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Published: 15 November 2011

Methadone and mortality

With an estimated 700 000 opioid users undergoing substitution treatment, drugs such as methadone have recently come under the spotlight with regard to drug- induced deaths. Methadone is often mentioned in the toxicology reports for deaths related to drug use, and is sometimes identified as the cause of death. In spite of this, the current available evidence strongly supports the benefits of well-regulated and supervised opioid substitution treatment, combined with psychosocial assistance interventions, for keeping patients in treatment and reducing illicit opioid use and mortality.

Observational studies report the mortality rate for opioid users in methadone treatment to be approximately one third the rate of those out of treatment. Treatment duration is an important factor, with recent studies showing that opioid substitution treatment has a greater than 85 % chance of reducing overall mortality among opioid users, if they remain in treatment for 12 months or more (Cornish et al., 2010). Survival benefits increase with cumulative exposure to treatment (Kimber et al., 2010). Furthermore, methadone appears to reduce the risk of HIV infection by approximately 50 % compared to withdrawal or no treatment (Mattick et al., 2009). With regard to methadone-related deaths in a population, a recent study in Scotland and England concluded that the introduction of supervised methadone dosing was followed by a substantial decline in deaths where methadone was involved. Between 1993 and 2008, there was at least a four-fold reduction in deaths due to methadone-related overdose per amount of methadone prescribed, against a background of treatment expansion (Strang et al., 2010).

Cornish, R., Macleod, J., Strang, J., Vickerman, P. and Hickman, M. (2010), 'Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database', BMJ 341, p. c5475.

Kimber, J., Copeland, L., Hickman, M., Macleod, J., McKenzie, J. et al. (2010), 'Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment', BMJ 341, p. c3172.

Mattick, R. P., Breen, C., Kimber, J. and Davoli, M. (2009), 'Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence', Cochrane Database of Systematic Reviews, Issue 3, p. CD002209.

Strang, J., Hall, W., Hickman, M. and Bird, S. M. (2010), 'Impact of supervision of methadone consumption on deaths related to methadone overdose (1993–2008): analyses using OD4 index in England and Scotland', BMJ 341, p. c4851.

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Page last updated: Friday, 28 October 2011