An admission cohort of 296 Australian methadone maintenance patients was followed over 15 years. The relative risks of death in and out of maintenance were calculated for two age groups, 20-29 and 30-39 years. Heroin addicts in both age groups were one-quarter as likely to die while receiving methadone maintenance as addicts not in treatment. This is because they were significantly less likely to die by heroin overdose or suicide while in maintenance. Methadone maintenance had no measurable effect on the risk of death through nonheroin overdose, violence or trauma, or natural causes. A meta-analysis showed the reduction in overall mortality was consistent with the results of cohort studies conducted in the United States, Sweden, and Germany. The combined results of the five studies again indicated that methadone maintenance reduced addicts' risk of death to a quarter, RR 0.25 (95% CI 0.19 to 0.33).

A long-term follow-up was made of a cohort of 307 heroin addicts admitted into a high-dose, Australian methadone maintenance programme in the early 1970s. Using data from clinic records, official death records and methadone treatment histories, it was found that subjects were nearly three times as likely to die outside of methadone maintenance as in it (95% CI RR 1.45 to 5.61). Data were further analyzed using Cox regression to investigate the association of maximum daily methadone dose and a change in clinic policy with retention in maintenance treatment. It is estimated that subjects given a maximum daily dose of 80 mg were nearly twice as likely to be discharged during the first three years of maintenance as those given 120 mg (95% CI RR 1.3 to 2.2). The estimated median time in maintenance for subjects given a maximum dose of 120 mg was 1150 days while for 80 mg it was 660 days. It is further estimated that the change in clinic policy from abstinence to indefinite maintenance reduced to one-third subjects' risk of leaving after three years' of treatment (95% CI RR 0.19 to 0.54). It is concluded that, in order to minimize heroin addicts' risk of death, they should be offered indefinite, high-dose methadone maintenance.

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