Identifying mortality risks in patients with opioid use disorder using brief screening assessment:Secondary mental health clinical records analysis

Bogdanowicz, Karolina Magda, Stewart, Robert, Chang, Chin-Kuo, Downs, Johnny, Khondoker, Mizanur, Shetty, Hitesh, Strang, John and Hayes, Richard Derek (2016) Identifying mortality risks in patients with opioid use disorder using brief screening assessment:Secondary mental health clinical records analysis. Drug and Alcohol Dependence, 164. pp. 82-88. ISSN 0376-8716

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Abstract

BACKGROUND: Risk assessments are widely used, but their ability to predict outcomes in opioid use disorder (OUD) treatment remains unclear. Therefore, the aim was to investigate if addiction-specific brief risk screening is effective in identifying high mortality risk groups and if subsequent clinical actions following risk assessment impacts on mortality levels.  METHODS: Opioid use disorder (OUD) patients were identified in the South London and Maudsley Case Register. Deaths were identified through database linkage to the national mortality dataset. Cox and competing-risk regression were used to model associations between brief risk assessment domains and all-cause and overdose mortality in 4488 OUD patients, with up-to 6-year follow-up time where 227 deaths were registered. Data were stratified by admission to general mental health services.  RESULTS: All-cause mortality was significantly associated with unsafe injecting (HR 1.53, 95% CI 1.10-2.11) and clinically appraised likelihood of accidental overdose (HR 1.48, 95% CI 1.00-2.19). Overdose-mortality was significantly associated with unsafe injecting (SHR 2.52, 95% CI 1.11-5.70) and clinically appraised suicidality (SHR 2.89, 95% CI 1.38-6.03). Suicidality was associated with a twofold increase in mortality risk among OUD patients who were not admitted to mental health services within 2 months of their risk assessment (HR 2.03, 95% CI 1.67-3.24).  CONCLUSIONS: Diagnosis-specific brief risk screening can identify OUD patient subgroups at increased risk of all-cause and overdose mortality. OUD patients, where suicidality is evident, who are not admitted into services are particularly vulnerable.

Item Type: Article
Additional Information: © 2016 The Author(s). Published by Elsevier Ireland Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Uncontrolled Keywords: opioids,heroin,treatment,mortality,risk assessment,suicide,overdose,injecting
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 24 Sep 2016 00:10
Last Modified: 27 Jul 2020 23:52
URI: https://ueaeprints.uea.ac.uk/id/eprint/59888
DOI: 10.1016/j.drugalcdep.2016.04.036

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