Estudio de seguimiento de 35 años de pacientes admitidos a tratamiento con metadona entre 1982-1984 en Asturias, España

Luis Jiménez-Treviño, Clara Martínez-Cao, Fernando Sánchez-Lasheras, Celso Iglesias, María Jesús Antuña, Leonor Riera, Pilar Alejandra Sáiz-Martínez, Julio Bobes

Resumen


El objetivo fue evaluar el estado de una población dependiente a la heroína 35 años después de su primera inscripción en un tratamiento de mantenimiento con metadona (TMM). Se utilizó un protocolo ad hoc para evaluar morbilidad, consumo y tratamiento de la adicción en la muestra de supervivientes. Se calculó la razón de mortalidad estandarizada (RME) con un intervalo de confianza (IC) del 95%. Un total de 214 pacientes ingresaron en TMM entre 1982 y 1984 en el Servicio de Salud Pública de Asturias. Se recibió información sobre 195 sujetos, de los cuales 146 habían fallecido. Los hombres representaron el 77,5% de la cohorte del estudio. Durante el período de seguimiento de 35 años, la RME fue de 11,75 (IC 95% = 9,95 – 13,77). En la muestra de supervivientes, el 5,7% todavía estaba inscrito en TMM; el virus de inmunodeficiencia humana (VIH) se diagnosticó en un 38,77% y la hepatitis B/C en un 73,46%; el consumo actual de heroína se informó en un 4,1%. No hubo diferencias de género en la mortalidad o la condición de VIH y hepatitis B/C. Ninguna de las mujeres consumía heroína en el seguimiento de 35 años en comparación con el 5,26% de los hombres. En conclusión, nuestro estudio confirma la alta tasa de mortalidad a largo plazo, incluso después de la inscripción en TMM.

 

Palabras clave


Mortalidad; adicción a la heroína; tratamiento de mantenimiento con metadona; seguimiento.

Texto completo:

.PDF .PDF (English)

Referencias


Adelson, M., Wilson, H. W., Celeste, V. Y. M., Linzy, S., Kreek, M. J. y Peles, E. (2013). Methadone maintenance treatment experience in Macao–prospective follow-up for initial 4.5 years. Journal of Psychoactive Drugs, 45, 313-321. doi:10.1080/02791072.2013.825032.

Bauer, S. M., Loipl, R., Jagsch, R., Gruber, D., Risser, D., Thau, K.,… Fischer, G. (2008). Mortality in opioid-maintained patients after release from an addiction clinic. European Addiction Research, 14, 82–91. doi:10.1159/000113722.

Berenguer, J. (2018). Elimination of Hepatitis C Virus in Spain: A pending challenge. Enfermedades Infecciosas y Microbiología Clínica, 36, 323-324. doi:10.1016/j.eimc.2018.03.001.

Buti, M., Calleja, J. L., García-Samaniego, J., Serra, M. Á., Crespo, J., Romero, M.,… Razavi, H. (2017). Elimination of hepatitis C in Spain: Adaptation of a mathematical model based on the public health strategic plan for addressing hepatitis C in the National Health System. Medicina Clínica, 148, 277–282. doi:10.1016/j.medcli.2016.12.018.

Clausen, T., Anchersen, K. y Waal, H. (2008). Mortality prior to, during and after opioid maintenance treatment (OMT): A national prospective cross-registry study. Drug and Alcohol Dependence, 94, 151-157. doi:10.1016/j.drugalcdep.2007.11.003.

Cousins, G., Boland, F., Courtney, B., Barry, J., Lyons, S. y Fahey, T. (2016). Risk of mortality on and off methadone substitution treatment in primary care: A national cohort study. Addiction, 111, 73-82. doi:10.1111/add.13087.

Cowie, M. R., Blomster, J. I., Curtis, L. H., Duclaux, S., Ford, I., Fritz, F.,… Zalewski, A. (2017). Electronic health records to facilitate clinical research. Clinical Research in Cardiology: Official Journal of the German Cardiac Society, 106, 1–9. doi:10.1007/s00392-016-1025-6.

Darke, S., Mills, K. L., Ross, J. y Teesson, M. (2011). Rates and correlates of mortality amongst heroin users: Findings from the Australian treatment outcome study (ATOS), 2001–2009. Drug and Alcohol Dependence, 115, 190-195. doi:10.1016/j.drugalcdep.2010.10.021.

