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Analyzing the Organizational ResearchArticle Review

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Organizational Research

Research Paradigms and Perspectives

Scholars who authored the paper, "Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies" are associated with the University of New South Wales (NSW), Sydney's 'National Drug and Alcohol Research Centre'. Sometimes, opioid addictiveness was diagnosed on the basis of clinical evaluation, while at other times, it was assumed, because of enrolment, opioid was a substitution therapy; this, however, might not constitute a well-founded assumption. Moreover, this analysis shed light on the absence of information from several nations well-known for their opioid dependence cases, especially middle- and low-income nations. Several cohorts offered information on out- and in-treatment rates of mortality, however, seldom was status of therapy treated as a variable that is time-dynamic (Degenhardt et al., 2011).

The authors of the article "Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database" are affiliated to University of Bristol's School of Social and Community Medicine; the National Addiction Centre of King's College, London's Institute of Psychiatry; and the London School of Hygiene and Tropical Medicine, all of which are situated in the UK. The scholars admit that their research is fraught with potential biases and shortcomings. First and foremost, some gaps in data on dosage and duration complicated time classification off and on medication. This might have given rise to an overestimate or underestimate of off- or on- treatment mortality, thus potentially overstating or understating the difference among them. Furthermore, there wasn't any active follow-up for patients transferred from the database (approximately 10% per annum), nor was there any follow-up procedure in place for monitoring opiate consumption of patients, following their exit from opiate substitution therapy. There were differences present in transferred patients' characteristics and those of individuals who had completed follow-up procedures. Also, limited covariates existed for which the analyses could be adjusted. More notably, there weren't any factors in the study capable of measuring intervention intensity or quality, which might have affected mortality risks at commencement of the opiate substitution therapy and the possibility of death or relapse immediately post-treatment. In addition, the research's outcome was all-cause death, since no information was available on the specific factors causing death. While prior British research works on the subject have demonstrated that a majority of opiate consumers' deaths result from overdose, a few studies have proven that there is a larger difference in overdose risks in the course of, and subsequent to, therapy compared to that for all-cause mortality that wouldn't have been detected. Lastly, researchers' comparisons of mortality risk among non-vulnerable and vulnerable populations in terms of opiate substitution therapy duration are calculated, rather than directly observed, results (Cornish, Macleod, Strang, Vickerman & Hickman, 2010).

Authors of the Australian study "Mortality among clients of a state-wide opioid pharmacotherapy program over 20 years: Risk factors and lives saved" are affiliates of NSW University, Sydney's National Drug and Alcohol Research Centre; University of Queensland's School of Population Health; Curtin University of Technology's National Drug Research Institute, and NSW University's National Centre in HIV Epidemiology and Clinical Research. Research bias stems from comparing mortality outside and inside of treatment. One may contend that the in-treatment mortality rate is lower, as patients in therapy are characterized by greater stability than drop-outs. It is likely that out-of-therapy mortality rates documented by study authors are lesser than pre-treatment rates, or rates among addicts who never enroll in therapy. If this holds true, a decline would be witnessed in observed difference of in-therapy mortality from out-of-therapy mortality, giving rise to a conservative evaluation of mortality drop in treatment (Degenhardt et al., 2009).

Research questions

The research question in the article "Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database" is 'what are the mortality rates as well as rate ratios after taking into consideration mortality of opiate users and the mortality rates in the general population?' The research question in "Mortality among clients of a state-wide opioid pharmacotherapy program over 20 years: Risk factors and lives saved" is 'what is the decrease in mortality associated with treatment of opioid dependent population?' The research question in "Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies" is 'what is mortality in both dependent and regular consumers of opioids in various regions?'

