The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage study

Nicola R. Jones; Matt  Hickman; Suzanne Nielsen; Sarah  Larney; Timothy Dobbins; Robert Ali; Louisa   Degenhardt

doi:10.1016/j.drugalcdep.2022.109464

The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage study

Nicola R. Jones, Matt Hickman, Suzanne Nielsen, Sarah Larney, Timothy Dobbins, Robert Ali, Louisa Degenhardt^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

11 Citations (Scopus)

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Abstract

Background
There are critical periods of mortality risk at onset and cessation of opioid agonist treatment. We aim to determine whether non-fatal overdose followed the same pattern as fatal overdose, comparing the first 4 weeks of treatment and treatment cessation and the remainder time off treatment, with the remainder treatment time, to determine intervention markers.

Methods
Retrospective cohort study of people with a history of opioid agonist treatment using linked New South Wales data. The incidence of non-fatal overdose hospitalization; emergency department presentation; and fatal overdose from national death records were compared. Rates were calculated using generalized estimating equations adjusting for demographics, year, and recent health and incarceration events.

Results
The remainder time in OAT had the lowest incidence of overdose for all outcomes and is the reference level for the adjusted incident rate ratios (aIRR). Fatal overdose was lowest in treatment and highest in the first four weeks out of treatment, aIRR of 12.83 (95% CI 10.0–16.4). Whereas the highest overdose rate for non-fatal opioid overdose was in the first four weeks in treatment, aIRR of 3.11 (95% CI 2.19–4.42).

Conclusions
Retention on opioid agonist treatment is protective against drug related overdose. There is elevated risk of non-fatal overdose at treatment initiation that is not evident for fatal overdose, but the first month of treatment cessation is a critical period for both non-fatal and fatal overdose. These findings emphasize the importance of treatment retention and interventions for polysubstance overdose at cessation.

Original language	English
Article number	109464
Number of pages	9
Journal	Drug and Alcohol Dependence
Volume	236
Early online date	15 Apr 2022
DOIs	https://doi.org/10.1016/j.drugalcdep.2022.109464
Publication status	Published - 1 Jul 2022

Bibliographical note

Funding Information:
SL is supported by a Fonds de recherche du Qu?bec ? Sant??career award (#296569). MH acknowledges funding from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The OATS study is funded by the National Institutes of Health (R01 DA144740 PI: Degenhardt). SN and LD are supported by Australian National Health and Medical Research Council Research Fellowships [1135991,1163961]. NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program.

Funding Information:
SL is supported by a Fonds de recherche du Québec – Santé career award ( #296569 ). MH acknowledges funding from NIHR Health Protection Research Unit ( HPRU ) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The OATS study is funded by the National Institutes of Health ( R01 DA144740 PI: Degenhardt). SN and LD are supported by Australian National Health and Medical Research Council Research Fellowships [ 1135991 , 1163961 ]. NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program.

Funding Information:
This work was supported by the National Institutes of Health (R01 DA144740 PI: Degenhardt). SN and LD are supported by Australian National Health and Medical Research Council Research Fellowships (grant numbers 1163961, 1135991). The National Drug and Alcohol Research Centre is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. SL is supported by a Fonds de recherche du Québec – Santé career award (#296569). MH acknowledges funding from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© 2022

Keywords

Opioid dependence
Opioid agonist
Data linkage
Opioid agonist treatment

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Jones, N. R., Hickman, M., Nielsen, S., Larney, S., Dobbins, T., Ali, R., & Degenhardt, L. (2022). The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage study. Drug and Alcohol Dependence, 236, Article 109464. https://doi.org/10.1016/j.drugalcdep.2022.109464

