CHESS researcher Can Liu co-authored a Swedish register-based study examining the consequences of a 2016 policy change that allowed opioid agonist therapy during compulsory care for people with severe substance use disorders.
People with severe substance use disorders can, under certain circumstances, receive compulsory care under the Swedish Care of Abusers Act. The period immediately following discharge is associated with a particularly high risk of mortality, including deaths related to opioid use. Despite opioid agonist therapy being an established treatment for opioid dependence, it was not permitted during compulsory care until a regulatory change came into effect in February 2016.
Together with her co-author, Can Liu used linked Swedish national registers, researchers followed all individuals discharged from compulsory care between 2012 and 2019. They examined participation in opioid agonist therapy during care and mortality during the first 180 days after discharge, comparing outcomes before and after the policy change.
Treatment uptake increased markedly after the reform. Around 3 to 4% of compulsory care episodes involved opioid agonist therapy in 2015, compared with more than 15% by 2020. Mortality during the first 180 days after discharge also declined, with a larger reduction among people considered eligible for treatment. Among eligible individuals admitted after the reform, participation in opioid agonist therapy during compulsory care was associated with substantially lower mortality.
Individuals who received treatment during compulsory care were also more likely to continue treatment after discharge. The findings highlight the importance of providing evidence based treatment during institutional care and maintaining continuity during the transition back to community based services, when the risk of death is particularly high.