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Death from liver disease in a cohort of injecting opioid users in a Swedish city in relation to registration for opioid substitution therapy

OGIONWO JERKEMAN, ANNA LU ; Håkansson, Anders; Rylance, Rebecca; Wagner, Philippe LU ; Alanko Blomé, Marianne LU and Björkman, Per LU (2016) In Drug and Alcohol Review
Abstract

Introduction and Aims: Injecting opioid users are at elevated risk of death. Although liver disease (especially hepatitis C) is common, its impact on mortality is low in active injectors. Because opioid substitution therapy (OST) reduces the risk of death from directly drug related causes, we hypothesised that the proportion of liver-related deaths would increase in subjects receiving OST. We investigated liver-related mortality in a cohort of injecting opioid users attending a needle exchange program (NEP) in a Swedish city in relation to OST exposure. Design and Methods: Participants enrolled in the NEP between 1987 and 2011 with available national identity numbers, and registered use of opioids, were included. Linkage based on... (More)

Introduction and Aims: Injecting opioid users are at elevated risk of death. Although liver disease (especially hepatitis C) is common, its impact on mortality is low in active injectors. Because opioid substitution therapy (OST) reduces the risk of death from directly drug related causes, we hypothesised that the proportion of liver-related deaths would increase in subjects receiving OST. We investigated liver-related mortality in a cohort of injecting opioid users attending a needle exchange program (NEP) in a Swedish city in relation to OST exposure. Design and Methods: Participants enrolled in the NEP between 1987 and 2011 with available national identity numbers, and registered use of opioids, were included. Linkage based on national identity numbers was performed with national registers for death, emigration and prescription of OST. Participants were categorised as non-OST recipients until the registered date of first OST prescription, and hence as OST recipients. Hazard ratios were calculated by Cox regression for overall and liver-related mortality in relation to OST, with OST as a time-dependent variable. Results: Among 4494 NEP participants, 1488 opioid users were identified; 711/1488 had been prescribed OST. During a follow-up period of 15546 person-years 368 deaths occurred. Sixteen deaths were caused by liver disease; 10 of these occurred in OST recipients. The risk of liver-related death was significantly increased in OST receiving participants (hazard ratio 3.08, 95% confidence interval [1.09, 8.68], P=0.03). Conclusions: Liver related mortality among opioid users was significantly elevated in OST recipients, showing the long-term importance of chronic liver disease in this population. [Jerkeman A, Håkansson A, Rylance R, Wagner P, Alanko Blomé M, Björkman P. Death from liver disease in a cohort of injecting opioid users in a Swedish city in relation to registration for opioid substitution therapy.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Hepatitis C, Heroin, Liver disease, Mortality, Opioid substitution treatment
in
Drug and Alcohol Review
publisher
Wiley-Blackwell
external identifiers
  • Scopus:84973649656
ISSN
0959-5236
DOI
10.1111/dar.12425
language
English
LU publication?
yes
id
4c0c2954-ebad-4abc-8644-d2f4bce5512a
date added to LUP
2016-06-22 10:01:43
date last changed
2016-10-27 13:09:33
@misc{4c0c2954-ebad-4abc-8644-d2f4bce5512a,
  abstract     = {<p>Introduction and Aims: Injecting opioid users are at elevated risk of death. Although liver disease (especially hepatitis C) is common, its impact on mortality is low in active injectors. Because opioid substitution therapy (OST) reduces the risk of death from directly drug related causes, we hypothesised that the proportion of liver-related deaths would increase in subjects receiving OST. We investigated liver-related mortality in a cohort of injecting opioid users attending a needle exchange program (NEP) in a Swedish city in relation to OST exposure. Design and Methods: Participants enrolled in the NEP between 1987 and 2011 with available national identity numbers, and registered use of opioids, were included. Linkage based on national identity numbers was performed with national registers for death, emigration and prescription of OST. Participants were categorised as non-OST recipients until the registered date of first OST prescription, and hence as OST recipients. Hazard ratios were calculated by Cox regression for overall and liver-related mortality in relation to OST, with OST as a time-dependent variable. Results: Among 4494 NEP participants, 1488 opioid users were identified; 711/1488 had been prescribed OST. During a follow-up period of 15546 person-years 368 deaths occurred. Sixteen deaths were caused by liver disease; 10 of these occurred in OST recipients. The risk of liver-related death was significantly increased in OST receiving participants (hazard ratio 3.08, 95% confidence interval [1.09, 8.68], P=0.03). Conclusions: Liver related mortality among opioid users was significantly elevated in OST recipients, showing the long-term importance of chronic liver disease in this population. [Jerkeman A, Håkansson A, Rylance R, Wagner P, Alanko Blomé M, Björkman P. Death from liver disease in a cohort of injecting opioid users in a Swedish city in relation to registration for opioid substitution therapy.</p>},
  author       = {OGIONWO JERKEMAN, ANNA and Håkansson, Anders and Rylance, Rebecca and Wagner, Philippe and Alanko Blomé, Marianne and Björkman, Per},
  issn         = {0959-5236},
  keyword      = {Hepatitis C,Heroin,Liver disease,Mortality,Opioid substitution treatment},
  language     = {eng},
  month        = {05},
  publisher    = {ARRAY(0x85e51a0)},
  series       = {Drug and Alcohol Review},
  title        = {Death from liver disease in a cohort of injecting opioid users in a Swedish city in relation to registration for opioid substitution therapy},
  url          = {http://dx.doi.org/10.1111/dar.12425},
  year         = {2016},
}