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MeSH: opiátová substituční terapie-metody

18 záznamů v Medvik Filtry

Článek

Large variations in all-cause and overdose mortality among >13,000 patients in and out of opioid maintenance treatment in different settings: a comparative registry linkage study

Gabrhelík, Roman
Autor Gabrhelík, Roman First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czechia Department of Addictology, General University Hospital in Prague, Prague, Czechia
Hesse, Morten
Autor Hesse, Morten Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
Nechanská, Blanka
Autor Nechanská, Blanka First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czechia Department of Addictology, General University Hospital in Prague, Prague, Czechia
Handal, Marte
Autor Handal, Marte Norwegian Institute of Public Health, Oslo, Norway Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
Mravčík, Viktor
Autor Mravčík, Viktor First Faculty of Medicine, Department of Addictology, Charles University, Prague, Czechia Department of Addictology, General University Hospital in Prague, Prague, Czechia
Tjagvad, Christian
Autor Tjagvad, Christian Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
Thylstrup, Birgitte
Autor Thylstrup, Birgitte Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
Seid, Abdu Kedir
Autor Seid, Abdu Kedir Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
Bukten, Anne
Autor Bukten, Anne Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
Clausen, Thomas
Autor Clausen, Thomas Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway

Frontiers in public health. 2023 ; 11 (-) : 1179763. [pub] 20230922

Front Public Health
ISSN 2296-2565
Medvik
Zdroj

BACKGROUND: Opioid maintenance treatment (OMT) has the potential to reduce mortality rates substantially. We aimed to compare all-cause and overdose mortality among OMT patients while in or out of OMT in two different countries with different approaches to OMT. METHODS: Two nation-wide, registry-based cohorts were linked by using similar analytical strategies. These included 3,637 male and 1,580 female patients enrolled in OMT in Czechia (years 2000-2019), and 6,387 male and 2,078 female patients enrolled in OMT in Denmark (years 2007-2018). The direct standardization method using the European (EU-27 plus EFTA 2011-2030) Standard was employed to calculate age-standardized rate to weight for age. All-cause and overdose crude mortality rates (CMR) as number of deaths per 1,000 person years (PY) in and out of OMT were calculated for all patients. CMRs were stratified by sex and OMT medication modality (methadone, buprenorphine, and buprenorphine with naloxone). RESULTS: Age-standardized rate for OMT patients in Czechia and Denmark was 9.7/1,000 PY and 29.8/1,000 PY, respectively. In Czechia, the all-cause CMR was 4.3/1,000 PY in treatment and 10.8/1,000 PY out of treatment. The overdose CMR was 0.5/1,000 PY in treatment and 1.2/1,000 PY out of treatment. In Denmark, the all-cause CMR was 26.6/1,000 PY in treatment and 28.2/1,000 PY out of treatment and the overdose CMR was 7.3/1,000 PY in treatment and 7.0/1,000 PY out of treatment. CONCLUSION: Country-specific differences in mortality while in and out of OMT in Czechia and Denmark may be partly explained by different patient characteristics and treatment systems in the two countries. The findings contribute to the public health debate about OMT management and may be of interest to practitioners, policy and decision makers when balancing the safety and accessibility of OMT.

MeSH
buprenorfin * terapeutické užití MeSH
lidé MeSH
methadon škodlivé účinky MeSH
opiátová substituční terapie škodlivé účinky metody MeSH
poruchy spojené s užíváním opiátů * farmakoterapie MeSH
předávkování léky * epidemiologie farmakoterapie etiologie MeSH
registrace MeSH
Check Tag
lidé MeSH
mužské pohlaví MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
práce podpořená grantem MeSH

Kapitola

Závislost na návykových látkách

Hrnčiarová, Jela, 1971-
Autor Autorita Psychiatrická klinika Lékařské fakulty UK v Hradci Králové a Fakultní nemocnice Hradec Králové Léčebna návykových nemocí, Nechanice

Psychiatrie a pedopsychiatrie. 2021 ; () : 142-180.

ISBN 978-80-246-5088-3
Medvik
Zdroj

Článek

Long-Term Opioid Agonist Treatment Participation after First Treatment Entry is Similar across 4 European Regions but Lower in Non-Nationals

European addiction research. 2018 ; 24 (4) : 173-183. [pub] 20180717

Eur Addict Res
ISSN 1421-9891
Medvik
Zdroj

Heroin users in opioid agonist treatment (OAT) show markedly reduced heroin consumption, less crime and a lower mortality rate. However, the extent of long-term OAT participation over subsequent treatment episodes remains unclear. We analysed the annual proportion of patients in treatment (at least 1 day) since the start of first OAT in 4 European regions: Barcelona (BA) 1996-2012: 8,602 patients; Czech -Republic (CZ) 2000-2014: 4,377 patients; Netherlands (NL) 1994-2014: 33,235 patients, Zurich (ZU) 1992-2015: 11,795. We estimated the long-term decline of treatment need due to mortality or abstinence and also a "nuisance" short-term decline until the equilibrium level of cycling in and out of OAT is reached to obtain the adjusted treatment participation value. The adjusted treatment participation was around 50% (BA: 47.4-51.4%; CZ: 49.8-53.9%; NL: 52.3-54.0%; ZU: 46.4-49.3%), and the annual decline of treatment need was close to 4%. Non-nationals (NL patients with a migrant background) showed substantial lower adjusted treatment participation (rate ratio BA: 0.059-0.343; NL: 0.710-0.751; ZU: 0.681-0.797; CZ: n.a.). Our method may provide a policy-relevant indicator of long-term provision, quality and access to OAT following first treatment.

