Mortality in heroin addiction: impact of methadone treatment

Abstract

The mortality within a cohort of 115 street heroin addicts was studied for 5-8 years using the Kaplan-Meier survival estimate technique. This differed markedly from the relatively low mortality of 166 comparable heroin addicts given methadone maintenance treatment (MT). The street addicts' mortality rate was 63 times that expected, compared with official statistics for a group of this age and sex distribution. When 53 patients in MT were involuntarily expelled from treatment, due to violation of programme rules, they returned to the high mortality of street addicts (55 times that expected). A group of 34 rehabilitated patients who left MT with medical consent retained the low mortality of MT patients (their mortality rate was 4 times that expected). Despite this great improvement in survival, even patients in MT showed a moderately elevated mortality (8 times that expected), mainly due to diseases acquired before entering the treatment programme. It is concluded that MT exerts a major improvement in the survival of heroin addicts.

Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”

“…Evidence accumulated over many years shows that stable methadone maintenance patients who withdraw from methadone have relapse rates approaching 80-85 % within 1 year [23]. In methadone-maintained patients, there are demonstrated reductions in death rates [24], reductions in the rates of intravenous drug use [23], reductions in crime [5,25,26], and reductions in rates of HIV seroconversion [27,28]. During 1983-84 the prevalence of HIV infection in untreated heroin addicts in New York City was 50-60 %, while only 9 % of methadone maintenance patients had the HIV-1 antibody [29].…”

An intriguing association between dental and mental pathology in addicted and control subjects: a cross-sectional survey

“…mortality, variously estimated at 10-70 times that of control populations. 20,22,25,28 The stereotypical unkempt appearance of many street SUD patients is well known. However, the existence of a signifi cant literature demonstrating that addictive drugs impair cell growth 29 on the one hand and stimulate cellular apoptosis [30][31][32][33][34] on the other, suggests that it is theoretically conceivable that substance dependence might actually be accelerating the ageing process in accordance with the cellular hypothesis of ageing.…”

“…19 The greatly elevated mortality rate associated with the disorders of substance dependence is also well known and well documented. [20][21][22][23][24][25] In the process of examining the agedependent prevalence of psychopathology including psychoses in our own drug-dependent patients, we noted that the age-dependent profi le of such disorders was very different in a group of addicted patients compared to medical controls, with the drug-dependent group developing more psychopathologies more rapidly and with greater severity than the medical controls. 26 Drug-dependent patients develop a wide variety of disorders in addition to the infective and neuropsychiatric diseases for which they are well known, and these appear similar to the disorders of old age.…”

Heroin Maintenance Treatment - Are the Further Investigation Needed?

“…Methadone maintenance treatment is associated with retention in treatment, and reductions in drug use, criminal activity, and HIV risk behaviors and mortality [6][7][8][9]. It is currently the most successful treatment for chronic opioid dependence [10].…”