Davstad, I., Stenbacka, M., Leifman, A. y Romelsjö, A. (2009). An 18-year follow-up of patients admitted to methadone treatment for the first time. Journal of Addictive Diseases, 28, 39–52. doi:10.1080/10550880802544997.

Degenhardt, L., Bucello, C., Mathers, B., Briegleb, C., Ali, H., Hickman, M. y McLaren, J. (2011). Mortality among regular or dependent users of heroin and other opioids: A systematic review and meta-analysis of cohort studies. Addiction, 106, 32-51. doi:10.1111/j.1360-0443.2010.03140.x.

Dole, V.P. (2008). Implications of methadone maintenance for theories of narcotic addiction. Journal of the American Medical Association, 260, 3025-3029.

Dole, V.P., Nyswander, M.E. y Kreek, M.J. (1966). Narcotic blockade. Archives of Internal Medicine, 118, 304-309.

Dunn, K.E., Finan, P.H., Tompkins, D. A. y Strain, E.C. (2018). Frequency and correlates of sleep disturbance in methadone and buprenorphine-maintained patients. Addictive Behaviors, 76, 8-14. doi:10.1016/j.addbeh.2017.07.016.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2019). EMCDDA—Information on drugs and drug addiction in Europe. Recuperado de http://www.emcdda.europa.eu/.

Esteban, J., Gimeno, C., Barril, J., Aragonés, A., Climent, J. M. y de la Cruz Pellín, M. (2003). Survival study of opioid addicts in relation to its adherence to methadone maintenance treatment. Drug and Alcohol Dependence, 70, 193-200. doi:10.1016/s0376-8716(03)00002-4.

Evans, E., Li, L., Min, J., Huang, D., Urada, D., Liu, L.,… Nosyk, B. (2015). Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006–10. Addiction, 110, 996-1005. doi:10.1111/add.12863.

Finkelstein, D. M., Muzikansky, A. y Schoenfeld, D. A. (2003). Comparing survival of a sample to that of a standard population. Journal of the National Cancer Institute, 95, 1434–1439. doi:10.1093/jnci/djg052.

Fridell, M., Bäckström, M., Hesse, M., Krantz, P., Perrin, S. y Nyhlén, A. (2019). Prediction of psychiatric comorbidity on premature death in a cohort of patients with substance use disorders: A 42-year follow-up. BMC Psychiatry, 19, 150. doi:10.1186/s12888-019-2098-3.

Haastrup, S. y Jepsen, P.W. (1988). Eleven-year follow-up of 300 young opioid addicts. Acta Psychiatrica Scandinavica, 77, 22-26. doi:10.1111/j.1600-0447.1988.tb05071.x.

Hall, W., Lynskey, M. y Degenhardt, L. (2002). Trends in opiate-related deaths in the United Kingdom and Australia, 1985–1995. Drug and Alcohol Dependence, 57, 247–254. doi:10.1016/s0376-8716(99)00057-5.

Hernando, V., Perez-Cachafeiro, S., Lewden, C., Gonzalez, J., Segura, F., Oteo, J. A.,… CoRIS. (2012). All-cause and liver-related mortality in HIV positive subjects compared to the general population: Differences by HCV co-infection. Journal of Hepatology, 57, 743–751. doi:10.1016/j.jhep.2012.06.010.

Holland, R., Maskrey, V., Swift, L., Notley, C., Robinson, A., Nagar, J.,… Kouimtsidis. (2013). Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment. Results from the super C randomized controlled trial. Addiction, 109, 596-607. doi:10.1111/add.12439.

Hser, Y. I., Evans, E., Grella, C., Ling, W. y Anglin, D. (2015). Long-term course of opioid addiction. Harvard Review of Psychiatry, 23, 76-89. doi:10.1097/HRP.0000000000000052.

Hser, Y.I., Hoffman, V., Grella, C.E. y Anglin, M.D. (2001). A 33-year follow-up of narcotics addicts. Archives of General Psychiatry, 58, 503–508. doi:10.1001/archpsyc.58.5.503.

Instituto Nacional de Estadística. (2018). Defunciones según causa de muerte. Año 2018. Recuperado de https://www.ine.es/dyngs/INEbase/es/operacion.htm?c= Estadistica_C&cid=1254736176780&menu=ultiDatos&idp=1254735573175.

