Aims To examine the risk of mortality associated with interruptions to the continuity of methadone maintenance treatment (MMT), including transfers between services, in opioid‐dependent individuals attending specialist addiction services. Design Retrospective cohort study using addiction services and primary care dispensing records, the National Methadone Register and National Drug‐Related Death Index (NDRDI). Setting Geographically defined population in Dublin, Ireland. Participants A total of 2899 people prescribed and dispensed methadone in specialist addiction services between January 2010 and December 2015. There were five exposure groups: weeks 1–4 following transfer between treatment providers; weeks 1–4 out of treatment; weeks 5–52 out of treatment; weeks 1–4 of treatment initiation; and weeks 5+ of continuous treatment (reference category). Measurements Primary outcome: drug‐related poisoning (DRP) deaths. Secondary outcome: all‐cause mortality (ACM). Mortality rates calculated by dividing number of deaths (DRP; ACM) in exposure groups by person‐years exposure. Unadjusted and adjusted Poisson regression (covariates age, sex, incarceration, methadone dose and comorbidities) estimated differences in mortality rates. Findings There were 154 ACM deaths, 55 (35.7%) identified as DRP deaths. No deaths were observed in the first month following transfer between treatment providers. The risk of DRP mortality was highest in weeks 1–4 out of treatment [adjusted relative risk (aRR = 4.04, 95% confidence interval (CI) = 1.43–11.43, P = 0.009] and weeks 1–4 of treatment initiation (ARR = 3.4, 95% CI = 1.2–9.64, P = 0.02). Similarly, risk of ACM was highest in weeks 1–4 out of treatment (ARR = 11.78, 95% CI = 7.73–17.94, P < 0.001), weeks 1–4 of treatment initiation (aRR = 5.11, 95% CI = 2.95–8.83, P < 0.001) and weeks 5–52 off treatment (aRR = 2.04, 95% CI = 1.2–3.47, P = 0.009). Conclusions Interruptions to the continuity of methadone maintenance treatment by treatment provider do not appear to be periods of risk for drug‐related poisoning or all‐cause mortality deaths. Risk of drug related poisoning and all‐cause mortality deaths appears to be greatest during the first 4 weeks of treatment initiation/re‐initiation and after treatment cessation.

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Purpose -This paper aims to illustrate realities of homeless people's lives during a time of significant change in UK pubiic sector funding and welfare policy Design/methodology/approach -A participatory research approach was used including working with two co-researchers; two people who have direct experience of homelessness. A sustainable livelihoods approach was adapted to provide a framework for analysis. The research was undertaken during May to Qctober2011. Findings -The paper interrogates five areas of assets held by people themselves that support sustainable livelihoods, an existing approach used in other research. Life journey narratives show that a connected range cf services, operating through an empowerment model, promote human dignity. Research limitations/implications -Findings resonate with issues identified in larger studies: however, as the funding and policy context is rapidly changing it Is recommended that additional local qualitative studies could be conducted during the next three years to iiiustrate impacts in people's lives.Practicai implications -The paper suggests front-iine services must include resettlement as well as crisis and stabilising services in order to ensure homeless people can successfuiiy move from home to home.Sociai impiications -The research identified negative attitudes towards homeless people. By illustrating homeless people's achievements the study provides evidence of the impact of, and the value of continuing to fund, homeless services. OriginaiityAraiue -The paper suggests that people who have experienced homelessness achieve a successful life with support by drawing on their considerable life experience and personal talents. This message is important for practitioners, commissioners and policy makers working through a period of change for homeiess services.