Document Type

Journal Article

Publisher

BMJ

School

School of Medical and Health Sciences

Comments

Originally published as: Reece, A. S., & Hulse, G. K. (2018). What are the characteristics of vitamin D metabolism in opioid dependence? An exploratory longitudinal study in Australian primary care. BMJ open, 8(1), e016806. Original article available here

Abstract

Objective Compare vitamin D levels in opioid dependence and control population and adjust for relevant confounding effects. Nuclear hormone receptors (including the vitamin D receptor) have been shown to be key transducers and regulators of intracellular metabolism and comprise an important site of pathophysiological immune and metabolic dysregulation potentially contributing towards pro-ageing changes observed in opioid-dependent patients (ODPs).

Design Longitudinal prospective comparing ODPs with general medical controls (GMCs).

Setting Primary care.

Participants Prospective review comparing 1168 ODP (72.5% men) and 415 GMC (51.6% men, p<0.0001). Mean ages were 33.92±0.31 (mean±SEM) and 41.22±1.32 years, respectively (p<0.0001). Opioid use in the ODP has been previously reported and shown to be typical.

Interventions Nil. Observational study only.

Primary and secondary outcomes Serum vitamin D levels and relevant biochemical parameters.

Results Vitamin D levels were higher in the ODP (70.35±1.16 and 57.06±1.81 nmol/L, p<0.0001). The difference in ages between the two groups was handled in an age-matched casecontrol subanalysis and also by multiple regression. Sexes were analysed separately. The age:status (or age:time:status) was significant in casecontrol, cross-sectional and longitudinal analyses in both sexes (p<0.05). Modelled vitamin D was 62.71 vs 57.81 nmol/L in the two groups. Time-dependent mixed-effects models quadratic in age outperformed linear-only models (p=0.0377). ODP vitamin D was shown to vary with age and to correlate with alanine aminotransferase establishing it as a biomarker of age in this group. Hepatitis C seronegativity was significant in regression models (from p=0.0015).

Conclusion Vitamin D was higher in ODP in both sexes in bivariate, cross-sectional, casecontrol and longitudinal analyses and was robust to the inclusion of metabolic and immune biomarkers. That Hepatitis C seronegativity was significant suggests opioid dependence has an effect beyond simply that of its associated hepatitides. This finding may relate to the accelerated ageing process previously described in opioid dependence.

DOI

10.1136/bmjopen-2017-016806

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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