Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013

Lu Gao, Polyxeni Dimitropoulou, J. Roy Robertson, Stuart McTaggart, Marion Bennie, Sheila M. Bird

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Aim: To quantify gender, age-group and quantity of methadone prescribed as risk factors for drugs-related deaths (DRDs), and for methadone-specific DRDs, in Scotland's methadone-prescription clients.

Design: Linkage to death-records for Scotland's methadone-clients with one or more Community Health Index (CHI)-identified methadone prescriptions during July 2009 to June 2013.

Setting: Scotland's Prescribing Information System and National Records of Scotland.

Measurements: Covariates defined at first CHI-identified methadone prescription, and person-years at-risk (pys) thereafter until the earlier of death-date or 31 December 2013. Methadone-specific DRDs were defined as: methadone implicated but neither heroin nor buprenorphine. Hazard ratios (HRs) were assessed using proportional hazards regression.

Findings: Scotland's CHI-identified methadone-prescription cohort comprised 33,128 clients, 121,254 pys, 1,171 non-DRDs and 760 DRDs (6.3 per 1,000 pys), of which 362 were methadone-specific. Irrespective of gender, methadone-specific DRD-rate, per 1,000 pys, was higher in the 35+ age-group (4.2; 95% CI: 3.6-4.7) than for younger clients (1.9; 95% CI: 1.5-2.2). For methadone-specific DRDs, age-related HRs (e.g., 2.9 at 45+ years; 95% CI: 2.1-3.9) were steeper than for all DRDs (1.9; 95% CI: 1.5-2.4); there was no hazard-reduction for females; no gender by age-group interaction; and, unlike for all DRDs, the highest quintile for quantity of prescribed methadone at cohort-entry (>1960mg) was associated with increased HR (1.8; 95% CI: 1.3-2.5).

Conclusion: Higher methadone-specific DRD rates in older clients, irrespective of gender, call for better understanding of methadone's pharmaco-dynamics in older, opioid-dependent clients, many with progressive physical or mental ill-health.

LanguageEnglish
Pages214-223
Number of pages10
JournalDrug and Alcohol Dependence
Volume167
Early online date29 Aug 2016
DOIs
Publication statusPublished - 1 Oct 2016

Fingerprint

Methadone
Scotland
Prescriptions
Pharmaceutical Preparations
Hazards
Health
Age Groups
Pharmacodynamics
Buprenorphine
Death Certificates
Mortality
Heroin
Information Systems
Opioid Analgesics

Keywords

  • deaths
  • drugs-related
  • methadone-specific
  • risk-factors
  • gender
  • age-group
  • prescribed-methadone
  • quantity
  • daily dose
  • quintiles

Cite this

@article{40db7b0c5fa9439382f70348a41c767c,
title = "Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013",
abstract = "Aim: To quantify gender, age-group and quantity of methadone prescribed as risk factors for drugs-related deaths (DRDs), and for methadone-specific DRDs, in Scotland's methadone-prescription clients.Design: Linkage to death-records for Scotland's methadone-clients with one or more Community Health Index (CHI)-identified methadone prescriptions during July 2009 to June 2013.Setting: Scotland's Prescribing Information System and National Records of Scotland.Measurements: Covariates defined at first CHI-identified methadone prescription, and person-years at-risk (pys) thereafter until the earlier of death-date or 31 December 2013. Methadone-specific DRDs were defined as: methadone implicated but neither heroin nor buprenorphine. Hazard ratios (HRs) were assessed using proportional hazards regression.Findings: Scotland's CHI-identified methadone-prescription cohort comprised 33,128 clients, 121,254 pys, 1,171 non-DRDs and 760 DRDs (6.3 per 1,000 pys), of which 362 were methadone-specific. Irrespective of gender, methadone-specific DRD-rate, per 1,000 pys, was higher in the 35+ age-group (4.2; 95{\%} CI: 3.6-4.7) than for younger clients (1.9; 95{\%} CI: 1.5-2.2). For methadone-specific DRDs, age-related HRs (e.g., 2.9 at 45+ years; 95{\%} CI: 2.1-3.9) were steeper than for all DRDs (1.9; 95{\%} CI: 1.5-2.4); there was no hazard-reduction for females; no gender by age-group interaction; and, unlike for all DRDs, the highest quintile for quantity of prescribed methadone at cohort-entry (>1960mg) was associated with increased HR (1.8; 95{\%} CI: 1.3-2.5).Conclusion: Higher methadone-specific DRD rates in older clients, irrespective of gender, call for better understanding of methadone's pharmaco-dynamics in older, opioid-dependent clients, many with progressive physical or mental ill-health.",
keywords = "deaths, drugs-related, methadone-specific, risk-factors, gender, age-group, prescribed-methadone, quantity, daily dose, quintiles",
author = "Lu Gao and Polyxeni Dimitropoulou and Robertson, {J. Roy} and Stuart McTaggart and Marion Bennie and Bird, {Sheila M.}",
note = "Copyright {\circledC} 2016. Published by Elsevier Ireland Ltd.",
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Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013. / Gao, Lu; Dimitropoulou, Polyxeni; Robertson, J. Roy; McTaggart, Stuart; Bennie, Marion; Bird, Sheila M.

