Bogdanowicz, KM;
Stewart, R;
Chang, CK;
Downs, J;
Khondoker, M;
Shetty, H;
Strang, J;
(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.
10.1016/j.drugalcdep.2016.04.036.
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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.
| Type: | Article |
|---|---|
| Title: | Identifying mortality risks in patients with opioid use disorder using brief screening assessment: Secondary mental health clinical records analysis |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.drugalcdep.2016.04.036 |
| Publisher version: | http://doi.org/10.1016/j.drugalcdep.2016.04.036 |
| Language: | English |
| Additional information: | Copyright © 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/). |
| Keywords: | Heroin, Injecting, Mortality, Opioids, Overdose, Risk assessment, Suicide, Treatment |
| UCL classification: | UCL |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/1493190 |
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