Suicide in people prescribed opioid-agonist therapy in Scotland, United Kingdom, 2011-2020: A national retrospective cohort study.

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2024-10-22 DOI:10.1111/add.16680

Rosalyn Fraser, Alan Yeung, Megan Glancy, Matthew Hickman, Hayley E Jones, Saket Priyadarshi, Kirsten Horsburgh, Sharon J Hutchinson, Andrew McAuley

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引用次数: 0

Abstract

Background and aims: Opioid dependence is associated with an increased risk of suicide. Drug-related mortality among people with opioid dependence in Scotland has more than tripled since 2010; less is known about changes in suicide risk. We aimed to determine if opioid agonist therapy (OAT) in Scotland is protective against suicide and to measure trends in suicide rates in those with opioid dependence over time.

Design: Retrospective cohort study.

Setting: Scotland, UK.

Participants: 46 453 individuals in Scotland who received at least one prescription for OAT between 2011 and 2020 with over 304 000 person-years (pys) of follow-up.

Measurements: We calculated standardised mortality ratios (SMR) using the age- and sex-specific suicide rates in Scotland for years 2011-2020. We fitted multivariable competing-risk regression models to estimate suicide rates by OAT exposure and to estimate trends over time, adjusting for potential confounders.

Findings: There were 575 deaths classed as suicide among the cohort and the overall suicide rate was 1.89 (95% confidence interval [CI] = 1.74-2.05) per 1000 pys. Age and sex SMR for suicide was 7.05 times (95% CI = 6.50-7.65) higher than in the general population. After adjustment, OAT was shown to be highly protective against suicide, with rates more than three times greater (adjusted hazard ratio: 3.07; 95% CI = 2.60-3.62) off OAT compared with on OAT. Suicide rates decreased over time, falling from 2.57 (95% CI = 2.19-3.02) per 1000 pys in 2011-12 to 1.48 (95% CI = 1.21-1.82) in 2019-20.

Conclusion: People with opioid dependence in Scotland appear to have a greater risk of suicide than the general population. Treatment is protective, with rates of suicide lower among those on opioid agonist therapy. Suicide rates have decreased over time, during a period in which drug-related death rates in Scotland have risen to globally high levels.

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2011-2020 年英国苏格兰阿片类受体激动剂处方治疗者的自杀情况：一项全国性回顾性队列研究。

背景和目的：阿片类药物依赖与自杀风险增加有关。自 2010 年以来，苏格兰阿片类药物依赖者中与药物相关的死亡率增加了两倍多；但人们对自杀风险的变化却知之甚少。我们旨在确定苏格兰的阿片类药物激动剂疗法（OAT）是否对自杀具有保护作用，并测量阿片类药物依赖者的自杀率随时间变化的趋势：设计：回顾性队列研究：环境：英国苏格兰：2011 年至 2020 年间，苏格兰有 46 453 人至少接受过一次 OAT 处方治疗，随访时间超过 304 000 人年：我们使用 2011-2020 年苏格兰特定年龄和性别的自杀率计算了标准化死亡率 (SMR)。我们建立了多变量竞争风险回归模型，以估算OAT暴露的自杀率，并在调整潜在混杂因素后估算随时间变化的趋势：在队列中有 575 例死亡被归类为自杀，总体自杀率为每 1000 人 1.89 例（95% 置信区间 [CI] = 1.74-2.05）。自杀的年龄和性别SMR是普通人群的7.05倍（95% CI = 6.50-7.65）。经调整后，OAT 对自杀具有高度保护作用，与服用 OAT 相比，停用 OAT 后的自杀率是服用 OAT 后的三倍多（调整后危险比：3.07；95% CI = 2.60-3.62）。随着时间的推移，自杀率有所下降，从2011-12年的每千人2.57例（95% CI = 2.19-3.02）下降到2019-20年的1.48例（95% CI = 1.21-1.82）：苏格兰阿片类药物依赖者的自杀风险似乎高于普通人群。治疗具有保护作用，接受阿片激动剂治疗者的自杀率较低。随着时间的推移，自杀率有所下降，而在此期间，苏格兰与毒品有关的死亡率已上升到全球较高水平。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.