Association between venlafaxine use and the risk of substance withdrawal in patients with nonopioid substance use
S.-Y. Wei1, B.M.-H. Li2, D.H.-T. Tsai2, H.-Y. Hu3, S.-Y. Lin3, S.-J. Lin4, C.-C. Su5, C.-H. Pan3, E.C.-C. Lai2
1National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Department of Psychiatry, Tainan, Taiwan, 2Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, School of Pharmacy, Tainan, Taiwan, 3Institute of Forensic Medicine, Ministry of Justice, Forensic Pathology Division, New Taipei City, Taiwan, 4University of Illinois at Chicago, Department of Pharmacy Administration, Chicago, United States, 5National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Clinical Innovation and Research Center, Tainan, Taiwan
Background: Appropriate treatments for nonopioid substance use are currently unavailable. Venlafaxine may reduce nonopioid substance withdrawal, but the effects have not been evaluated.
Aims & Objectives: To investigate the association between venlafaxine use and the risk of nonopioid substance withdrawal.
Method: We linked Taiwan’s National Health Insurance Research Database and the Taiwan Illicit Drug Issue Database from January 2012 to December 2019. We used a case-case-time-control study involving a case-crossover analysis and a control-crossover analysis consisting of future cases. The outcomes were substance withdrawal and all-cause mortality. For each individual, venlafaxine use during the hazard period (day −8 to −67 before the outcome) was compared with that during the 60-day reference period (between days −248 and −307). Conditional logistic regression was used to determine odds ratios with 95% confidence intervals to evaluate the associations between outcome events and the use of venlafaxine.
Results: The participants’ average age on the index date was 39.5 years (standard deviation 8.7), with 84.1% men and 88.3% having low income. Venlafaxine was significantly associated with a 0.35-fold decreased risk of substance withdrawal (95% confidence interval 0.13 to 0.96). However, we found no association between the recent use of venlafaxine and all-cause mortality (1.08, 0.55 to 2.14). The results remained consistent throughout a series of sensitivity analyses, including various lengths of time for hazard or reference periods or restricting patients with stimulant use only.
Discussion & Conclusions: This study provides strong ground for clinicians to consider the use of venlafaxine to reduce patient substance withdrawal.
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