Abstract
BackgroundOpioid dependence carries the highest disease burden of all illicit drugs. Opioid agonist therapy (OAT) is an evidence-based medical intervention that reduces morbidity and mortality. There is limited knowledge on the health-related quality of life (HRQoL) of long-term patients in OAT. This study measures HRQoL and self-perceived health of long-term patients on OAT, compares the scores to a Norwegian reference population, and assesses changes in these scores at 1-year follow up.MethodsWe conducted a nested prospective cohort study among nine OAT outpatient clinics in Norway. 609 OAT patients were included, 245 (40%) followed-up one year later. Data on patient characteristics, HRQoL, and self-perceived health was collected. HRQoL was assessed with the EQ-5D-5L, which measures five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) on a five-point Likert scale (from “no problems” to “extreme problems”). An UK value set was applied to calculate index values (from 0 to 1) for the EQ-5D-5L and compare them to a Norwegian reference population. Self-perceived health was measured with EQ-VAS (from 0 to 100).ResultsMean (standard deviation (SD)) EQ-5D-5L index value at baseline was 0.699 (0.250) and EQ-VAS 57 (22) compared to 0.848 (0.200) and 80(19) for the Norwegian reference population. There were large variations in EQ-5D-5L index values, where 43% had > 0.8 and 5% had < 0.2 at baseline. The lowest EQ-5D-5L index values were observed for female patients, age groups older than 40 years and for methadone users. At follow-up, improvements in HRQoL were observed across almost all dimensions and found significant for mobility and pain/discomfort. Mean (SD) overall index value and EQ-VAS at follow up were 0.729 (0.237) and 59 (22) respectively.ConclusionThe average HRQoL and self-perceived health of OAT patients is significantly lower than that of the general population, and lower than what has been found among other severe somatic and psychiatric conditions. Around 34% had very good HRQoL, higher than average Norwegian values, and around 5% had extremely poor HRQoL.
Highlights
Opioid dependence carries the highest disease burden of all illicit drugs
The average health-related quality of life (HRQoL) and self-perceived health of Opioid agonist therapy (OAT) patients is significantly lower than that of the general population, and lower than what has been found among other severe somatic and psychiatric conditions
We found considerably lower HRQoL among long-term OAT patients in average compared to the general Norwegian reference population
Summary
Opioid dependence carries the highest disease burden of all illicit drugs. Opioid agonist therapy (OAT) is an evidence-based medical intervention that reduces morbidity and mortality. People with opioid use disorders suffer from a shorter life-span as compared to the general population, and severe social marginalization and long-term impairments in most aspects of their lives [6]. Research consistently shows that people with opioid use disorders have inferior quality of life (QoL) compared to the general population [7, 8]. This is partly explained by the extensive co-occurrence of substance use disorder and mental disorders, which both seem underdiagnosed and undertreated [9], in addition to high prevalence of somatic disorders such as chronic hepatitis C of almost 50% [10].
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