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Journal Club

Journal Club. Alcohol, Other Drugs, and Health: Current Evidence April 2008. Featured Article. Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study Clausen T, et al. Drug Alcohol Depend. 2008;94(1-3):151-157 . Study Objective.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence April 2008 www.aodhealth.org

  2. Featured Article Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study Clausen T, et al. Drug Alcohol Depend. 2008;94(1-3):151-157. www.aodhealth.org

  3. Study Objective • To assess differences in mortality rates prior to, during, and after opioid maintenance treatment (OMT) in opioid-dependent patients • To evaluate changes in mortality rates using an “intention-to-treat” perspective • To examine the distribution of deaths attributable to drug overdose versus other causes www.aodhealth.org

  4. Study Design • In this prospective cohort study, Norwegian researchers followed 3789 persons with opioid dependence over 7 years. • Data were gathered and cross-linked from 2 national registries: • opioid dependent registry • death registry • Subgroup data from the opioid dependent registry (persons on a waiting list for OMT, receiving OMT,* or who had discontinued OMT) were compared with death registry data. *predominantly methadone www.aodhealth.org

  5. Assessing Validity of an Article about Prognosis • Are the results valid? • What are the results? • How can I apply the results to patient care? www.aodhealth.org

  6. Are the Results Valid? • Was the sample representative? • Were the subjects sufficiently homogeneous with respect to prognostic risk? • Was follow-up sufficiently complete? • Were objective and unbiased outcome criteria used? www.aodhealth.org

  7. Was the sample representative? All subjects in this study were… • severely addicted to heroin. • had several years of addiction dominated by opioid dependence. • had not benefited from other types of treatment. www.aodhealth.org

  8. Were the subjects sufficiently homogeneous with respect to prognostic risk? • The sample was divided into 3 groups: • Pretreatment (applicants qualifying for OMT but not yet receiving treatment, referred to as “waiting list”) • In treatment (receiving OMT) • Posttreatment (after termination of OMT) • Female subjects constituted 31.9% of the sample. • Ages ranged from 23 to 66 years. • No information was presented on prognostic risk for death (e.g., comorbid medical/psychiatric conditions) or overdose. www.aodhealth.org

  9. Was follow-up sufficiently complete? • The follow-up period ranged from 0 to 7 years. www.aodhealth.org

  10. Were objective and unbiased outcome criteria used? • Mortality was determined via a death registry. • The potential for bias existed in that... • overdose death was determined according to coroner records. • autopsy was performed in one-third of cases triggered by reasons not stated in the research report. www.aodhealth.org

  11. What Are the Results? • How likely are the outcomes over time? • How precise are the estimates of likelihood? www.aodhealth.org

  12. How likely are the outcomes over time? Mortality Rates per 100 Person-Years (CI) www.aodhealth.org

  13. How precise are the estimates of likelihood? • The confidence intervals were narrow. www.aodhealth.org

  14. How Can I Apply the Resultsto Patient Care? • Were the study patients and their management similar to those in my practice? • Was follow-up sufficiently long? • Can I use the results in the management of patients in my practice? www.aodhealth.org

  15. Were the study patients similar to those in my practice? • The inclusion criteria were broad. • The demographics of this Norwegian study were similar to those of patients with opioid dependence in the United States. www.aodhealth.org

  16. Was follow-up sufficiently long? • Yes. The follow-up period ranged from 0 to 7 years. • The median (SD) number of days of follow-up time was… • pretreatment: 169 (359) • in treatment: 614 (532) • posttreatment:349 (392) www.aodhealth.org

  17. Can I use the results in the management of patients in my practice? • Yes. The essential finding was that OMT decreased mortality in patients with opioid dependence. www.aodhealth.org

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