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Glancy M, Yeung A, McAuley A, Palmateer N, Bishop J, Taylor B, Lang J, Barnsdale L, Priyadarshi S, Hutchinson S. Factors associated with SARS-CoV-2 testing, diagnosis and COVID-19 disease among individuals prescribed opioid-agonist treatment: a nationwide retrospective cohort study. Clin Microbiol Infect 2024:S1198-743X(24)00299-4. [PMID: 38936544 DOI: 10.1016/j.cmi.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 06/03/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Among people receiving opioid-agonist treatment (OAT), the risk of COVID-19 infection and disease may be higher owing to underlying health problems and vulnerable social circumstances. We aimed to determine whether recent OAT, when compared with past exposure, affected the risk of (i) testing for SARS-CoV-2, (ii) testing positive for SARS-CoV-2, and (iii) being hospitalized or dying with COVID-19 disease. METHODS We included individuals prescribed OAT in Scotland from 2015 to 2020. We performed record linkage to SARS-CoV-2 PCR testing, vaccination, hospitalization, and mortality data, and followed up from March 2020 to December 2021. We used proportional hazards analysis and multivariate logistic regression to estimate associations between recent OAT prescription (in the previous 2 months), compared with past exposure (off treatment for over a year), and COVID-19 outcomes. Models were adjusted for confounders. RESULTS Among 36 093 individuals prescribed OAT, 19 071 (52.9%) were tested for SARS-CoV-2; 2896 (8.3%) tested positive; and 552 (1.5%) were hospitalized or died with COVID-19. Recent OAT, compared with past exposure, was associated with lower odds of testing positive among those tested (aOR, 0.63; 95% CI, 0.57-0.69). However, among those testing positive, recent OAT was associated with two-fold higher odds of hospitalization or death (aOR, 2.04; 95% CI, 1.60-2.59). DISCUSSION We found that recent OAT was associated with lower odds of SARS-CoV-2 infection, but with higher odds of disease once diagnosed. Clinical studies are needed to unravel the role of OAT in these associations. An enhanced effort is warranted to increase vaccine coverage among OAT patients to mitigate the severe consequences of COVID-19.
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Affiliation(s)
- Megan Glancy
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK.
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | | | | | | | | | - Saket Priyadarshi
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Glasgow Alcohol and Drug Recovery Services, Glasgow, UK
| | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
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Bird SM. Opioid-related deaths and their counterpart by occurrence era, age group and coimplicated drugs: Scotland vs. England and Wales. Br J Clin Pharmacol 2023. [PMID: 38009544 DOI: 10.1111/bcp.15976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
AIMS Compare by occurrence era and age group how opioid-related deaths (ORDs) and their counterpart evolved in Scotland vs. England and Wales during 2006-2020. For Scotland, compare coimplication rates between ORDs and non-ORDs for any benzodiazepine, cocaine or gabapentin/pregabalin, and consider whether coimplication in ORDs depended on opioid-specificity. METHODS Cross-tabulations of drug misuse deaths (DMDs) obtained by 3 yearly occurrence era (2006-2008 to 2018-2020) and age group (under 25, 25-34, 35-44, 45-54, 55+ years) for England and Wales and subdivided by whether at least 1 opiate was mentioned on death certificate (DMD-Os or not); and of Scotland's opioid-related deaths (ORDs vs. non-ORDs) together with (i) coimplication by any benzodiazepine, cocaine or gabapentin/pregabalin; and (ii) opioid-specificity of ORDs. ORD is defined by heroin/morphine, methadone or buprenorphine being implicated in DMD. RESULTS Per era between 2012-2014 and 2018-2020, Scotland's ORDs increased by 54% and non-ORDs by 34%. Increase in DMD-Os in England and Wales was more modest. Cocaine was implicated in 83% of Scotland's 2690 non-ORDs during 2006-2020; and any benzodiazepine in 53% of 8409 ORDs. However, in 2018-2020, coimplication rates in 2926 ORDs (880 non-ORDs) were 81% (33%) for any benzodiazepine, 30% (74%) for cocaine and 38% (22%) for gabapentin/pregabalin. Coimplication rate in 2018-2020 for any benzodiazepine was lowest at 70% (616/877) for heroin/morphine ORDs; and, by age group, at 66% (160/241) for ORDs aged 55+ years. CONCLUSIONS Drug testing to inform users, shared intelligence between police and public health for earlier detection of changes in supply and monitoring of prescribed daily-dose of methadone are urgent.
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McAuley A, Fraser R, Glancy M, Yeung A, Jones HE, Vickerman P, Fraser H, Allen L, McDonald SA, Stone J, Liddell D, Barnsdale L, Priyadarshi S, Markoulidakis A, Hickman M, Hutchinson SJ. Mortality among individuals prescribed opioid-agonist therapy in Scotland, UK, 2011-20: a national retrospective cohort study. Lancet Public Health 2023; 8:e484-e493. [PMID: 37295452 DOI: 10.1016/s2468-2667(23)00082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/31/2023] [Accepted: 04/14/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Drug-related death (DRD) rate in Scotland, UK, has increased rapidly to one of the highest in the world. Our aim was to examine the extent to which opioid-agonist therapy (OAT) in Scotland is protective against drug-related mortality and how this effect has varied over time. METHODS We included individuals in Scotland with opioid use disorder who received at least one OAT prescription between Jan 1, 2011, and Dec 31, 2020. We calculated drug-related mortality rates and used Quasi-Poisson regression models to estimate trends over time and by OAT exposure, adjusting for potential confounding. FINDINGS In a cohort of 46 453 individuals prescribed OAT with a total of 304 000 person-years of follow-up, DRD rates more than trebled from 6·36 per 1000 person-years (95% CI 5·73-7·01) in 2011-12 to 21·45 (20·31-22·63) in 2019-20. DRD rates were almost three and a half times higher (hazard ratio 3·37; 95% CI 1·74-6·53) for those off OAT compared with those on OAT after adjustment for confounders. However, confounder adjusted DRD risk increased over time for both people off and on OAT. INTERPRETATION Drug-related mortality rates among people with opioid use disorders in Scotland increased between 2011 and 2020. OAT remains protective but is insufficient on its own to slow the increase in DRD risk for people who are opioid dependent in Scotland. FUNDING Scottish Government Drug Deaths Taskforce, Public Health Scotland, and National Institute for Health and Care Research.
