22 June 2009

Dundee study identifies factors influencing drug-related deaths

* Factors associated with mortality in Scottish patients receiving methadone in primary care: a retrospective cohort study.

Research carried out at the University of Dundee has highlighted the links between drug-related deaths in Tayside and factors such as mental health problems and the method of prescribing methadone.

The results of the study, which assessed predictors of mortality in 2378 patients prescribed methadone in the NHS Tayside area between 1993 and 2004, are published in the British Medical Journal.

The paper showed that 181 (8 per cent) patients died during that period. Strong predictors of death were identified as taking the methadone over a shorter period than the prescribed period, a history of being prescribed benzodiazepines, and a history of psychiatric admission.

The research was carried out using data from the Health Information Centre (HIC) - a unique database which records all medication prescribed by GPs in Tayside. Clinical data is rendered anonymous and linked to other databases that record hospital admission or deaths so it can be used for research purposes.

As a result, Tayside is the only area where such research of this depth can be cross-referenced and used to study such large numbers of patients.

Of those people who commit suicide, 40 per cent have substance abuse problems and the study identifies a need to address issues of access to appropriate mental health care and treatment.

Patients who took their methadone in a shorter period than that stated within the prescription had increased risk while those addicts who were assessed and monitored by doctors through urine testing were less likely to die prematurely.

Subjects who were also prescribed benzodiazepines were found to be at increased risk, which is an important issue for GPs who may prescribe benzodiazepines for a range of complaints.

Many of the factors identified in the study have already been addressed in a review of prescribing policy in Tayside.

Whereas it was previously common for large volumes of the heroin substitute to be prescribed at a time, the vast majority of addicts are now restricted to a daily dose, while around half are subject to supervised dosage.

Dr Brian Kidd, a member of the Dundee team, said the retrospective study backed the approach to prescribing adopted in Tayside, and identified further areas of study vital to cutting the number of drug-related deaths.

He said: 'The findings support local policy such as avoiding benzodiazepine prescribing and add to the understanding of factors affecting premature death in this population. They identify key areas of concern, such as mental health, which must be addressed as part of a joined-up approach to combating drug-related death.'

'When you look at the relationship between mental health, substance abuse and suicide you’re already starting to connect the dots that predict premature death.'

'The findings also identify clinical practice issues which increase risk - and these support the changes which have been made to the Tayside prescribing approach from 2004. They also illustrate the need for more research into the links to other factors such as anxiety, depression, prescription drugs and levels of supervision.'

For media enquiries contact:
Roddy Isles
Head, Press Office
University of Dundee
Nethergate Dundee, DD1 4HN
TEL: 01382 384910
E-MAIL: r.isles@dundee.ac.uk