One-year Mortality Rates of Patients Receiving Methadone and Buprenorphine Maintenance Therapy

Abstract

Mortality rates in drug-dependent patients in substitution treatment remain a matter of debate. Although several retrospective toxicological or forensic postmortem studies on this issue have been conducted, few prospective studies have addressed this problem. In a nationally representative sample of 2694 opioid dependent patients in substitution treatment either with methadone or buprenorphine at baseline were monitored over a 12-month period (response rate, 91%). A total number of 1629 (60.4%) were still in treatment after 12 months. The overall mortality rate was 1.04%. In total, 28 patients of the initial sample deceased within the 1-year follow-up period. Eleven (0.4%) of these deaths are due to a fatal intoxication. Three patients (0.1%) died of human immunodeficiency virus/acquired immunodeficiency syndrome, and 3 (0.1%) committed suicide. Thirteen of these patients (4 with overdose/polyintoxication) were not in substitution treatment at the time of death. Other reasons included accidents and deaths due to other medical conditions. Only in one case the reason could not be ascertained. The mortality rate was similar in methadone as compared with buprenorphine patients. Taking into account the high comorbidity of opioid dependent patients and the severity of dependence, the mortality rate of approximately 1% confirms that maintenance treatment could be regarded as a fairly safe treatment.

Trends in methadone-related deaths in Zurich

“…We showed a distinct and even increasing predominance of males among methadone-related deaths which is also a common finding in other studies [1,16,17,19,22]. The only exception is the study by The mean age in other investigations, including the studies from Zurich, ranged from the late 20´s to the late 30´s [15-18, 22, 23].…”

“…This measure successfully helped to reduce mortality, criminal behaviour and the spreading of disease transmitted through intravenous drug use [18,19]. Other studies showed a significant lower rate of additional consumption of drugs -especially of opioids -and an increase in quality of life [17,19].…”

“…Because of its long half-life, good enteral resorption and low costs it became an important substance in the treatment of opiate addiction [2,16,18,22]. This measure successfully helped to reduce mortality, criminal behaviour and the spreading of disease transmitted through intravenous drug use [18,19]. Other studies showed a significant lower rate of additional consumption of drugs -especially of opioids -and an increase in quality of life [17,19].…”

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

“…has also shown in British Columbia that the majority of patients do not discharge successfully from maintenance therapy 61, but a recent study in multiple sites suggests that the preponderance of shorter treatments may be greater in the United Kingdom than elsewhere 62. For example, a study in Germany found almost two‐thirds of patients retained on OST at 1 year 63, 64.…”

Buprenorphine Use and Risk of Abuse and Diversion

“…A large German naturalistic follow-up study (N=2694) on one-year outcome in opioid-dependent maintenance patients found an annual mortality rate of 1.04% for methadone-and buprenorphine-treated patients [142]. The study was a nationally representative, prospective, longitudinal naturalistic study program with three waves (baseline, 1 year, 5-7 years) and was based on a nationwide representative sample of physicians and their opioid-dependent patients [143].…”