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Patients receiving opiate substitution have elevated mortality risks at the start and end of treatment

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Question: How do mortalities compare across treatment periods for patients with diagnosed substance misuse receiving opiate substitution treatment in primary care?

People: 5577 patients with a diagnosis of substance misuse aged between 16 and 59 who had received at least one prescription for methadone or buprenorphine between January 1990 and December 2005. Exclusions: age above 60 at prescription, prescription of injectable drugs or opiates specifically for pain.

Setting: UK primary care records (General Practice Research Database), 1990–2005.

Risk factors: Duration of time receiving or not receiving opiate substitution treatment with at least one daily dose of methadone, buprenorphine or dihydrocodeine. Patients were defined as being ‘on treatment’ from date of prescription until its expiry. ‘Planned discharge’ was defined on the basis of dose tapering towards the end of the prescribing period. Included adjustment for confounders including: comorbidities (proxy score of total prescriptions for drugs other than for opiate substitution), sex, age, calendar period, treatment episode and episodes at or above recommended maintenance levels.

Outcomes: All-cause mortality (mortalities and rate ratios, standardised mortality …

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