Jimenez, L., Saiz, P. A., Gutierrez, E., Bascaran, M. T., Carreño, E. y González-Quiros, M. (2000). Valoración transversal tras quince años en una muestra de adictos a opiáceos en Asturias. Adicciones, 12, 507–513.

Jimenez-Treviño, L., Saiz, P. A., García-Portilla, M. P., Díaz-Mesa, E. M., Sánchez-Lasheras, F., Burón, P.,… Bobes, J. (2011). A 25-year follow-up of patients admitted to methadone treatment for the first time: Mortality and gender differences. Addictive Behaviors, 36, 1184-1190. doi:10.1016/j.addbeh.2011.07.019.

Kleber, H. D. (2008). Methadone maintenance 4 decades later: Thousands of lives saved but still controversial. Journal of the American Medical Association, 300, 2303–2305. doi:10.1001/jama.2008.648.

Levine, O.S., Vlahov, O., Koehler, J., Cohn, S., Spronk, A.M. y Nelson, K.E. (1995). Seroepidemiology of hepatitis B virus in a population of injecting drug users. Association with drug injection patterns. American Journal of Epidemiology, 142, 331-341. doi:10.1093/oxfordjournals.aje.a117639.

Lin, C., Wu, Z. y Detels, R. (2011). Opiate users’ perceived barriers against attending methadone maintenance therapy: A qualitative study in china. Substance Use and Misuse, 46, 1190–1198. doi:10.3109/10826084.2011.561905. 

Maremmani, A. G., Pallucchini, A., Rovai, L., Bacciardi, S., Spera, V., Maiello, M.,... Maremmani, I. (2018). The long-term outcome of patients with heroin use disorder/dual disorder (chronic psychosis) after admission to enhanced methadone maintenance. Annals of General Psychiatry, 17, 14. doi:10.1186/s12991-018-0185-3.

Marotta, P. L. y McCullagh, C. A. (2017). A cross-national analysis of the association between years of implementation of opioid substitution treatments and drug-related deaths in Europe from 1995 to 2013. European Journal of Epidemiology, 33, 679-688. doi:10.1007/s10654-017-0342-z.

Mattick, R.P., Breen, C., Kimber, J. y Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews, 3, 1-32. doi:10.1002/14651858.CD002209.pub2.

Motta-Ochoa, R., Bertrand, K., Arruda, N., Jutras-Aswad, D. y Roy, E. (2017). “I love having benzos after my coke shot”: The use of psychotropic medication among cocaine users in downtown Montreal. International Journal of Drug Policy, 49, 15–23. doi:10.1016/j.drugpo.2017.07.012.

Nehkant, H., Rathod, W., Addenbrooke, M. y Rosenbach, A.F. (2005). Heroin dependence in an English town: 33-year follow-up. British Journal of Psychiatry, 18, 421-425. doi:10.1192/bjp.187.5.421.

Nordmann, S., Lions, C., Vilotitch, A., Michel, L., Mora, M., Spire, B.,… ANRS Methaville study group. (2016). A prospective, longitudinal study of sleep disturbance and comorbidity in opiate dependence (the ANRS Methaville study). Psychopharmacology, 233, 1203-1213. doi:10.1007/s00213-016-4202-4.

Nosyk, B., Min, J. E., Evans, E., Li, L., Liu, L., Lima, V. D.,… Montaner, J.S.G. (2015). The effects of opioid substitution treatment and highly active antiretroviral therapy on the cause-specific risk of mortality among HIV-positive people who inject drugs. Clinical Infectious Diseases, 61, 1157-1165. doi:10.1093/cid/civ476.

Novick, D. M., Richman, B. L., Friedman, J. M., Friedman, J. E., Fried, C., Wilson, J. P.,… Kreek, M.J. (1993). The medical status of methadone maintenance patients in treatment for 11–18 years. Drug and Alcohol Dependence, 33, 235-245. doi:10.1016/0376-8716(93)90110-c.

Nyhlén, A., Fridell, M., Bäckström, M., Hesse, M. y Krantz, P. (2011). Substance abuse and psychiatric co-morbidity as predictors of premature mortality in Swedish drug abusers: A prospective longitudinal study 1970-2006. BMC Psychiatry, 11, 122. doi:10.1186/1471-244X-11-122.