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Affiliation(s)
- Andrew McAuley
- School of Health and Life Sciences, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Edinburgh, UK.
| | - Rosalyn Fraser
- School of Health and Life Sciences, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Edinburgh, UK
| | - Megan Glancy
- School of Health and Life Sciences, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Edinburgh, UK
| | - Alan Yeung
- School of Health and Life Sciences, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Edinburgh, UK
| | - Hayley E Jones
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Hannah Fraser
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Lara Allen
- Public Health Scotland, Edinburgh, UK; Bristol Medical School, University of Bristol, Bristol, UK
| | - Scott A McDonald
- School of Health and Life Sciences, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Edinburgh, UK
| | - Jack Stone
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Saket Priyadarshi
- School of Health and Life Sciences, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK; Glasgow Alcohol and Drug Recovery Services, Glasgow, UK
| | - Andreas Markoulidakis
- Public Health Scotland, Edinburgh, UK; Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Edinburgh, UK
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Bird SM. Study-design in pandemics: From surveillance and performance-evaluation to licensing and pharmacovigilance. Pharm Stat 2022; 21:764-777. [PMID: 35819118 PMCID: PMC9544724 DOI: 10.1002/pst.2217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/10/2022]
Abstract
Andy Grieve, the first pharmaceutical statistician to be President of the Royal Statistical Society, practiced in the regulated world of drug development. With reduction in drug development costs as his motivation, Grieve advanced Bayesian methods for developing predictive methods for efficacy and toxicity - to be used as early as possible in the drug development process; and his presidential address exhorted statisticians to weigh-in wherever data are used to make decisions. Diagnostic tests for infectious diseases are less regulated than drugs and vaccines unless the blood supply is at risk. Unlike in the HIV and HCV pandemics of the late 20th century, even well-designed surveys linked to a volunteered biological sample (to be tested for SARS-CoV-2 antigen or antibodies) have had modest or low consent rates. Record-linkage, statistical design and reporting standards have seen triumph and tragedy. Among the triumphs are: Liverpool's insistence on dual testing (lateral flow device; polymerase chain reaction [PCR]) of some 6000 asymptomatic citizens who attended for SARS-CoV-2-screening; two tricky randomized controlled public-policy trials on daily contact testing for close contacts of index cases of SARS-CoV-2 infection versus self-isolation (with or without initial PCR); and among already-consented participants in surveillance, over 80% secondary consent for linkage to their health records, including the Immunization Management Service. Before the next pandemic we need to entrench better regulation of diagnostic tests, better informed consent (not via weblinks), better feedback to participants, and transparency about basic safety data.
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Affiliation(s)
- Sheila M Bird
- MRC Biostatistics Unit, Cambridge, UK.,College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Fonville L, Paterson L, Herlinger K, Hayes A, Hill R, Nutt D, Lingford-Hughes A. Functional evaluation of NK 1 antagonism on cue reactivity in opiate dependence; An fMRI study. Drug Alcohol Depend 2021; 221:108564. [PMID: 33548897 PMCID: PMC8047866 DOI: 10.1016/j.drugalcdep.2021.108564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 10/26/2022]
Abstract
BACKGROUND Opiate addiction is a major health challenge with substantial societal cost. Though harm minimisation strategies have been effective, there is a growing need for new treatments for detoxification and relapse prevention. Preclinical research has found neurokinin 1 (NK1) receptors have prominent effects on opiate reward and reinforcement, and human studies have found NK1 antagonism led to reductions in craving and withdrawal. However, its effect on brain mechanisms in opiate addiction has not yet been examined. METHODS This study aims to assess the impact of NK1 antagonist aprepitant on heroin cue-elicited changes in blood-oxygenation level dependent (BOLD) signal in opiate dependent individuals undergoing detoxification. Participants will attend two scanning sessions and receive a single dose of aprepitant (320 mg) and a placebo in a randomised, cross-over design. During functional magnetic resonance imaging participants will undergo two runs of a cue reactivity task, which consists of passive viewing of drug cues or neutral cues in a block design fashion. We hypothesise that NK1 antagonism will attenuate the BOLD response to drug cues in the caudate nucleus and amygdala. Regions of interest were selected based on NK1 receptor density and their role in cue reactivity and craving.
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Affiliation(s)
- Leon Fonville
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, United Kingdom.
| | - Louise Paterson
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Katherine Herlinger
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Alexandra Hayes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Raymond Hill
- Department of Metabolism, Digestion and Reproduction, Imperial College London, United Kingdom
| | - David Nutt
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, United Kingdom
| | - Anne Lingford-Hughes
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, United Kingdom
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