Mortality among individuals prescribed opioid-agonist therapy in Scotland, 2011-2020: a national retrospective cohort study

Andrew McAuley; Rosalyn Fraser; Megan  Glancy; Alan Yeung; Hayley E. Jones; Peter Vickerman; Hannah Fraser; Lara Allen; Scott A. McDonald; Jack Stone; David  Liddell; Lee Barnstable; Saket Priyadarshi; Andreas Markoulidakis; Matthew Hickman; Sharon J. Hutchinson

doi:10.1016/S2468-2667(23)00082-8

Mortality among individuals prescribed opioid-agonist therapy in Scotland, 2011-2020: a national retrospective cohort study

Andrew McAuley^*, Rosalyn Fraser, Megan Glancy, Alan Yeung, Hayley E. Jones, Peter Vickerman, Hannah Fraser, Lara Allen, Scott A. McDonald, Jack Stone, David Liddell, Lee Barnstable, Saket Priyadarshi, Andreas Markoulidakis, Matthew Hickman, Sharon J. Hutchinson

^*Corresponding author for this work

SHLS School Office

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Abstract

Background
Drug-related death (DRD) rate in Scotland, UK, 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 Jan 1, 2011, and Dec 31, 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 1000 person-years (95% CI 5·73–7·01) in 2011–12 to 21·45 (20·31–22·63) in 2019–20. DRD rates were almost three and a half times higher (hazard ratio 3·37; 95% CI 1·74–6·53) for those off OAT compared with those on OAT after adjustment for confounders. However, confounder adjusted DRD risk increased over time 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 for people who are opioid dependent in Scotland.

Funding
Scottish Government Drug Deaths Taskforce, Public Health Scotland, and National Institute for Health and Care Research.

Original language	English
Pages (from-to)	e484-e493
Journal	Lancet Public Health
Volume	8
Issue number	7
Early online date	7 Jun 2023
DOIs	https://doi.org/10.1016/S2468-2667(23)00082-8
Publication status	Published - Jul 2023

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/S2468-2667(23)00082-8

Final published versionFinal published version, 512 KBLicence: CC BY-NC-ND

Cite this

McAuley, A., Fraser, R., Glancy, M., Yeung, A., Jones, H. E., Vickerman, P., Fraser, H., Allen, L., McDonald, S. A., Stone, J., Liddell, D., Barnstable, L., Priyadarshi, S., Markoulidakis, A., Hickman, M., & Hutchinson, S. J. (2023). Mortality among individuals prescribed opioid-agonist therapy in Scotland, 2011-2020: a national retrospective cohort study. Lancet Public Health, 8(7), e484-e493. https://doi.org/10.1016/S2468-2667(23)00082-8

@article{ba4bfba0431b47eebf84af971b4978da,

title = "Mortality among individuals prescribed opioid-agonist therapy in Scotland, 2011-2020: a national retrospective cohort study",

abstract = "BackgroundDrug-related death (DRD) rate in Scotland, UK, 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.MethodsWe included individuals in Scotland with opioid use disorder who received at least one OAT prescription between Jan 1, 2011, and Dec 31, 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.FindingsIn 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 1000 person-years (95% CI 5·73–7·01) in 2011–12 to 21·45 (20·31–22·63) in 2019–20. DRD rates were almost three and a half times higher (hazard ratio 3·37; 95% CI 1·74–6·53) for those off OAT compared with those on OAT after adjustment for confounders. However, confounder adjusted DRD risk increased over time for both people off and on OAT.InterpretationDrug-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 for people who are opioid dependent in Scotland.FundingScottish Government Drug Deaths Taskforce, Public Health Scotland, and National Institute for Health and Care Research.",

author = "Andrew McAuley and Rosalyn Fraser and Megan Glancy and Alan Yeung and Jones, {Hayley E.} and Peter Vickerman and Hannah Fraser and Lara Allen and McDonald, {Scott A.} and Jack Stone and David Liddell and Lee Barnstable and Saket Priyadarshi and Andreas Markoulidakis and Matthew Hickman and Hutchinson, {Sharon J.}",

year = "2023",

month = jul,

doi = "10.1016/S2468-2667(23)00082-8",

language = "English",

volume = "8",

pages = "e484--e493",

journal = "Lancet Public Health",

issn = "2468-2667",

publisher = "Elsevier B.V.",

number = "7",

}

McAuley, A , Fraser, R, Glancy, M, Yeung, A, Jones, HE, Vickerman, P, Fraser, H, Allen, L, McDonald, SA, Stone, J, Liddell, D, Barnstable, L, Priyadarshi, S, Markoulidakis, A, Hickman, M & Hutchinson, SJ 2023, 'Mortality among individuals prescribed opioid-agonist therapy in Scotland, 2011-2020: a national retrospective cohort study', Lancet Public Health, vol. 8, no. 7, pp. e484-e493. https://doi.org/10.1016/S2468-2667(23)00082-8

TY - JOUR

T1 - Mortality among individuals prescribed opioid-agonist therapy in Scotland, 2011-2020: a national retrospective cohort study

AU - McAuley, Andrew

AU - Fraser, Rosalyn

AU - Glancy, Megan

AU - Yeung, Alan

AU - Jones, Hayley E.

AU - Vickerman, Peter

AU - Fraser, Hannah

AU - Allen, Lara

AU - McDonald, Scott A.

AU - Stone, Jack

AU - Liddell, David

AU - Barnstable, Lee

AU - Priyadarshi, Saket

AU - Markoulidakis, Andreas

AU - Hickman, Matthew

AU - Hutchinson, Sharon J.

PY - 2023/7

Y1 - 2023/7

N2 - BackgroundDrug-related death (DRD) rate in Scotland, UK, 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.MethodsWe included individuals in Scotland with opioid use disorder who received at least one OAT prescription between Jan 1, 2011, and Dec 31, 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.FindingsIn 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 1000 person-years (95% CI 5·73–7·01) in 2011–12 to 21·45 (20·31–22·63) in 2019–20. DRD rates were almost three and a half times higher (hazard ratio 3·37; 95% CI 1·74–6·53) for those off OAT compared with those on OAT after adjustment for confounders. However, confounder adjusted DRD risk increased over time for both people off and on OAT.InterpretationDrug-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 for people who are opioid dependent in Scotland.FundingScottish Government Drug Deaths Taskforce, Public Health Scotland, and National Institute for Health and Care Research.

AB - BackgroundDrug-related death (DRD) rate in Scotland, UK, 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.MethodsWe included individuals in Scotland with opioid use disorder who received at least one OAT prescription between Jan 1, 2011, and Dec 31, 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.FindingsIn 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 1000 person-years (95% CI 5·73–7·01) in 2011–12 to 21·45 (20·31–22·63) in 2019–20. DRD rates were almost three and a half times higher (hazard ratio 3·37; 95% CI 1·74–6·53) for those off OAT compared with those on OAT after adjustment for confounders. However, confounder adjusted DRD risk increased over time for both people off and on OAT.InterpretationDrug-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 for people who are opioid dependent in Scotland.FundingScottish Government Drug Deaths Taskforce, Public Health Scotland, and National Institute for Health and Care Research.

U2 - 10.1016/S2468-2667(23)00082-8

DO - 10.1016/S2468-2667(23)00082-8

M3 - Article

SN - 2468-2667

VL - 8

SP - e484-e493

JO - Lancet Public Health

JF - Lancet Public Health

IS - 7

ER -

Mortality among individuals prescribed opioid-agonist therapy in Scotland, 2011-2020: a national retrospective cohort study

Abstract

ASJC Scopus subject areas

UN SDGs

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