Patients most at risk of overdose at the beginning and after end of methadone treatment

February 20, 2020

Thursday, 20 February 2020: A new study, led by RCSI researchers, has found that patients receiving methadone treatment are most at risk of overdosing in the month following the end of methadone treatment and during the first four weeks of treatment.

However, the study did not observe transfers between services as high risk periods, with no deaths occurring following a transfer. This suggests that the current structures in Ireland promote a smooth transition of patients between services.

The study, published in the current edition of Addiction, was funded by the Health Research Board and was a collaboration between the School of Pharmacy and Biomolecular Sciences in RCSI, HRB Centre for Primary Care Research in RCSI, the HSE Addiction Services, Trinity College Dublin and the HSE National Social Inclusion Office.

People with opioid dependence have more than 10 times the risk of premature death than the general population. The most effective treatment is the prescription of legal, substitution drugs, most commonly methadone.

The researchers analysed data from 2,899 people who were prescribed and dispensed methadone in addiction services between January 2010 and December 2015. They observed 154 deaths, and 55 (35.7%) of those were identified as drug-related poisonings.

The rate of drug-related poisoning deaths was more than four times higher in the month following the end of treatment and over three times higher in the first four weeks of treatment when compared to the remaining time in treatment. These findings are consistent with growing evidence from other international studies.

"Identifying a higher risk at the beginning and immediately after the end of treatment highlights that retaining patients in treatment for longer periods will save lives. People often cycle in and out of treatment, thereby increasing their exposure to repeated periods of high risk," said Dr Gráinne Cousins, senior lecturer at RCSI's School of Pharmacy and Biomolecular Sciences and the study's lead author.

"Close monitoring of opioid tolerance before starting treatment and more effective methods of preventing relapse during the induction period may reduce this risk. Additionally, increasing patient awareness of the risk of overdose and increasing the availability of take-home naloxone may mitigate the risk of overdose during the high risk periods, particularly following treatment cessation."

No deaths were observed in the first month following transfer between treatment providers. Transfers between addiction services and primary care are facilitated by GP Coordinators employed by the addiction services. The GP Coordinator provides all relevant clinical details on the patient being transferred to the new treatment provider. The provision of opioid substitution treatment is also available in Irish prisons; if a prisoner is in treatment prior to incarceration, their treatment is continued in prison.

"Any inferences regarding risk must be cautious as less than half our sample experienced a transfer, and among those who did, it was most frequently a transition to and from prison. Further investigation of the impact of transfers between services is warranted," said Louise Duran, an RCSI postdoctoral research Fellow in the School of Pharmacy and Biomolecular Sciences.
-end-
RCSI University of Medicine and Health Sciences is ranked among the top 250 (top 2%) of universities worldwide in the Times Higher Education World University Rankings (2020) and its research is ranked first in Ireland for citations. It is an international not-for-profit university, with its headquarters in Dublin, focused on education and research to drive improvements in human health worldwide. RCSI has been awarded Athena Swan Bronze accreditation for positive gender practice in higher education.

RCSI

Related Primary Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Continuity of English primary care has worsened with GP expansions
A new study published by the British Journal of General Practice has found that patients' abilities to see their preferred GP has fallen greater in English practices that have expanded, compared with those that stayed about the same size.

Primary care office-based vs telemedicine care visits during COVID-19 pandemic
This observational study quantified national changes in the volume, type and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based visits compared with telemedicine encounters.

Expenditures for primary care may affect how primary care is delivered
This study looks at trends in out-of-pocket and total visit expenditures for visits to primary care physicians.

Primary care clinicians drove increasing use of Medicare's chronic care management codes
To address the problem of care fragmentation for Medicare recipients with multiple chronic conditions, Medicare introduced Chronic Care Management (CCM) in 2015 to reimburse clinicians for care management and coordination.

Primary care at a crossroads: Experts call for change
Primary care providers have experienced a rise in responsibilities with little or no increase in the time they have to get it all done, or reduction in the number of patients assigned to them.

Primary care physicians during the COVID-19 epidemic
Scientists from the University of Geneva has analysed clinical data from more than 1,500 ambulatory patients tested for COVID-19.

The five phases of pandemic care for primary care
The authors present a roadmap for necessary primary care practice transformations to care for patients and communities during the COVID-19 pandemic.

Women almost twice as likely to choose primary care as men
Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

Read More: Primary Care News and Primary Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.