Methodology

Degenhardt and colleagues (2009) made use of definitions -- considering 6 days after the completion of any therapeutic intervention as being a part of the intervention -- while allocating in-therapy or out-of-therapy mortalities. This technique of allocating post-treatment deaths to in-treatment period might be associated with some potential bias; however, any such inaccuracies bias mortality out of therapy downwards and in therapy upwards, leading to conservative estimated in-treatment mortality reductions. All Australian deaths were coded at the ABS (Australian Bureau of Statistics) by professional clinical coders, based on data present in the deceased's death certificate as well as that present in coronial files, in some instances (Degenhardt et al., 2009).

Various search approaches were employed in accordance with a strategy utilized for the global disease burden venture of 2005, for identifying information sources like peer reviewed works describing mortality in connection with opioid dependency. Firstly, an investigation of peer reviewed texts (PsycINFO, Medline, and EMBASE) was performed, in keeping with MOOSE-recommended (Meta-analysis of Observational Studies in Epidemiology) methodology (Stroup et al., 2000). A number of broad conditions formed the basis for exclusion of data: a failure to report on opioid or heroin users, opioid-associated mortality, and a failure to report case study data or data from primary research (Degenhardt et al., 2011).

This research work's data was gleaned from the GPRD (General Practice Research Database), an enormous databank of anonymous patient records obtained from over 460 British general practices. The database gathers information from no less than 3.5 million individuals (i.e., about 5.5% of the population of the United Kingdom). The research's cohort comprised of individuals who have been prescribed one or more buprenorphine or methadone prescriptions from January 1, 1990 to December 31, 2005, with a documented substance abuse diagnosis. Patients aged 60+ on their first diagnosis of the aforementioned two drugs, or those given an opiate prescription specifically to relieve pain, or those given an injectable drug prescription, were excluded from the study. Study scholars utilized patient IDs for linking prescription data to demographic data (like gender and age) and also to every other medication prescribed to the individual at the time of follow-up (Cornish, Macleod, Strang, Vickerman & Hickman, 2010).

Findings

Cornish and coworkers (2010) maintain that, compared to general society, opiate consumers under study were significantly more prone to mortality. The overall mortality risk at the time of opiate substitution therapy was lesser than out-of-therapy mortality risk. Patients who began opiate substitution therapy were twice or thrice more likely to meet their end during the first two and four weeks of therapy, as compared to the mortality risk in the remainder of their treatment duration. Mortality risk increased eight to nine times during the month just post-treatment. No sound evidence was obtained that these results varied with treatment type (buprenorphine or methadone), whether therapy cessation was unplanned or prearranged (evidence of lower dose prior to cessation), or whether the dosage remained within recommended thresholds of treatment. The researchers postulated that opiate substitution therapy's net benefit on general mortality might be connected to average treatment duration (Cornish, Macleod, Strang, Vickerman & Hickman, 2010).

Degenhardt and colleagues (2011) analyzed updated prior systematic evaluations of prospective researches on mortality of opioid dependents, extending them in many ways. Combined estimates for the cohorts discovered an aggregate all-cause crude death rate of 2.09 mortalities per hundred person-years, as well as an aggregate standardized death rate of 14.66. Crude death rate was higher in males than in females. Both meta-analyses reflected very high heterogeneity, which was examined by way of further analyses. This research reveals that crude death rates and mortality risks of opioid consumers are considerably higher than that of the general global population. There are some common risks in young adults responsible for increased mortality risks to that of opioid consumption: obesity raises death risk by about three times, while schizophrenia raises it roughly 2.5 times, when compared to almost 15 times for opioid consumption. In spite of limitations in study authors' grasp of the precise size of global opioid users, a rise in worldwide estimates of opioid consumers' deaths during the last decade of the twentieth century indicates that a growing number of individuals across the globe might face risks, owing to their opioid consumption (Degenhardt et al., 2011).

Degenhardt and coworkers (2009) believe that mortality increases in opioid abusers who enter opioid pharmacotherapy, as compared to gender and age peers; key contributors are overdose, suicide, and external factors. This raised mortality rate increases further when the dependent goes out of therapy (in other words, treatment lowers… [END OF PREVIEW]

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