Methadone maintenance treatment: the balance between life‐saving treatment and fatal poisonings

Fugelstad, Anna; Stenbacka, Marlene; Leifman, Anders; Nylander, Magnus; Thiblin, Ingemar

doi:10.1111/j.1360-0443.2006.01714.x

Cited by 97 publications

(81 citation statements)

References 19 publications

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“…We observed an increase in the number of methadone-related deaths in recent years which is consitent with the findings of many other investigators [6,9,17,18,22]. One author however found a decrease [16] -but this finding may result from only a small collective.…”

Section: Discussionsupporting

confidence: 62%

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Trends in methadone-related deaths in Zurich

Laberke

Bärtsch

2010

Int J Legal Med

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Methadone has a long and successful history in the treatment of opioid-addiction. In recent years it has become popular again -as potent and inexpensive analgesic in patients with chronic pain. Since methadone has been used fatalities have been reported. In our study all methadone-associated deaths in Zurich from 1998 to 2007 were analysed. Most of the 146 detected deaths of the past ten years occurred during substitution programmes or illicit intake of methadone while only three of them could be attributed to methadone used as an analgesic. Noticeable in our study was the high percentage of cases of combined drug intoxication (76%). The most frequent co-intoxicants were alcohol and cocaine. Mortalities attributed to methadone intoxication alone were a rare finding and could only be detected in five cases of deceased who had received methadone maintenance treatment.The aim of our study is to assess the trends in the number and nature of methadone-related fatalities in Zurich during the last nineteen years. For this purpose a previous study from Zurich (1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997) was included, whereby a very long oberservation period and large number of cases resulted.

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Section: Discussionsupporting

confidence: 62%

“…Among the long-term studies [6,7,8,10] with an observation period of 10 years or more with 146 deceased we investigated a relatively large number of cases. However, some shorter studies of five years in length or less presented data with an even larger number of victims [5,18].…”

Section: Discussionmentioning

confidence: 99%

Trends in methadone-related deaths in Zurich

Laberke

Bärtsch

2010

Int J Legal Med

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“…The majority of drug‐related deaths are among individuals not in treatment 22, 56. Restricting access to OST is associated with high rates of mortality among opioid‐dependent people who have been discharged or denied treatment 57. Open access to OST is a feature of the ‘British System’ of drug treatment and a response to HIV/AIDS epidemic in the early 1990s 58.…”

Section: Discussionmentioning

confidence: 99%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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AimsTo estimate whether opioid substitution treatment (OST) with buprenorphine or methadone is associated with a greater reduction in the risk of all‐cause mortality (ACM) and opioid drug‐related poisoning (DRP) mortality.DesignCohort study with linkage between clinical records from Clinical Practice Research Datalink and mortality register.SettingUK primary care.ParticipantsA total of 11 033 opioid‐dependent patients who received OST from 1998 to 2014, followed‐up for 30 410 person‐years.MeasurementsExposure to methadone (17 373, 61%) OST episodes or buprenorphine (9173, 39%) OST episodes. ACM was available for all patients; information on cause of death and DRP was available for 5935 patients (54%) followed‐up for 16 363 person‐years. Poisson regression modelled mortality by treatment period with an interaction between OST type and treatment period (first 4 weeks on OST, rest of time off OST, first 4 weeks off OST, rest of time out of OST censored at 12 months) to test whether ACM or DRP differed between methadone and buprenorphine. Inverse probability weights were included to adjust for confounding and balance characteristics of patients prescribed methadone or buprenorphine.FindingsACM and DRP rates were 1.93 and 0.53 per 100 person‐years, respectively. DRP was elevated during the first 4 weeks of OST [incidence rate ratio (IRR) = 1.93 95% confidence interval (CI) = 0.97–3.82], the first 4 weeks off OST (IRR = 8.15, 95% CI = 5.45–12.19) and the rest of time out of OST (IRR = 2.13, 95% CI = 1.47–3.09) compared with mortality risk from 4 weeks to end of treatment. Patients on buprenorphine compared with methadone had lower ACM rates in each treatment period. After adjustment, there was evidence of a lower DRP risk for patients on buprenorphine compared with methadone at treatment initiation (IRR = 0.08, 95% CI = 0.01–0.48) and rest of time on treatment (IRR = 0.37, 95% CI = 0.17–0.79). Treatment duration (mean and median) was shorter on buprenorphine than methadone (173 and 40 versus 363 and 111, respectively). Model estimates suggest that there was a low probability that methadone or buprenorphine reduced the number of DRP in the population: 28 and 21%, respectively.ConclusionsIn UK general medical practice, opioid substitution treatment with buprenorphine is associated with a lower risk of all‐cause and drug‐related poisoning mortality than methadone. In the population, buprenorphine is unlikely to give greater overall protection because of the relatively shorter duration of treatment.

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“…Studies have shown that patients who leave methadone programmes have increased mortality risks relative to those remaining in treatment. ( Caplehorn, Dalton, Haldar, Petrenas, & et al, 1996;Clausen, Anchersen, & Waal, 2008;Davoli, et al, 2007;Fugelstad, Stenbacka, Leifman, Nylander, & Thiblin, 2007;Langendam, van Brussel, Coutinho, & van Ameijden, 2001;Zanis & Woody, 1998) A recent prospective cohort study of Italian opiate users found that the risk of overdose following treatment cessation was more than three times higher in the first 30 days after treatment drop-out or discharge compared to the subsequent 31 days or more after treatment. (Davoli, et al, 2007) However, these effects are not specific to MMT but rather a range of treatments for heroin dependence, including MMT, methadone detoxification, other pharmacological detoxification and psychological interventions.…”

Section: Introductionmentioning

confidence: 99%