小柯机器人

加拿大不列颠哥伦比亚省艾滋病卓越中心Bohdan Nosyk团队在研究中取得进展。他们研究了阿片受体激动剂治疗与阿片类药物过量突发公共卫生事件死亡风险的关系。这一研究成果于2020年发表在《英国医学杂志》上。

非法药物供应中非法生产的芬太尼和其他合成阿片类药物越来越流行，为了比较阿片类药物使用障碍人群中使用或停止阿片受体激动剂治疗（OAT）的死亡风险，研究组进行了一项基于人群的回顾性队列研究。

研究组从加拿大不列颠哥伦比亚省的5个卫生行政中心获取个人数据，1996年1月1日至2018年9月30日，共有55347名阿片类药物使用障碍者接受了OAT。

随访期间，共有7030人（12.7%）死亡。进行OAT的人群中全因标准化死亡率（4.6）显著低于停止OAT的人群（9.7）。在芬太尼滥用时期，停止OAT的相对死亡风险是引入芬太尼之前进行OAT的2.1倍，在研究结束时风险增加至3.4。

总之，持续OAT可以大大降低阿片药物使用障碍患者的死亡风险。随着芬太尼和其他合成阿片类药物在非法药物供应中变得普遍，OAT对死亡率的保护作用增加，但OAT导致的死亡风险仍然很高。

附：英文原文

Title: Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study

Author: Lindsay A Pearce, Jeong Eun Min, Micah Piske, Haoxuan Zhou, Fahmida Homayra, Amanda Slaunwhite, Mike Irvine, Gina McGowan, Bohdan Nosyk

Issue&Volume: 2020/03/31

Abstract: Abstract

Objective To compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply.

Design Population based retrospective cohort study.

Setting Individual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada.

Participants 55347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018.

Main outcome measures All cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply.

Results 7030 (12.7%) of 55347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk).

Conclusions Retention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.

DOI: 10.1136/bmj.m772

Source: https://www.bmj.com/content/368/bmj.m772

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