Opioid substitution treatment (OST) with methadone maintenance to reduce mortality — evidence summary

Summary of the evidence

Rating:
Beneficial

Opioid substitution treatment (OST) with methadone maintenance was found to be effective in systematic reviews (Mattick et al., 2009, Bargagli A.M. et al., 2007, Mathers et al., 2013) in:

  • reducing the risk of death:
    • mortality (any cause): three RCTs (N= 435) (RR 0.493, 95 % CI, 0.06 to 4.23) (1)
    • mortality (any cause): five observational studies (N= 69970) (RR 0.3795, 95 % CI 0.29 to 0.48)
    • mortality during in-treatment and off-treatment periods at follow-up: six observational studies (RR 2.52, 95 % CI 1.50 to 4.00)
    • reducing risk of overdose death for those retained in treatment compared to those waiting for treatment, those who have left treatment or those that are in detoxification treatment:
    • five observational studies (N=69 970) (RR 0.17, 95 % CI 0.05 to 0.63)

(1): the measure from the RCT is not statistically significant, nevertheless the evidence when considered together with the results of the observational studies, is significant.

Details

Note: this evidence summary is only valid for the outcomes, target groups, settings and substances/patterns of use described below.

Name of response option:
Pharmacological treatment
Desired outcome(s):
reduce mortality
Area(s)
Harm reduction
Specific substance or pattern of use:
opioids
Target group(s) or setting(s):
PWID – people who inject drugs