Professor Matt Hickman
Matt Hickman is Head of Population Health Sciences and Deputy Head of Bristol Medical School, Professor in Public Health and Epidemiology at Bristol, NIHR Senior Investigator, and Honorary Public Health Consultant at Bristol City Council and Public Health England. He is the director of National Institute Health Research (NIHR) Health Protection Research Unit on Evaluation of Interventions, and member of NIHR School of Public Health Research. He is deputy regional editor of Addiction, and a member of the Scientific Committee of European Monitoring Centre on Drugs and Drug Addiction (EMCDDA), WHO Technical Advisory Group on alcohol and drug epidemiology, and International Network on Hepatitis Care for Substance Users (INHSU).
Opioid Agonist Treatment (OAT) and prevention of drug related deaths and overdose mortality
In UK we have called the increase drug related poisonings (DRP) to the highest ever recorded a public health crisis. Recent UK evidence from cohort studies show that (a) opioid dependent patients are at excess risk of mortality from all major causes of death; (b) mortality risk varies at different periods on and off OAT – especially at the very beginning and end of treatment; (c) prison OAT could reduce premature mortality in the period immediately following prison release by 75% (d) patients prescribed buprenorphine have a lower risk of DRP death during treatment but overall shorter duration of treatment compared to patients on methadone; (e) there may be interactions between morbidity, DRP risk and type of OAT; (f) co-prescription of benzodiazepines in opioid dependent patients increases risk of OAT irrespective of positive association with OAT duration.
Global evidence shows also that opioid dependent patients have a substantially higher risk of premature mortality than general population – with pooled mortality risk across multiple cohorts of 1.7 per 100 person years approximately 10 times higher than general population. But there is also evidence of substantial heterogeneity with mortality risk varying from 0.8 per 100 person years in Australia to 7.6 per 100 person years in South Asia. Model projections suggest that scaling up OAT, prolonging duration of OAT in the community and providing OAT in prison, could substantially reduce DRP in multiple sites (e.g. Kentucky, Tehran and Kiev).
An increase in the number of opioid-related overdose deaths could signify a commensurate increase in the underlying population of opioid users; an increase in mortality risk due to changes in drug use patterns, drug user characteristics or risk environment; an increase in mortality risk due to changes in treatment and other intervention delivery and coverage; or an interplay of multiple factors. The UK is uniquely placed to determine what is driving the increase in DRP and re-design drug treatment services and other interventions. But this would require recognition that our current policies and strategies are failing.
NIHR Health Protection Research Unit (HPRU) in Evaluation
NIHR HS&DR Project: 12/136/105 – Evaluating the impact of opiate substitution treatment on drug related deaths in the population: a natural experiment using primary care, other drug treatment databases & model projections. ISAC CPRD Protocol 14_073R2.
NIHR School of Public Health Research
NIHR BRC at Bristol
The funder had no role in study design, data collection, the analysis and interpretation, or the writing of this report. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.