Incidence and predictors of drug overdoses among a cohort of >10, 000 patients treated for substance use disorder. (1st January 2020)

• Record Type: Journal Article
• Authors: Thylstrup, Birgitte; Seid, Abdu Kedir; Tjagvad, Christian; Hesse, Morten
• Is Part Of: Drug and alcohol dependence. Volume 206(2020)
• Publication Date: 2020-01-01
• Subjects: Opioid -- Overdose -- Methadone -- Longitudinal -- Risk -- Substance use disorders; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2019.107714
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Around 40% of people with opioid dependence later had a non-fatal overdose. Non-fatal and fatal overdoses had different risk factors. A history of a non-fatal overdose is a strong predictor of a later fatal overdose. Cannabis or MDMA use predicted lower risk of a non-fatal overdose. Abstract: Background: Drug overdoses remain a significant public health burden throughout the world. This study assessed the incidence and predictors of non-fatal and fatal drug overdoses among patients with an opioid use, treated for drug use disorders (DUD) at public treatment centers in Denmark. Methods: A consecutive cohort of patients (n = 11, 199) were tracked from date of first registered enrollment between the year 2000 and 2010 to first registered drug overdose, death or December 31st 2010, whichever occurred first. Competing-risks regression models were fitted to estimate the sub hazard ratios (SHRs) of non-fatal and fatal drug overdoses and confounding risk factors. Results: A total of 3186 (28%) patients experienced a non-fatal drug overdose during follow-up, and 572 (6%) died from an overdose. Use of benzodiazepines (SHR: 1.15 95% CI 1.03, 1.28) was significantly associated with non-fatal overdose. Intravenous drug use and previous hospitalization for a non-fatal overdose increased the risk of later non-fatal (SHR: 1.57 95% CI 1.42, 1.73) and fatal overdoses (SHR: 1.43 95% CI 1.12, 1.82). Conclusions: Patients who use opioids remain at risk of overdoses for a long time after discharge from drug treatment. Besides relevant monitoring and psychosocial support in opioid maintenance treatment, there is a need for informing and educating opioid users in risk factors and preventive measures in settings where they are often difficult to access for traditional treatment services.