Comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation
Context: Most research on heroin dependence treatments assesses short-term changes in patients' self-reported drug use. To our knowledge, long-term sustainability of changes in patients' drug use and associated hospital morbidity posttreatment have not been studied. Objectives: To evaluate...
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| Format: | Journal Article |
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American Medical Association
2008
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| Online Access: | http://hdl.handle.net/20.500.11937/47406 |
| _version_ | 1848757823671894016 |
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| author | Ngo, H. Tait, Robert Hulse, G. |
| author_facet | Ngo, H. Tait, Robert Hulse, G. |
| author_sort | Ngo, H. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Context: Most research on heroin dependence treatments assesses short-term changes in patients' self-reported drug use. To our knowledge, long-term sustainability of changes in patients' drug use and associated hospital morbidity posttreatment have not been studied. Objectives: To evaluate drug-related hospital morbidity in heroin users at 6 months and 31/2 years after receiving naltrexone implant treatment and to compare these results with outcomes from a similar cohort treated with methadone maintenance treatment. Design: Retrospective longitudinal follow-up, using data prospectively collected via a state hospital (public and private) reporting system. Setting: Perth, Western Australia. Methadone maintenance dosage was generally dispensed daily by registered community pharmacies. Naltrexone implant treatment was performed as a day procedure at a community clinic. Participants: A total of 522 and 314 heroin-dependent persons (according to DSM-IV), first time treated with methadone maintenance or a naltrexone implant, respectively, between January 1, 2001, and December 30, 2002, were identified, using health record linkage. Main Outcome Measures: Planned outcomes included crude hospital admission rates, adjusted changes in risks (odds ratio [OR]), and rates (rate ratio) of "overdose-related" and "non-overdose-related" hospital morbidity associated with opioid vs nonopioid drugs 6 months and 31/2 years posttreatment. Results: Following naltrexone implant treatment, opioid-related risk decreased for overdose (OR, 0.23; 95% confidence interval [CI], 0.11-0.48) and nonoverdose (OR, 0.64; 95% CI, 0.46-0.89) conditions at 31/2 years. Such reductions were not observed after methadone treatment. Overdose on nonopioid drugs increased in older patients to 6 months: OR of 16.31 (95% CI, 3.07-86.53) for naltrexone and OR of 5.03 (95%CI, 1.18-21.54) for methadone. Nonoverdose (eg, dependence and withdrawal) associated with nonopioid drugs also increased for patients receiving the naltrexone implant: OR of 1.52 (95% CI, 1.04-2.23) at 31/2 years. In addition, there were 6 drug-related deaths: 5 after methadone maintenance and 1 after naltrexone implantation. Conclusions: Naltrexone implants, but not methadone maintenance, has long-term benefits in reducing opioid-related hospital morbidity. However, long-lasting and increased nonopioid drug-related morbidity following naltrexone implantation is particularly concerning. Similar studies are required to confirm these findings. ©2008 American Medical Association. All rights reserved. |
| first_indexed | 2025-11-14T09:34:13Z |
| format | Journal Article |
| id | curtin-20.500.11937-47406 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T09:34:13Z |
| publishDate | 2008 |
| publisher | American Medical Association |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-474062017-09-13T14:10:55Z Comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation Ngo, H. Tait, Robert Hulse, G. Context: Most research on heroin dependence treatments assesses short-term changes in patients' self-reported drug use. To our knowledge, long-term sustainability of changes in patients' drug use and associated hospital morbidity posttreatment have not been studied. Objectives: To evaluate drug-related hospital morbidity in heroin users at 6 months and 31/2 years after receiving naltrexone implant treatment and to compare these results with outcomes from a similar cohort treated with methadone maintenance treatment. Design: Retrospective longitudinal follow-up, using data prospectively collected via a state hospital (public and private) reporting system. Setting: Perth, Western Australia. Methadone maintenance dosage was generally dispensed daily by registered community pharmacies. Naltrexone implant treatment was performed as a day procedure at a community clinic. Participants: A total of 522 and 314 heroin-dependent persons (according to DSM-IV), first time treated with methadone maintenance or a naltrexone implant, respectively, between January 1, 2001, and December 30, 2002, were identified, using health record linkage. Main Outcome Measures: Planned outcomes included crude hospital admission rates, adjusted changes in risks (odds ratio [OR]), and rates (rate ratio) of "overdose-related" and "non-overdose-related" hospital morbidity associated with opioid vs nonopioid drugs 6 months and 31/2 years posttreatment. Results: Following naltrexone implant treatment, opioid-related risk decreased for overdose (OR, 0.23; 95% confidence interval [CI], 0.11-0.48) and nonoverdose (OR, 0.64; 95% CI, 0.46-0.89) conditions at 31/2 years. Such reductions were not observed after methadone treatment. Overdose on nonopioid drugs increased in older patients to 6 months: OR of 16.31 (95% CI, 3.07-86.53) for naltrexone and OR of 5.03 (95%CI, 1.18-21.54) for methadone. Nonoverdose (eg, dependence and withdrawal) associated with nonopioid drugs also increased for patients receiving the naltrexone implant: OR of 1.52 (95% CI, 1.04-2.23) at 31/2 years. In addition, there were 6 drug-related deaths: 5 after methadone maintenance and 1 after naltrexone implantation. Conclusions: Naltrexone implants, but not methadone maintenance, has long-term benefits in reducing opioid-related hospital morbidity. However, long-lasting and increased nonopioid drug-related morbidity following naltrexone implantation is particularly concerning. Similar studies are required to confirm these findings. ©2008 American Medical Association. All rights reserved. 2008 Journal Article http://hdl.handle.net/20.500.11937/47406 10.1001/archpsyc.65.4.457 American Medical Association unknown |
| spellingShingle | Ngo, H. Tait, Robert Hulse, G. Comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation |
| title | Comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation |
| title_full | Comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation |
| title_fullStr | Comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation |
| title_full_unstemmed | Comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation |
| title_short | Comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation |
| title_sort | comparing drug-related hospital morbidity following heroin dependence treatment with methadone maintenance or naltrexone implantation |
| url | http://hdl.handle.net/20.500.11937/47406 |