Health-related quality of life of long-term patients receiving opioid agonist therapy: a nested prospective cohort study in Norway

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Abstract

Background

Opioid dependence carries the highest disease burden of all illicit drugs. Opioid agonist therapy (OAT) is an evidence-based medical intervention that reduces morbidity and mortality. There is limited knowledge on the health-related quality of life (HRQoL) of long-term patients in OAT. This study measures HRQoL and self-perceived health of long-term patients on OAT, compares the scores to a Norwegian reference population, and assesses changes in these scores at 1-year follow up.

Methods

We conducted a nested prospective cohort study among nine OAT outpatient clinics in Norway. 609 OAT patients were included, 245 (40%) followed-up one year later. Data on patient characteristics, HRQoL, and self-perceived health was collected. HRQoL was assessed with the EQ-5D-5L, which measures five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) on a five-point Likert scale (from “no problems” to “extreme problems”). An UK value set was applied to calculate index values (from 0 to 1) for the EQ-5D-5L and compare them to a Norwegian reference population. Self-perceived health was measured with EQ-VAS (from 0 to 100).

Results

Mean (standard deviation (SD)) EQ-5D-5L index value at baseline was 0.699 (0.250) and EQ-VAS 57 (22) compared to 0.848 (0.200) and 80(19) for the Norwegian reference population. There were large variations in EQ-5D-5L index values, where 43% had > 0.8 and 5% had < 0.2 at baseline. The lowest EQ-5D-5L index values were observed for female patients, age groups older than 40 years and for methadone users. At follow-up, improvements in HRQoL were observed across almost all dimensions and found significant for mobility and pain/discomfort. Mean (SD) overall index value and EQ-VAS at follow up were 0.729 (0.237) and 59 (22) respectively.

Conclusion

The average HRQoL and self-perceived health of OAT patients is significantly lower than that of the general population, and lower than what has been found among other severe somatic and psychiatric conditions. Around 34% had very good HRQoL, higher than average Norwegian values, and around 5% had extremely poor HRQoL.

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Most cited references 32

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Global patterns of opioid use and dependence: harms to populations, interventions, and future action

Louisa Degenhardt, Jason Grebely, Jack Stone … (2019)

This paper summarises evidence for medicinal uses of opioids; harms related to the extra-medical use and dependence upon these drugs, and for a wide range of interventions to address the harms related to extra-medical opioid use. Finally, we use mathematical modelling to estimate harms and explore the overall health benefits of opioid agonist treatment (OAT) in a range of settings that vary in levels of opioid use and associated harms (overdose, HIV, HCV, suicide, accidental injuries) and responses. Estimates in 2017 suggest 40.5 million people were dependent upon opioids (40.5 million people, 95%UI 34.3–47.9 million) and 109,500 people died from opioid overdose (10.5,800–113,600). OAT can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes, including reduced overall mortality and key causes of death including overdose, suicide, and other injuries. Modelling suggested scaling-up and retaining people in OAT, including providing OAT in prison, could avert a median of 7.7%, 14.5% and 25.9% deaths over the next 20 years (compared to scenarios without OAT) in Kentucky, Kyiv and Tehran, with more impact achieved in Tehran and Kyiv due to the added benefits on HIV mortality.. Other pharmacological and non-pharmacological treatments have varying levels of evidence for effectiveness and patient acceptability. Other effective interventions are those focused on preventing harms associated with problematic opioid use. Despite strong evidence for the effectiveness of a range of interventions to improve the health and well-being of people who are dependent on opioids, coverage is low even in high income countries. Treatment quality may be less than desirable, and considerable human, social, and economic harms arise from the criminalisation of illicit opioid use and dependence. Alternative policy frameworks are recommended that adopt a human rights and public health-based approach, do not make drug use a criminal behaviour and seek to reduce drug related harm at the population level.

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The Burden of Opioid-Related Mortality in the United States

Tara Gomes, Mina Tadrous, Muhammad Mamdani … (2018)

Key Points Question What has been the burden of opioid-related deaths in the United States over a recent 15-year period? Findings In this serial cross-sectional study, we found that the percentage of all deaths attributable to opioids increased 292% (from 0.4% to 1.5%) between 2001 and 2016, resulting in approximately 1.68 million person-years of life lost in 2016 alone (5.2 per 1000 population). The burden was particularly high among adults aged 24 to 35 years; in 2016, 20% of deaths in this age group involved opioids. Meaning Premature death from opioids imposes an enormous and growing public health burden across the United States.

