Evidence map›Paper›PMID 20978062›Full record

ArticleBMJ (Clinical research ed.)2010

Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database.

Rosie Cornish, John Macleod, John Strang, Peter Vickerman, Matt Hickman

Registry-linked trialOpen access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04622995 (Exploring the Utility and Safety of Benzodiazepine Prescribing Among People Receiving Opiate Replacement Therapy in Scotland), which is not on this map. Cited by 133 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
133citing papers in PubMed, 13 pooled it
19.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04622995 completednot on this mapstarted 2021, after this paper: background citation

Exploring the Utility and Safety of Benzodiazepine Prescribing Among People Receiving Opiate Replacement Therapy in Scotland (the BENZORT Study).

TypeobservationalSponsorUniversity of StirlingRan2021 to 2022Enrolled46,899ConditionsSubstance-Related DisordersArmsBenzodiazepine
3 · Its place in the literature

Who cites it

133 citing papers in PubMed, 13 syntheses or guidelines pooled it, 309 citations in OpenAlex.

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  17. Smoking and opioid detoxification: behavioral changes and response to treatment.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2013
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73 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Rosie CornishSchool of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
John Macleod
John Strang
Peter Vickerman
Matt Hickman
University of Bristol · GBKing's College London · GBLondon School of Hygiene & Tropical Medicine · GB

Funding

Medical Research Council G0701627Medical Research Council G9815508
6 · The paper itself

Abstract

objectiveTo investigate the effect of opiate substitution treatment at the beginning and end of treatment and according to duration of treatment.

designProspective cohort study. Setting UK General Practice Research Database.

participantsPrimary care patients with a diagnosis of substance misuse prescribed methadone or buprenorphine during 1990-2005. 5577 patients with 267 003 prescriptions for opiate substitution treatment followed-up (17 732 years) until one year after the expiry of their last prescription, the date of death before this time had elapsed, or the date of transfer away from the practice.

main outcome measuresMortality rates and rate ratios comparing periods in and out of treatment adjusted for sex, age, calendar year, and comorbidity; standardised mortality ratios comparing opiate users' mortality with general population mortality rates.

resultsCrude mortality rates were 0.7 per 100 person years on opiate substitution treatment and 1.3 per 100 person years off treatment; standardised mortality ratios were 5.3 (95% confidence interval 4.0 to 6.8) on treatment and 10.9 (9.0 to 13.1) off treatment. Men using opiates had approximately twice the risk of death of women (morality rate ratio 2.0, 1.4 to 2.9). In the first two weeks of opiate substitution treatment the crude mortality rate was 1.7 per 100 person years: 3.1 (1.5 to 6.6) times higher (after adjustment for sex, age group, calendar period, and comorbidity) than the rate during the rest of time on treatment. The crude mortality rate was 4.8 per 100 person years in weeks 1-2 after treatment stopped, 4.3 in weeks 3-4, and 0.95 during the rest of time off treatment: 9 (5.4 to 14.9), 8 (4.7 to 13.7), and 1.9 (1.3 to 2.8) times higher than the baseline risk of mortality during treatment. Opiate substitution treatment has a greater than 85% chance of reducing overall mortality among opiate users if the average duration approaches or exceeds 12 months.

conclusionsClinicians and patients should be aware of the increased mortality risk at the start of opiate substitution treatment and immediately after stopping treatment. Further research is needed to investigate the effect of average duration of opiate substitution treatment on drug related mortality.

Indexed as

AdolescentAdultBuprenorphineFemaleHumansMaleMethadoneMiddle AgedNarcoticsOpioid-Related DisordersProspective StudiesRisk FactorsTime FactorsUnited KingdomYoung AdultBuprenorphineMethadoneNarcotics

Identifiers

PMID20978062
PMCPMC2965139
OpenAlexW1965862609

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.