The Comorbidity and Trauma Study (CATS) is a large retrospective case-control study, which examined the influence of genetics and environmental factors (e.g. childhood trauma) contributing to opioid dependence liability. The present research proposes a new data linkage component, which will link data from the CATS cohort with mortality, opioid substitution therapy, emergency department and hospital data.

Project Collaborators External

• Professor Elliot Nelson Department of Psychiatry, Washington University

Project Supporters

National Institute of Drug Abuse (Grant R01 DA017305)

The aim of the present research is to examine causes and predictors of mortality, and patterns of engagement with opioid substitution therapy among the CATS cohort. The specific aims of this research are to:

• Estimate overall mortality (both underlying and contributing causes) for the CATS cohort;
• Explore whether demographic or treatment variables are related to mortality levels during and following cessation of treatment;
• Estimate mortality risk, according to specific causes of death;
• Identify patterns and predictors of engagement (e.g. retention) in OST;
• Identify patterns and predictors of emergency department presentations;
• Identify patterns and predictors of hospital separations; and
• Explore neonatal outcomes among opioid dependent women compared with matched controls, and associations of childbirth with engagement with OST among opioid dependent woman.

Design and Method

A sample of 1487 opioid dependent cases and 515 non-dependent controls matched on age, sex and socio-economic status participated in face-to-face structured interviews between 2004 and 2008. Cases were recruited from 34 of the 35 available public and private opioid substitution therapy clinics in the greater Sydney region, and through word of mouth and snowballing recruitment methods. Controls were recruited from community and employment centres, open street malls and local press servicing the same geographic area as the clinics.

Data from the CATS cohort will be linked with the following administrative databases:

1. National Death Index (NDI) at the Australian Institute of Health and Welfare;
2. Ministry of Health –
   • Pharmaceutical Drugs of Addiction System (PHDAS) at the Pharmaceutical Services, Legal and Regulatory Services Branch (PBS).
   • NSW Admitted Patient Data (APD) at the Health System Information and Performance Reporting Unit.
   • NSW Emergency Department Data Collection (EDDC) at the Health System Information and Performance Reporting Unit.

Progress/Update

CATS cohort data has been linked to administrative data from the National Death Index (NDI), Pharmaceutical Drugs of Addiction System (PHDAS), NSW Admitted Patient Data (APD) and NSW Emergency Department Data Collection (EDDC) databases. Data analysis is currently underway.

Benefits

The CATS study seeks to provide a better understanding of the genetics of opioid dependence. The data linkage component of the study will examine underlying and contributing causes of death among this cohort of opioid dependent people, in addition to factors (i.e. demographics, childhood and adult victimisation, and psychiatric disorders) that predict mortality and engagement in OST. The analysis of data from opioid dependent cases and non-opioid dependent controls will provide unique insight into the role of opioid dependence and opioid substitution therapy in mortality risk.

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2. Conroy, E., Degenhardt, L., Mattick, R.P. & Nelson, E. (2009).Child maltreatment as a risk factor for opioid dependence: Comparison of family characteristics and type and severity of child maltreatment with a matched control group. Child Abuse and Neglect, 33(6), 343-352.
3. Maloney, E., Degenhardt, L., Darke, S., and Nelson, E., (2009). Are non-fatal opioid overdoses misclassified suicide attempts? Comparing the associated correlates. Addictive Behaviors, 34(9), 723-729.
4. Maloney, E., Degenhardt, L., Darke, S., and Nelson, E., (2009). Impulsivity and borderline personality as risk factors for suicide attempts among opioid-dependent individuals. Psychiatry Research, 169, 15-21.
5. Shand, F., Degenhardt, L., Slade, T., & Nelson, E. (2009). The structure of polysubstance dependence and its correlates in a heroin dependent sample (abstract). Drug and Alcohol Review, 28, A58-A58.
6. Shand, F. Slade, T., Degenhardt, L., & Nelson, E.C. (2009). The severity of heroin dependence: does it exist and is it clinically relevant? Drug and Alcohol Review, 28, A58-A58.
7. Shand, F., Degenhardt, L., Nelson, E. & Mattick, R.P., (2010). Predictors of social anxiety in an opioid dependent sample and a matched control group. Journal of Anxiety Disorders, 24, 49-54.
8. Maloney, E., Degenhardt, L., Darke, S., & Nelson, E. (2010). Investigating the co-occurrence of self-mutilation and suicide attempts among opioid dependent individuals and matched controls. Suicide and Life Threatening Behavior, 40(1), 50-62.
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22. Kristjansson, S., McCutcheon, V., Agrawal, A., Lynskey, M., Conroy, E., Statham, D., Madden, P., Henders, A., Todorov, A., Bucholz, K., Degenhardt, L., Martin, N., Heath, A. & Nelson, E., (2016). The variance shared across forms of childhood trauma is strongly associated with liability for psychiatric and substance use disorders. Brain and Behavior, 6(2), 1-11.
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36. Santo Jr, T., Gisev, N., Campbell, G., Nelson, E., & Degenhardt, L. (Under Review). The effects of childhood trauma and mental disorders on treatment engagement, contact with the criminal justice system, and mortality among people with opioid dependence. Drug and Alcohol Dependence.

Presentations:

Santo Jr, Thomas, Natasa Gisev, Gabrielle Campbell, & Louisa Degenhardt The effects of childhood trauma and mental disorders on treatment engagement, contact with the criminal justice system, and mortality among people with opioid dependence. Lisbon Addictions European Conference on Addictive Behaviours and Dependence. 23-25 November 2022. (Accepted) Lisbon, Portugal.