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title = "The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage study",

abstract = "BackgroundThere are critical periods of mortality risk at onset and cessation of opioid agonist treatment. We aim to determine whether non-fatal overdose followed the same pattern as fatal overdose, comparing the first 4 weeks of treatment and treatment cessation and the remainder time off treatment, with the remainder treatment time, to determine intervention markers.MethodsRetrospective cohort study of people with a history of opioid agonist treatment using linked New South Wales data. The incidence of non-fatal overdose hospitalization; emergency department presentation; and fatal overdose from national death records were compared. Rates were calculated using generalized estimating equations adjusting for demographics, year, and recent health and incarceration events.ResultsThe remainder time in OAT had the lowest incidence of overdose for all outcomes and is the reference level for the adjusted incident rate ratios (aIRR). Fatal overdose was lowest in treatment and highest in the first four weeks out of treatment, aIRR of 12.83 (95% CI 10.0–16.4). Whereas the highest overdose rate for non-fatal opioid overdose was in the first four weeks in treatment, aIRR of 3.11 (95% CI 2.19–4.42).ConclusionsRetention on opioid agonist treatment is protective against drug related overdose. There is elevated risk of non-fatal overdose at treatment initiation that is not evident for fatal overdose, but the first month of treatment cessation is a critical period for both non-fatal and fatal overdose. These findings emphasize the importance of treatment retention and interventions for polysubstance overdose at cessation.",

keywords = "Opioid dependence, Opioid agonist, Data linkage, Opioid agonist treatment",

author = "Jones, {Nicola R.} and Matt Hickman and Suzanne Nielsen and Sarah Larney and Timothy Dobbins and Robert Ali and Louisa Degenhardt",

note = "Funding Information: SL is supported by a Fonds de recherche du Qu?bec ? Sant??career award (#296569). MH acknowledges funding from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The OATS study is funded by the National Institutes of Health (R01 DA144740 PI: Degenhardt). SN and LD are supported by Australian National Health and Medical Research Council Research Fellowships [1135991,1163961]. NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. Funding Information: SL is supported by a Fonds de recherche du Qu{\'e}bec – Sant{\'e} career award ( #296569 ). MH acknowledges funding from NIHR Health Protection Research Unit ( HPRU ) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The OATS study is funded by the National Institutes of Health ( R01 DA144740 PI: Degenhardt). SN and LD are supported by Australian National Health and Medical Research Council Research Fellowships [ 1135991 , 1163961 ]. NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. Funding Information: This work was supported by the National Institutes of Health (R01 DA144740 PI: Degenhardt). SN and LD are supported by Australian National Health and Medical Research Council Research Fellowships (grant numbers 1163961, 1135991). The National Drug and Alcohol Research Centre is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. SL is supported by a Fonds de recherche du Qu{\'e}bec – Sant{\'e} career award (#296569). MH acknowledges funding from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2022",

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Jones, NR, Hickman, M, Nielsen, S, Larney, S, Dobbins, T, Ali, R & Degenhardt, L 2022, 'The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage study', Drug and Alcohol Dependence, vol. 236, 109464. https://doi.org/10.1016/j.drugalcdep.2022.109464

The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage study. / Jones, Nicola R.; Hickman, Matt ; Nielsen, Suzanne et al.
In: Drug and Alcohol Dependence, Vol. 236, 109464, 01.07.2022.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018

T2 - Findings from the OATS retrospective linkage study

AU - Jones, Nicola R.

AU - Hickman, Matt

AU - Nielsen, Suzanne

AU - Larney, Sarah

AU - Dobbins, Timothy

AU - Ali, Robert

AU - Degenhardt, Louisa

N1 - Funding Information: SL is supported by a Fonds de recherche du Qu?bec ? Sant??career award (#296569). MH acknowledges funding from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The OATS study is funded by the National Institutes of Health (R01 DA144740 PI: Degenhardt). SN and LD are supported by Australian National Health and Medical Research Council Research Fellowships [1135991,1163961]. NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. Funding Information: SL is supported by a Fonds de recherche du Québec – Santé career award ( #296569 ). MH acknowledges funding from NIHR Health Protection Research Unit ( HPRU ) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The OATS study is funded by the National Institutes of Health ( R01 DA144740 PI: Degenhardt). SN and LD are supported by Australian National Health and Medical Research Council Research Fellowships [ 1135991 , 1163961 ]. NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. Funding Information: This work was supported by the National Institutes of Health (R01 DA144740 PI: Degenhardt). SN and LD are supported by Australian National Health and Medical Research Council Research Fellowships (grant numbers 1163961, 1135991). The National Drug and Alcohol Research Centre is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Program. SL is supported by a Fonds de recherche du Québec – Santé career award (#296569). MH acknowledges funding from NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, NIHR School of Public Health Research (SPHR), and NIHR Biomedical Research Centre (BRC) at Bristol. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2022

