Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study
- Ivar Skeie1,2,
- Mette Brekke3,
- Michael Gossop2,4,
- Morten Lindbaek3,5,
- Even Reinertsen6,
- Magne Thoresen7,
- Helge Waal2
- 1Centre for Addiction Treatment, Oslo University Hospital, Oslo, Norway
- 2Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- 3Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- 4National Addiction Centre, Department of Psychiatry, King's College London, London, UK
- 5The antibiotic centre for primary care, Institute of Health and Society, University of Oslo, Oslo, Norway
- 6Department of Internal Medicine, Innlandet Hospital, Gjoevik, Norway
- 7Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Correspondence to Dr Ivar Skeie;
- Received 28 March 2011
- Accepted 7 June 2011
- Published 6 August 2011
Objectives To examine the effect of opioid maintenance treatment (OMT) on somatic morbidity in a cohort of OMT patients.
Design Retrospective cohort study.
Setting OMT programme in two Norwegian counties.
Participants 200 OMT patients, participation rate 71.2%.
Main outcome measures Incidence rates (IR) before, during and after OMT for acute/subacute hospital-treated somatic disease incidents (drug-related, non-drug-related, injuries) and rates for inpatient days and outpatient treatment contacts.
Results IR for drug-related hospital treatment episodes were 76% lower during compared to before OMT (before versus during incidence rate ratio (IRR) 4.2 (95% CI 2.9 to 6.2), p<0.001) and 11 times higher after compared to during OMT (after versus during IRR 11.1 (6.6 to 18.5), p<0.001). For non-drug-related treatment episodes, IR were 35% higher during than before OMT (before versus during IRR 0.7 (0.6 to 1.0), p=0.02) and 32% higher after compared to during OMT (IRR 1.4 (0.9 to 2.2), p=0.15), while injuries showed little change according to OMT status. Although patients with on-going drug-taking during OMT showed less reduction in drug-related hospital-treated incidents during treatment than patients not using illicit drugs, the quartile with most drug-taking showed a significant reduction (before versus during IRR 3.6 (2.4 to 5.3)). Patients who had experienced cessation of OMT showed a significant reduction in drug-related treatment episodes during OMT (before versus during IRR 1.7 (1.0 to 2.9)), although less than patients without OMT interruptions (before versus during IRR 6.1 (3.6 to 10.6)), and a significant increase after OMT cessation compared with during OMT (IRR 5.4 (3.0 to 9.7)).
Conclusion Acute/subacute drug-related somatic morbidity is reduced during compared to before OMT. This was also found for patients with on-going drug-taking during OMT. However, acute drug-related health problems show an increase after OMT cessation, and this is a matter of concern. Further studies on somatic morbidity after OMT cessation should be carried out.
To cite: Skeie I, Brekke M, Gossop M, et al. Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study. BMJ Open 2011;1:e000130. doi:10.1136/bmjopen-2011-000130
Competing interests None.
Ethics approval This study was approved by the Regional Committee for Medical Research Ethics - Southern Norway (REK Sør) and the Norwegian Data Inspectorate.
Contributors IS had the original idea for the study, took part in the planning and developed the questionnaire and the list of diagnoses, carried out interviews, collected record data, performed data analyses and statistical analyses, took part in interpretation of data, drafted and is first author of the article, and is guarantor of the study. MB supervised the study and took part in the planning of the study, interpretation of data and revision of the article. MG contributed to the interpretation of data and took part in revision of the article. ML supervised the study and took part in the planning of the study, interpretation of data and revision of the article. ER took part in the interpretation of record data and revision of the article. MT took part in the interpretation of data, planned and performed the statistical analyses and took part in the revision of the article. HW is project leader and the main supervisor of the study and participated in the planning of the study, interpretation of data and revision of the article.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Anonymised additional data are available from the corresponding author.
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