Health-care resource use among patients who use illicit opioids in England, 2010–20: a descriptive matched cohort study

van Hest, N., Brothers, T. D., Williamson, A. and Lewer, D. (2023) Health-care resource use among patients who use illicit opioids in England, 2010–20: a descriptive matched cohort study. Addiction, (doi: 10.1111/add.16401) (Early Online Publication)

Abstract

Background and aims: People who use illicit opioids have higher mortality and morbidity than the general population. Limited quantitative research has investigated how this population engages with health-care, particularly regarding planned and primary care. We aimed to measure health-care use among patients with a history of illicit opioid use in England across five settings: general practice (GP), hospital outpatient care, emergency departments, emergency hospital admissions and elective hospital admissions. Design: This was a matched cohort study using Clinical Practice Research Datalink and Hospital Episode Statistics. Setting: Primary and secondary care practices in England took part in the study. Participants: A total of 57 421 patients with a history of illicit opioid use were identified by GPs between 2010 and 2020, and 172 263 patients with no recorded history of illicit opioid use matched by age, sex and practice. Measurements: We estimated the rate (events per unit of time) of attendance and used quasi-Poisson regression (unadjusted and adjusted) to estimate rate ratios between groups. We also compared rates of planned and unplanned hospital admissions for diagnoses and calculated excess admissions and rate ratios between groups. Findings: A history of using illicit opioids was associated with higher rates of health-care use in all settings. Rate ratios for those with a history of using illicit opioids relative to those without were 2.38 [95% confidence interval (CI) = 2.36–2.41] for GP; 1.99 (95% CI = 1.94–2.03) for hospital outpatient visits; 2.80 (95% CI = 2.73–2.87) for emergency department visits; 4.98 (95% CI = 4.82–5.14) for emergency hospital admissions; and 1.76 (95% CI = 1.60–1.94) for elective hospital admissions. For emergency hospital admissions, diagnoses with the most excess admissions were drug-related and respiratory conditions, and those with the highest rate ratios were personality and behaviour (25.5, 95% CI = 23.5–27.6), drug-related (21.2, 95% CI = 20.1–21.6) and chronic obstructive pulmonary disease (19.4, 95% CI = 18.7–20.2). Conclusions: Patients who use illicit opioids in England appear to access health services more often than people of the same age and sex who do not use illicit opioids among a wide range of health-care settings. The difference is especially large for emergency care, which probably reflects both episodic illness and decompensation of long-term conditions.

• Item Type: Articles
• Additional Information: D.L. was funded by the National Institute for Health and Care Research (NIHR; DRF-2018-11-ST2-016). This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the UK Department of Health and Social Care. T.D.B. is supported by a Dalhousie University Internal Medicine Research Foundation Fellowship, a Canadian Institutes of Health Research Fellowship (CIHR-FRN# 171259) and through the Research in Addiction Medicine Scholars (RAMS) Program (National Institutes of Health/National Institute on Drug Abuse; R25DA033211).
• Keywords: Crack cocaine, general practice, health-care use, heroin, secondary care, substance-related disorders.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Williamson, Professor Andrea

Creator Roles

Williamson, A.: Methodology, Validation, Writing – original draft, Writing – review and editing

• Authors: van Hest, N., Brothers, T. D., Williamson, A., and Lewer, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Journal Name: Addiction
• Publisher: Wiley
• ISSN: 0965-2140
• ISSN (Online): 1360-0443
• Published Online: 04 December 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Addiction 2023
• Publisher Policy: Reproduced under a Creative Commons License