PY - 2022/7/1

Y1 - 2022/7/1

N2 - BackgroundThere are critical periods of mortality risk at onset and cessation of opioid agonist treatment. We aim to determine whether non-fatal overdose followed the same pattern as fatal overdose, comparing the first 4 weeks of treatment and treatment cessation and the remainder time off treatment, with the remainder treatment time, to determine intervention markers.MethodsRetrospective cohort study of people with a history of opioid agonist treatment using linked New South Wales data. The incidence of non-fatal overdose hospitalization; emergency department presentation; and fatal overdose from national death records were compared. Rates were calculated using generalized estimating equations adjusting for demographics, year, and recent health and incarceration events.ResultsThe remainder time in OAT had the lowest incidence of overdose for all outcomes and is the reference level for the adjusted incident rate ratios (aIRR). Fatal overdose was lowest in treatment and highest in the first four weeks out of treatment, aIRR of 12.83 (95% CI 10.0–16.4). Whereas the highest overdose rate for non-fatal opioid overdose was in the first four weeks in treatment, aIRR of 3.11 (95% CI 2.19–4.42).ConclusionsRetention on opioid agonist treatment is protective against drug related overdose. There is elevated risk of non-fatal overdose at treatment initiation that is not evident for fatal overdose, but the first month of treatment cessation is a critical period for both non-fatal and fatal overdose. These findings emphasize the importance of treatment retention and interventions for polysubstance overdose at cessation.

AB - BackgroundThere are critical periods of mortality risk at onset and cessation of opioid agonist treatment. We aim to determine whether non-fatal overdose followed the same pattern as fatal overdose, comparing the first 4 weeks of treatment and treatment cessation and the remainder time off treatment, with the remainder treatment time, to determine intervention markers.MethodsRetrospective cohort study of people with a history of opioid agonist treatment using linked New South Wales data. The incidence of non-fatal overdose hospitalization; emergency department presentation; and fatal overdose from national death records were compared. Rates were calculated using generalized estimating equations adjusting for demographics, year, and recent health and incarceration events.ResultsThe remainder time in OAT had the lowest incidence of overdose for all outcomes and is the reference level for the adjusted incident rate ratios (aIRR). Fatal overdose was lowest in treatment and highest in the first four weeks out of treatment, aIRR of 12.83 (95% CI 10.0–16.4). Whereas the highest overdose rate for non-fatal opioid overdose was in the first four weeks in treatment, aIRR of 3.11 (95% CI 2.19–4.42).ConclusionsRetention on opioid agonist treatment is protective against drug related overdose. There is elevated risk of non-fatal overdose at treatment initiation that is not evident for fatal overdose, but the first month of treatment cessation is a critical period for both non-fatal and fatal overdose. These findings emphasize the importance of treatment retention and interventions for polysubstance overdose at cessation.

KW - Opioid dependence

KW - Opioid agonist

KW - Data linkage

KW - Opioid agonist treatment

U2 - 10.1016/j.drugalcdep.2022.109464

DO - 10.1016/j.drugalcdep.2022.109464

M3 - Article (Academic Journal)

C2 - 35523111

SN - 0376-8716

VL - 236

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

M1 - 109464

ER -

Jones NR, Hickman M, Nielsen S, Larney S, Dobbins T, Ali R et al. The impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage study. Drug and Alcohol Dependence. 2022 Jul 1;236:109464. Epub 2022 Apr 15. doi: 10.1016/j.drugalcdep.2022.109464