| Summary: | 碩士 === 國立成功大學 === 公共衛生研究所 === 101 === Background: Recent years have seen increased concern being given to the life-saving effect of Opioid Substitution Treatment (OST) on heroin abusing population and OST have been implemented in Taiwan since 2006, evidence-base research is helpful for the future direction of OST strategies.
Objective: To investigate the mortality among heroin users and related risk factors. The current study also aims to examine reductions in mortality related to OST.
Material and Methods: A cohort of heroin users (N=1283) who had been evaluated were recruited from 2006-2008. These subjects were followed through December 31, 2011(longest following period: 71 months). We divided the cohort to receiving OST or not (OST group, N=983 and non-OST group, N=300) through the National MMT system. Record linkage performed to identify the death of these patients was managed by computerized files of Death Certification System. Crude mortality rate was calculated according to age, sex, receiving OST or not, period in-or out-of-treatment and medication type. Survival analysis was conducted to compare between heroin users receiving OST or not. The mortality risk among the heroin users after seeking OST was also examined using Cox regression model.
Results: Compared with non-OST group, the characteristics OST group were: older age (37.8±7.7:36.6±11.7, p 〈0.05), lower educational level (two-thirds below junior high school), longer length of heroin use (6.9±4.3:5.7±5.2, p〈0.001), higher proportion of criminal records( illegal drugs offense：91.5%:74.1%,p〈0.001;Property offense：46.5%:26.1%, p〈0.001.), ever needle/syringe sharing (78.3%:40.8%,p〈0.001), IDUs (Injection drug users) (91.0%:84.5%,p=0.0016), HCV-seropositive (91.4%:86.4%,p=0.038) and HIV-seropositive (18.1%:6.3%,p〈0.001).The result of survival analysis showed that the all-cause mortality rate per 1000 person-year among OST group (15.5/1000 py) was lower than non-OST group (23.9/1000 py).After adjustment for significant covariates using the Cox regression model, all-cause mortality rate among OST group still had better survival outcome(Adjusted Harzard Ratio: 0.47; 95% CI: 0.28 – 0.79).However, the mortality rate directly related to suicide among OST group was significantly higher than non-OST group, (3.88/1000 py: 0.7/1000 py, p 〈 0.05). The survival analysis among OST group showed that the all-cause mortality relative risk between out-of-OST and in-OST period was 7.
Conclusions: The all-cause mortality rate among OST group is significantly lower than non-OST group. Among OST group, the survival outcome among in-OST period is better than out-of-OST period. The life-saving effect of enrollment and continued participation in OST still exists under the circumstances that harm reduction strategies in Taiwan is more attractive for HIV carrier and ex-prisoner. However, mortality from suicide among OST group is higher than non-OST. In addition to increasing the availability and access of OST program, suicide prevention program should be given high priority in order to prevent mortality among this high risk population.
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