MeSH
databáze faktografické trendy MeSH
dospělí MeSH
emigranti a imigranti * MeSH
lidé středního věku MeSH
lidé MeSH
opiátová substituční terapie metody trendy MeSH
opioidní analgetika aplikace a dávkování MeSH
poruchy spojené s užíváním opiátů diagnóza epidemiologie terapie MeSH
rozvrh dávkování léků MeSH
výsledek terapie MeSH
zapojení pacienta metody trendy MeSH
Check Tag
dospělí MeSH
lidé středního věku MeSH
lidé MeSH
mužské pohlaví MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
Geografické názvy
Česká republika epidemiologie MeSH
Nizozemsko epidemiologie MeSH
Španělsko epidemiologie MeSH
Švýcarsko epidemiologie MeSH

Článek

Neonatal outcomes after fetal exposure to methadone and buprenorphine: national registry studies from the Czech Republic and Norway

Addiction. 2018 ; 113 (7) : 1286-1294. [pub] 20180324

ISSN 1360-0443
Medvik
Zdroj

BACKGROUND AND AIMS: Opioid maintenance treatment (OMT) is recommended to opioid-dependent females during pregnancy. However, it is not clear which medication should be preferred. We aimed to compare neonatal outcomes after prenatal exposure to methadone (M) and buprenorphine (B) in two European countries. DESIGN: Nation-wide register-based cohort study using personalized IDs assigned to all citizens for data linkage. SETTING: The Czech Republic (2000-14) and Norway (2004-13). [Correction added after online publication on 26 April 2018: The Czech Republic (2000-04) corrected to (2000-14).] PARTICIPANTS: Opioid-dependent pregnant Czech (n = 333) and Norwegian (n = 235) women in OMT who received either B or M during pregnancy and their newborns. MEASUREMENTS: We linked data from health registries to identify the neonatal outcomes: gestational age, preterm birth, birth weight, length and head circumference, small for gestational age, miscarriages and stillbirth, neonatal abstinence syndrome (NAS) and Apgar score. We performed multivariate linear regression and binary logistic regression to explore the associations between M and B exposure and outcomes. Regression coefficient (β) and odds ratio (OR) were computed. FINDINGS: Most neonatal outcomes were more favourable after exposure to B compared with M, but none of the differences was statistically significant. For instance, in the multivariate analysis, birth weight was β = 111.6 g [95% confidence interval (CI) = -10.5 to 233.6 and β = 83.1 g, 95% CI = -100.8 to 267.0] higher after B exposure in the Czech Republic and Norway, respectively. Adjusted OR of NAS for B compared with M was 0.94 (95% CI = 0.46-1.92) in the Norwegian cohort. CONCLUSIONS: Two national cohorts of women receiving opioid maintenance treatment during pregnancy showed small but not statistically significant differences in neonatal outcomes in favour of buprenorphine compared with methadone.

MeSH
Apgar skóre MeSH
buprenorfin terapeutické užití MeSH
dospělí MeSH
gestační stáří MeSH
hypotrofický novorozenec MeSH
komplikace těhotenství farmakoterapie MeSH
lidé MeSH
lineární modely MeSH
logistické modely MeSH
methadon terapeutické užití MeSH
mladý dospělý MeSH
narození mrtvého plodu epidemiologie MeSH
novorozenec MeSH
novorozenecký abstinenční syndrom epidemiologie MeSH
opiátová substituční terapie metody MeSH
opioidní analgetika terapeutické užití MeSH
poruchy spojené s užíváním opiátů farmakoterapie MeSH
předčasný porod epidemiologie MeSH
registrace MeSH
samovolný potrat epidemiologie MeSH
těhotenství MeSH
výsledek těhotenství epidemiologie MeSH
Check Tag
dospělí MeSH
lidé MeSH
mladý dospělý MeSH
mužské pohlaví MeSH
novorozenec MeSH
těhotenství MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
práce podpořená grantem MeSH
srovnávací studie MeSH
Geografické názvy
Česká republika MeSH
Norsko MeSH

Článek

Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe

Journal of hepatology. 2018 ; 68 (3) : 402-411. [pub] 20180108

J Hepatol
ISSN 1600-0641
Medvik
Zdroj

BACKGROUND & AIMS: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. METHODS: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. RESULTS: At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12-24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5-17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. CONCLUSIONS: The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. LAY SUMMARY: Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment).