Drug and alcohol dependence · 2026
Treatment uptake and post-discharge mortality after a policy change enabling opioid agonist therapy during compulsory care.
СтатьяНазвание и аннотация: Перевод в очереди
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Ledberg Anders, Liu Can
Аннотация
BACKGROUND: In Sweden, individuals with severe substance use disorder may be committed to compulsory care under the Care of Abusers Act (LVM). Mortality after discharge from LVM is high, particularly from opioid-related causes. Until February 2016, participation in opioid agonist therapy (LARO) was prohibited during LVM care despite national treatment guidelines. A regulatory change on 15 February 2016 allowed initiation and continuation of LARO during compulsory care. This study aimed to assess the impact of that reform on LARO uptake and post-discharge mortality.
METHODS: Using linked national registers, we followed all individuals discharged from LVM between 2012 and 2019. Participation in LARO during LVM was identified through prescription data and in-facility medication records. Mortality within 180 days after discharge was analyzed using Cox regression. Analyses included before-after comparisons around the policy change with interaction by LARO eligibility, and direct comparisons between eligible clients who did versus did not participate in LARO during LVM.
RESULTS: After the policy change, the proportion of LVM episodes involving LARO increased from approximately 3%-4% in 2015 to over 15% by 2020. Mortality within 180 days after discharge declined after the reform, with a larger reduction among clients eligible for LARO. Among eligible clients admitted after the policy change, participation in LARO during LVM was associated with lower mortality (hazard ratio 0.15, 95% CI 0.04-0.59).
CONCLUSIONS: Allowing opioid agonist therapy during compulsory care was associated with increased treatment uptake and reduced short-term post-discharge mortality. Integrating evidence-based treatment into compulsory care may reduce avoidable deaths.
METHODS: Using linked national registers, we followed all individuals discharged from LVM between 2012 and 2019. Participation in LARO during LVM was identified through prescription data and in-facility medication records. Mortality within 180 days after discharge was analyzed using Cox regression. Analyses included before-after comparisons around the policy change with interaction by LARO eligibility, and direct comparisons between eligible clients who did versus did not participate in LARO during LVM.
RESULTS: After the policy change, the proportion of LVM episodes involving LARO increased from approximately 3%-4% in 2015 to over 15% by 2020. Mortality within 180 days after discharge declined after the reform, with a larger reduction among clients eligible for LARO. Among eligible clients admitted after the policy change, participation in LARO during LVM was associated with lower mortality (hazard ratio 0.15, 95% CI 0.04-0.59).
CONCLUSIONS: Allowing opioid agonist therapy during compulsory care was associated with increased treatment uptake and reduced short-term post-discharge mortality. Integrating evidence-based treatment into compulsory care may reduce avoidable deaths.