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Mortality among people who inject drugs: a systematic review and meta-analysis

Bradley M Mathers, Louisa Degenhardt, Chiara Bucello … (2013)

OBJECTIVE: To systematically review cohort studies of mortality among people who inject drugs, examine mortality rates and causes of death in this group, and identify participant- and study-level variables associated with a higher risk of death. METHODS: Tailored search strings were used to search EMBASE, Medline and PsycINFO. The grey literature was identified through online grey literature databases. Experts were consulted to obtain additional studies and data. Random effects meta-analyses were performed to estimate pooled crude mortality rates (CMRs) and standardized mortality ratios (SMRs). FINDINGS: Sixty-seven cohorts of people who inject drugs were identified, 14 of them from low- and middle-income countries. The pooled CMR was 2.35 deaths per 100 person-years (95% confidence interval, CI: 2.12-2.58). SMRs were reported for 32 cohorts; the pooled SMR was 14.68 (95% CI: 13.01-16.35). Comparison of CMRs and the calculation of CMR ratios revealed mortality to be higher in low- and middle-income country cohorts, males and people who injected drugs that were positive for human immunodeficiency virus (HIV). It was also higher during off-treatment periods. Drug overdose and acquired immunodeficiency syndrome (AIDS) were the primary causes of death across cohorts. CONCLUSION: Compared with the general population, people who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Any comprehensive approach to improving health outcomes in this group must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose.

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Author and article information

Contributors

Christer Frode Aas:

ORCID: http://orcid.org/0000-0002-6469-9354

christer.frode.aas@helse-bergen.no

Journal

Journal ID (nlm-ta): Subst Abuse Treat Prev Policy

Journal ID (iso-abbrev): Subst Abuse Treat Prev Policy

Title: Substance Abuse Treatment, Prevention, and Policy

Publisher: BioMed Central (London )

ISSN (Electronic): 1747-597X

Publication date (Electronic): 3 September 2020

Publication date PMC-release: 3 September 2020

Publication date Collection: 2020

Volume: 15

Electronic Location Identifier: 68

Affiliations

[1 ]GRID grid.412008.f, ISNI 0000 0000 9753 1393, Bergen Addiction Research group, Department of Addiction Medicine, , Haukeland University Hospital, ; Østre Murallmenningen 7, N-5012 Bergen, Norway

[2 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Department of Global Public Health and Primary Care, , University of Bergen, ; Bergen, Norway

[3 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Norwegian Centre for Addiction Research, , University of Oslo, ; Oslo, Norway

[4 ]GRID grid.418193.6, ISNI 0000 0001 1541 4204, Department of Mental Disorders, , Norwegian Institute of Public Health, ; Oslo, Norway

[5 ]GRID grid.5337.2, ISNI 0000 0004 1936 7603, Population Health Sciences, , Bristol Medical School, University of Bristol, ; Bristol, UK

[6 ]GRID grid.426489.5, Research Unit for General Practice, , NORCE Norwegian Research Centre, ; Bergen, Norway

[7 ]Department of Social Sciences, NORCE Norwegian Research Centre, Bergen, Norway

[8 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Department of Economics, , University of Bergen, ; Bergen, Norway

[9 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Department of Clinical Psychology, Medicine, , University of Bergen, ; Bergen, Norway

[10 ]GRID grid.412008.f, ISNI 0000 0000 9753 1393, Division of Psychiatry, , Haukeland University Hospital, ; Bergen, Norway

Author information

Christer Frode Aas http://orcid.org/0000-0002-6469-9354

Article

Publisher ID: 309

DOI: 10.1186/s13011-020-00309-y

PMC ID: 7469909

PubMed ID: 32883319

SO-VID: cd913abb-c907-4967-8512-0fdfc9f4a14b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 22 June 2020

Date accepted : 25 August 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100005416, Norges Forskningsråd;

Award ID: no. 269855

Funded by: FundRef http://dx.doi.org/10.13039/501100004257, Helse Vest;

Award ID: Åpen prosjektstøtte

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: health related quality of life,quality of life,eq-5d,opiate substitution therapy,opioid agonist therapy,opioid dependence,epidemiology

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: health related quality of life, quality of life, eq-5d, opiate substitution therapy, opioid agonist therapy, opioid dependence, epidemiology

Health-related quality of life of long-term patients receiving opioid agonist therapy: a nested prospective cohort study in Norway

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Abstract

Background

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Conclusion

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Pan African Medical Journal

Most cited references 32

Global patterns of opioid use and dependence: harms to populations, interventions, and future action

The Burden of Opioid-Related Mortality in the United States

Mortality among people who inject drugs: a systematic review and meta-analysis

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