

    Conclusions Important elements of care in provision of methadone maintenance treatment are likely to influence, or be a marker for, a person's risk of death.

    Original languageEnglish
    Article numberb2225
    Pages (from-to)-
    Number of pages7
    JournalBMJ
    Volume338
    DOIs
    Publication statusPublished - 17 Jun 2009

    Keywords

    • MAINTENANCE TREATMENT
    • OPIOID DEPENDENCE
    • COMORBIDITY INDEX
    • DRUG-USERS
    • HEROIN
    • DEATHS
    • OVERDOSE
    • ENGLAND
    • GUIDELINES
    • IMPACT

    Cite this

    @article{f7538092a8434e9fac4c309b1094cae1,
    title = "Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study",
    abstract = "Objective To assess predictors of mortality in a population of people prescribed methadone.Design Retrospective cohort study.Setting Geographically defined population in Tayside, Scotland.Participants 2378 people prescribed and dispensed liquid methadone between January 1993 and February 2004.Main outcome measures All cause mortality (primary outcome) and drug dependent cause specific mortality (secondary outcome) by means of Cox proportional hazards models during 12 years of follow-up.Results Overall, 181 (8{\%}) people died. Overuse of methadone (adjusted hazard ratio 1.67, 95{\%} confidence interval 1.05 to 2.67), history of psychiatric admission (2.47, 1.67 to 3.66), and increasing comorbidity measured as Charlson index >= 3 (1.20, 1.15 to 1.26) were all associated with an increase in all cause mortality. Longer duration of use (adjusted hazard ratio 0.95, 0.94 to 0.96), history of having urine tested (0.33, 0.22 to 0.49), and increasing time since last filled prescription were protective in relation to all cause mortality. Drug dependence was identified as the principal cause of death in 60 (33{\%}) people. History of psychiatric admission was significantly associated with drug dependent death (adjusted hazard ratio 2.41, 1.25 to 4.64), as was history of prescription of benzodiazepines (4.35, 1.32 to 14.30).Conclusions Important elements of care in provision of methadone maintenance treatment are likely to influence, or be a marker for, a person's risk of death.",
    keywords = "MAINTENANCE TREATMENT, OPIOID DEPENDENCE, COMORBIDITY INDEX, DRUG-USERS, HEROIN, DEATHS, OVERDOSE, ENGLAND, GUIDELINES, IMPACT",
    author = "C. McCowan and B. Kidd and T. Fahey",
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    language = "English",
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    Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study. / McCowan, C.; Kidd, B.; Fahey, T.

    In: BMJ, Vol. 338, b2225, 17.06.2009, p. -.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study

    AU - McCowan, C.

    AU - Kidd, B.

    AU - Fahey, T.

    PY - 2009/6/17

    Y1 - 2009/6/17

    N2 - Objective To assess predictors of mortality in a population of people prescribed methadone.Design Retrospective cohort study.Setting Geographically defined population in Tayside, Scotland.Participants 2378 people prescribed and dispensed liquid methadone between January 1993 and February 2004.Main outcome measures All cause mortality (primary outcome) and drug dependent cause specific mortality (secondary outcome) by means of Cox proportional hazards models during 12 years of follow-up.Results Overall, 181 (8%) people died. Overuse of methadone (adjusted hazard ratio 1.67, 95% confidence interval 1.05 to 2.67), history of psychiatric admission (2.47, 1.67 to 3.66), and increasing comorbidity measured as Charlson index >= 3 (1.20, 1.15 to 1.26) were all associated with an increase in all cause mortality. Longer duration of use (adjusted hazard ratio 0.95, 0.94 to 0.96), history of having urine tested (0.33, 0.22 to 0.49), and increasing time since last filled prescription were protective in relation to all cause mortality. Drug dependence was identified as the principal cause of death in 60 (33%) people. History of psychiatric admission was significantly associated with drug dependent death (adjusted hazard ratio 2.41, 1.25 to 4.64), as was history of prescription of benzodiazepines (4.35, 1.32 to 14.30).Conclusions Important elements of care in provision of methadone maintenance treatment are likely to influence, or be a marker for, a person's risk of death.

    AB - Objective To assess predictors of mortality in a population of people prescribed methadone.Design Retrospective cohort study.Setting Geographically defined population in Tayside, Scotland.Participants 2378 people prescribed and dispensed liquid methadone between January 1993 and February 2004.Main outcome measures All cause mortality (primary outcome) and drug dependent cause specific mortality (secondary outcome) by means of Cox proportional hazards models during 12 years of follow-up.Results Overall, 181 (8%) people died. Overuse of methadone (adjusted hazard ratio 1.67, 95% confidence interval 1.05 to 2.67), history of psychiatric admission (2.47, 1.67 to 3.66), and increasing comorbidity measured as Charlson index >= 3 (1.20, 1.15 to 1.26) were all associated with an increase in all cause mortality. Longer duration of use (adjusted hazard ratio 0.95, 0.94 to 0.96), history of having urine tested (0.33, 0.22 to 0.49), and increasing time since last filled prescription were protective in relation to all cause mortality. Drug dependence was identified as the principal cause of death in 60 (33%) people. History of psychiatric admission was significantly associated with drug dependent death (adjusted hazard ratio 2.41, 1.25 to 4.64), as was history of prescription of benzodiazepines (4.35, 1.32 to 14.30).Conclusions Important elements of care in provision of methadone maintenance treatment are likely to influence, or be a marker for, a person's risk of death.

    KW - MAINTENANCE TREATMENT

    KW - OPIOID DEPENDENCE

    KW - COMORBIDITY INDEX

    KW - DRUG-USERS

    KW - HEROIN

    KW - DEATHS

    KW - OVERDOSE

    KW - ENGLAND

    KW - GUIDELINES

    KW - IMPACT

    U2 - 10.1136/bmj.b2225

    DO - 10.1136/bmj.b2225

    M3 - Article

    VL - 338

    SP - -

    JO - British Medical Journal

    JF - British Medical Journal

    SN - 0959-8146

    M1 - b2225

    ER -