Abstract
Background
Scotland’s drug-related death (DRD) rate has increased rapidly to one of the highest in the world. Our aim was to examine the extent to which opioid-agonist therapy (OAT) in Scotland is protective against drug-related mortality and how this effect has varied over time.
Methods
We included individuals in Scotland with opioid use disorder who received at least one OAT prescription between 1 January 2011 and 31 December 2020. We calculated drug-related mortality rates and used Quasi-Poisson regression models to estimate trends over time and by OAT exposure, adjusting for potential confounding.
Findings
In a cohort of 46,453 individuals prescribed OAT with a total of 304,000 person years of follow-up, DRD rates more than trebled from 6·36 per 1,000 pys (95% CI: 5·73 to 7·01) in 2011-12 to 21.45 (95% CI: 20·31 to 22·63) in 2019-20. DRD rates were almost three and a half times higher (HR 3·37, 95% CI: 1·74 to 6·53) for those off OAT relative to those on OAT after adjustment for confounders. However, DRD risk increased over time after adjustment for both people off and on OAT.
Interpretation
Drug-related mortality rates among people with opioid use disorders in Scotland increased between 2011 and 2020. OAT remains protective but is insufficient on its own to slow the increase in DRD risk experienced by people who are opioid dependent in Scotland.
Funding
This study was funded by the Scottish Government Drug Death Task Force. The funding source was independent of the design of this study and did not have any role during its execution, analyses, data interpretation, writing, or decision to submit results. This study was also supported by Public Health Scotland (PHS) and the National Institute for Health and Care Research (NIHR). NIHR funding was through the Programme Grants for Applied Research programme (Grant Reference number RP-PG-0616-20 008) and Health Protection Research Unit in Behavioural Science and Evaluation (HPRU BSE). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. All authors were not precluded from accessing data in the study and take responsibility for the integrity of the data and accuracy of analysis.
Scotland’s drug-related death (DRD) rate has increased rapidly to one of the highest in the world. Our aim was to examine the extent to which opioid-agonist therapy (OAT) in Scotland is protective against drug-related mortality and how this effect has varied over time.
Methods
We included individuals in Scotland with opioid use disorder who received at least one OAT prescription between 1 January 2011 and 31 December 2020. We calculated drug-related mortality rates and used Quasi-Poisson regression models to estimate trends over time and by OAT exposure, adjusting for potential confounding.
Findings
In a cohort of 46,453 individuals prescribed OAT with a total of 304,000 person years of follow-up, DRD rates more than trebled from 6·36 per 1,000 pys (95% CI: 5·73 to 7·01) in 2011-12 to 21.45 (95% CI: 20·31 to 22·63) in 2019-20. DRD rates were almost three and a half times higher (HR 3·37, 95% CI: 1·74 to 6·53) for those off OAT relative to those on OAT after adjustment for confounders. However, DRD risk increased over time after adjustment for both people off and on OAT.
Interpretation
Drug-related mortality rates among people with opioid use disorders in Scotland increased between 2011 and 2020. OAT remains protective but is insufficient on its own to slow the increase in DRD risk experienced by people who are opioid dependent in Scotland.
Funding
This study was funded by the Scottish Government Drug Death Task Force. The funding source was independent of the design of this study and did not have any role during its execution, analyses, data interpretation, writing, or decision to submit results. This study was also supported by Public Health Scotland (PHS) and the National Institute for Health and Care Research (NIHR). NIHR funding was through the Programme Grants for Applied Research programme (Grant Reference number RP-PG-0616-20 008) and Health Protection Research Unit in Behavioural Science and Evaluation (HPRU BSE). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. All authors were not precluded from accessing data in the study and take responsibility for the integrity of the data and accuracy of analysis.
| Original language | English |
|---|---|
| Pages (from-to) | E484-E493 |
| Journal | The Lancet Public Health |
| Volume | 8 |
| Issue number | 7 |
| Early online date | 6 Jun 2023 |
| DOIs | |
| Publication status | Published - 1 Jul 2023 |
Bibliographical note
Funding Information:We are grateful to the individuals from the data linkage and drugs teams at Public Health Scotland for their support and advice in provision of data. This study was funded by the Scottish Government Drug Death Task Force with support from Public Health Scotland and the National Institute for Health and Care Research (NIHR). NIHR funding was through Programme Grants for Applied Research (reference number RP-PG-0616-20 008) and Health Protection Research Unit in Behavioural Science and Evaluation. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Funding Information:
We are grateful to the individuals from the data linkage and drugs teams at Public Health Scotland for their support and advice in provision of data. This study was funded by the Scottish Government Drug Death Task Force with support from Public Health Scotland and the National Institute for Health and Care Research (NIHR). NIHR funding was through Programme Grants for Applied Research (reference number RP-PG-0616-20 008) and Health Protection Research Unit in Behavioural Science and Evaluation. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license