In: Drug and Alcohol Dependence, Vol. 167, 01.10.2016, p. 214-223.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013

AU - Gao, Lu

AU - Dimitropoulou, Polyxeni

AU - Robertson, J. Roy

AU - McTaggart, Stuart

AU - Bennie, Marion

AU - Bird, Sheila M.

N1 - Copyright © 2016. Published by Elsevier Ireland Ltd.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Aim: To quantify gender, age-group and quantity of methadone prescribed as risk factors for drugs-related deaths (DRDs), and for methadone-specific DRDs, in Scotland's methadone-prescription clients.Design: Linkage to death-records for Scotland's methadone-clients with one or more Community Health Index (CHI)-identified methadone prescriptions during July 2009 to June 2013.Setting: Scotland's Prescribing Information System and National Records of Scotland.Measurements: Covariates defined at first CHI-identified methadone prescription, and person-years at-risk (pys) thereafter until the earlier of death-date or 31 December 2013. Methadone-specific DRDs were defined as: methadone implicated but neither heroin nor buprenorphine. Hazard ratios (HRs) were assessed using proportional hazards regression.Findings: Scotland's CHI-identified methadone-prescription cohort comprised 33,128 clients, 121,254 pys, 1,171 non-DRDs and 760 DRDs (6.3 per 1,000 pys), of which 362 were methadone-specific. Irrespective of gender, methadone-specific DRD-rate, per 1,000 pys, was higher in the 35+ age-group (4.2; 95% CI: 3.6-4.7) than for younger clients (1.9; 95% CI: 1.5-2.2). For methadone-specific DRDs, age-related HRs (e.g., 2.9 at 45+ years; 95% CI: 2.1-3.9) were steeper than for all DRDs (1.9; 95% CI: 1.5-2.4); there was no hazard-reduction for females; no gender by age-group interaction; and, unlike for all DRDs, the highest quintile for quantity of prescribed methadone at cohort-entry (>1960mg) was associated with increased HR (1.8; 95% CI: 1.3-2.5).Conclusion: Higher methadone-specific DRD rates in older clients, irrespective of gender, call for better understanding of methadone's pharmaco-dynamics in older, opioid-dependent clients, many with progressive physical or mental ill-health.

AB - Aim: To quantify gender, age-group and quantity of methadone prescribed as risk factors for drugs-related deaths (DRDs), and for methadone-specific DRDs, in Scotland's methadone-prescription clients.Design: Linkage to death-records for Scotland's methadone-clients with one or more Community Health Index (CHI)-identified methadone prescriptions during July 2009 to June 2013.Setting: Scotland's Prescribing Information System and National Records of Scotland.Measurements: Covariates defined at first CHI-identified methadone prescription, and person-years at-risk (pys) thereafter until the earlier of death-date or 31 December 2013. Methadone-specific DRDs were defined as: methadone implicated but neither heroin nor buprenorphine. Hazard ratios (HRs) were assessed using proportional hazards regression.Findings: Scotland's CHI-identified methadone-prescription cohort comprised 33,128 clients, 121,254 pys, 1,171 non-DRDs and 760 DRDs (6.3 per 1,000 pys), of which 362 were methadone-specific. Irrespective of gender, methadone-specific DRD-rate, per 1,000 pys, was higher in the 35+ age-group (4.2; 95% CI: 3.6-4.7) than for younger clients (1.9; 95% CI: 1.5-2.2). For methadone-specific DRDs, age-related HRs (e.g., 2.9 at 45+ years; 95% CI: 2.1-3.9) were steeper than for all DRDs (1.9; 95% CI: 1.5-2.4); there was no hazard-reduction for females; no gender by age-group interaction; and, unlike for all DRDs, the highest quintile for quantity of prescribed methadone at cohort-entry (>1960mg) was associated with increased HR (1.8; 95% CI: 1.3-2.5).Conclusion: Higher methadone-specific DRD rates in older clients, irrespective of gender, call for better understanding of methadone's pharmaco-dynamics in older, opioid-dependent clients, many with progressive physical or mental ill-health.

KW - deaths

KW - drugs-related

KW - methadone-specific

KW - risk-factors

KW - gender

KW - age-group

KW - prescribed-methadone

KW - quantity

KW - daily dose

KW - quintiles

UR - http://www.sciencedirect.com/science/journal/03768716

U2 - 10.1016/j.drugalcdep.2016.08.627

DO - 10.1016/j.drugalcdep.2016.08.627

M3 - Article

VL - 167

SP - 214

EP - 223

JO - Drug and Alcohol Dependence

T2 - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

SN - 0376-8716

ER -