Oppenheimer, E., Tobutt, C., Taylor, C. y Andrew, T. (1994). Death and survival in a cohort of heroin addicts from London clinics: A 22-year follow-up study. Addiction, 89, 1299–1308. doi:10.1111/j.1360-0443.1994.tb03309.x.

Potik, D., Abramsohn, Y., Schreiber, S., Adelson, M. y Peles, E. (2020). Drug abuse and behavioral transgressions during methadone maintenance treatment (MMT) are related to high psychopathy levels. Substance Use & Misuse, 55, 460-468. doi:10.1080/10826084.2019.1685546.

R Core Team (2019). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Recuperado de https://www.R-project.org/.

Randesi, M., Van den Brink, W., Levran, O., Blanken, P., Butelman, E. R., Yuferov, V.,… Kreek, M.J. (2016). Variants of opioid system genes are associated with non-dependent opioid use and heroin dependence. Drug and Alcohol Dependence, 168, 164-169. doi:10.1016/j.drugalcdep.2016.08.634.

Ravndal, E. y Vaglum, P. (1998). Psychopathology, treatment completion and 5 years outcome. A prospective study of drug abusers. Journal of Substance Abuse Treatment, 15, 135–142.

Rehm, J., Frick, U., Hartwig, C., Gutzwiller, F., Gschwend, P. y Uchtenhagen, A. (2005). Mortality in heroin-assisted treatment in Switzerland 1994-2000. Drug and Alcohol Dependence, 79, 137–143. doi:10.1016/j.drugalcdep.2005.01.005.

Russolillo, A., Moniruzzaman, A. y Somers, J. M. (2018). Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada. PLoS Medicine, 15. doi:10.1371/journal.pmed.1002625.

Sammet, J.H., Walley, A.Y. y Bridden, C. (2007). Illicit drugs, alcohol, and addiction in human immunodeficiency virus. Panminerva Medica, 49, 67-77.

Sánchez-Carbonell, X. y Seus, L. (2000). Ten-year survival analysis of a cohort of heroin addicts in Catalonia: The EMETYST project. Addiction, 95, 941–948. doi:10.1046/j.1360-0443.2000.95694110.x.

Segest, E., Mygind, O. y Bay, H. (1990). The influence of prolonged stable methadone maintenance treatment on mortality and employment: An 8-year follow-up. International Journal of the Addictions, 25, 53–63.

Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L.,... Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. British Medical Journal, 357, 1550. doi:10.1136/bmj.j1550.

Soyka, M., Strehle, J., Rehm, J., Bühringer, G. y Wittchen, H. U. (2017). Six-year outcome of opioid maintenance treatment in heroin-dependent patients: Results from a naturalistic study in a nationally representative sample. European Addiction Research, 23, 97-105. doi:10.1159/000468518.

Stenbacka, M., Leifman, A. y Romelsjö, A. (2010). Mortality and cause of death among 1705 illicit drug users: A 37 year follow up. Drug and Alcohol Review, 29, 21-27. doi:10.1111/j.1465-3362.2009.00075.x.

Sutlovic, D., Kljucevic, Z., Sliskovic, L., Susnjar, H., Viskovic, I. y Definis-Gojanovic, M. (2018). Methadone maintenance treatment: A 15-year retrospective study in Split-Dalmatia County, Croatia. Therapeutic Drug Monitoring, 40, 486-494. doi:10.1097/FTD.0000000000000519.

Wang, K., Fu, H., Longfield, K., Modi, S., Mundy, G. y Firestone, R. (2014). Do community- based strategies reduce HIV risk among people who inject drugs in China? A quasi-experimental study in Yunnan and Guangxi provinces. Harm Reduction Journal, 6, 11-15. doi:10.1186/1477-7517-11-15.

Ward, J., Hall, W. y Mattick, R.P. (1999). Role of maintenance treatment in opioid dependence. Lancet, 353, 221–226. doi:10.1016/S0140-6736(98)05356-2.

Zhou, K. y Zhuang, G. (2014). Retention in methadone maintenance treatment in mainland China, 2004–2012: A literature review. Addictive Behaviors, 39, 22-29. doi:10.1016/j.addbeh.2013.09.001.




DOI: https://doi.org/10.20882/adicciones.1662

Enlaces refback

  • No hay ningún enlace refback.