To examine the effect of opioid maintenance treatment (OMT) on somatic morbidity in a cohort of OMT patients.
Retrospective cohort study.
OMT programme in two Norwegian counties.
200 OMT patients, participation rate 71.2%.
Main outcome measures
Incidence rates (IR) before, during and after OMT for acute/subacute hospital-treated somatic disease incidents (drug-related, non-drug-related, injuries) and rates for inpatient days and outpatient treatment contacts.
IR for drug-related hospital treatment episodes were 76% lower during compared to before OMT (before versus during incidence rate ratio (IRR) 4.2 (95% CI 2.9 to 6.2), p<0.001) and 11 times higher after compared to during OMT (after versus during IRR 11.1 (6.6 to 18.5), p<0.001). For non-drug-related treatment episodes, IR were 35% higher during than before OMT (before versus during IRR 0.7 (0.6 to 1.0), p=0.02) and 32% higher after compared to during OMT (IRR 1.4 (0.9 to 2.2), p=0.15), while injuries showed little change according to OMT status. Although patients with on-going drug-taking during OMT showed less reduction in drug-related hospital-treated incidents during treatment than patients not using illicit drugs, the quartile with most drug-taking showed a significant reduction (before versus during IRR 3.6 (2.4 to 5.3)). Patients who had experienced cessation of OMT showed a significant reduction in drug-related treatment episodes during OMT (before versus during IRR 1.7 (1.0 to 2.9)), although less than patients without OMT interruptions (before versus during IRR 6.1 (3.6 to 10.6)), and a significant increase after OMT cessation compared with during OMT (IRR 5.4 (3.0 to 9.7)).
Acute/subacute drug-related somatic morbidity is reduced during compared to before OMT. This was also found for patients with on-going drug-taking during OMT. However, acute drug-related health problems show an increase after OMT cessation, and this is a matter of concern. Further studies on somatic morbidity after OMT cessation should be carried out.
Opioid maintenance treatment (OMT) is the most widely used treatment for opioid dependence, but the effects of OMT on physical health problems have received relatively little attention.
This study investigates how acute somatic morbidity (drug-related, non-drug-related, injuries) varies according to OMT status (before, during, after OMT) in a cohort of 200 OMT patients.
The research questions were: Is somatic morbidity reduced during OMT compared to before and after treatment? If so, what types of disease incidents are reduced? How is the effect of OMT status on somatic morbidity influenced by various patient characteristics?
Acute drug-related somatic morbidity (overdoses, injecting-related, other) is substantially reduced during compared to before OMT.
This was also found for ‘problem patients’ with on-going drug-taking during OMT, but to a lesser degree than for patients not using illicit drugs.
Strengths and limitations of this study
Participation rate was high, selection bias limited, observation period long and the evaluation of morbidity changes was based on assessment of full-text hospital records.
The study focused on acute health problems treated in hospital, but elective hospital contact due to chronic health problems and primary healthcare contacts were not included.