Healthcare Contacts Regarding Circulatory Conditions among Swedish Patients in Opioid Substitution Treatment, with and without On-Site Primary Healthcare.

Eric Bäckström,Katja Troberg,Anders Håkansson,Disa Dahlman

doi:10.3390/ijerph18094614

Abstract

Patients in Opioid Substitution Treatment (OST) have increased mortality and morbidity, with circulatory conditions suggested to be a contributing factor. Since OST patients tend to have unmet physical healthcare needs, a small-scale intervention providing on-site primary healthcare (PHC) in OST clinics was implemented in Malmö, Sweden in 2016. In this study, we assessed registered circulatory conditions and healthcare utilization in OST patients with and without use of on-site PHC. Patients from four OST clinics in Malmö, Sweden, were recruited to a survey study in 2017–2018. Medical records for the participants were retrieved for one year prior to study participation (n = 192), and examined for circulatory diagnoses, examinations and follow-ups. Patients with and without on-site PHC were compared through descriptive statistics and univariate analyses. Eighteen percent (n = 34) of the sample had 1≤ registered circulatory condition, and 6% (n = 12) attended any clinical physiology examination or follow-up, respectively. Among patients utilizing on-site PHC (n = 26), the numbers were 27% (n = 7) for circulatory diagnosis, 15% (n = 4) for examinations, and 12% (n = 3) for follow-up. OST patients seem underdiagnosed in regard to their circulatory health. On-site PHC might be a way to diagnose and treat circulatory conditions among OST patients, although further research is needed.

Highlights

People with opioid dependence have increased mortality compared to the general population, with contributing causes including overdosing, suicide and chronic diseases [1,2]
While opioid substitution treatment (OST) with buprenorphine or methadone effectively decreases mortality [3,4], both drug-related and non-drug-related deaths are over-represented among OST patients compared to the general population [5,6]
Other lifestyle factors known to increase the risk of circulatory disease are common among patients in OST according to previous research, such as overweight [39,40] and prior or current use of other substances such as alcohol [41] and stimulants [42]

Summary

Introduction

People with opioid dependence have increased mortality compared to the general population, with contributing causes including overdosing, suicide and chronic diseases [1,2]. While opioid substitution treatment (OST) with buprenorphine or methadone effectively decreases mortality [3,4], both drug-related and non-drug-related deaths are over-represented among OST patients compared to the general population [5,6]. Suggested reasons for the increased mortality have been circulatory diseases in combination with potent substitution medication, especially among patients older than 55 years [5]. In a Scottish, longitudinal study, Gao et al [5] conclude that “Circulatory disease is the co-morbidity most likely implicated in the quadrupling of methadone-specific DRD-risk [DRD = drug related death]. One study associated consumption of opium via smoking and oral intake with increased severity of

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