Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006–10

Abstract

Aims To estimate mortality rates among treated opioid-dependent individuals by cause and in relation to the general population, and to estimate the instantaneous effects of opioid detoxification and maintenance treatment (MMT) on the hazard of all-cause and cause-specific mortality. Design Population-based treatment cohort study. Setting Linked mortality data on all individuals first enrolled in publicly-funded pharmacological treatment for opioid dependence in California, USA from 2006 to 2010. Participants 32,322 individuals, among whom there were 1,031 deaths (3.2%) over a median follow-up of 2.6 years (interquartile range: 1.4 - 3.7). Measurements The primary outcome was mortality, indicated by time to death, crude mortality rates (CMR), and standardized mortality ratios (SMR). Findings Individuals being treated for opioid dependence had a more than four-fold increase of mortality risk compared with the general population (SMR 4.5 95% CI: 4.2, 4.8). Mortality risk was higher (1) when individuals were out-of-treatment (SMR 6.1, 95% CI: 5.7, 6.5) than in-treatment (SMR 1.8, 95% CI: 1.6, 2.1) and (2) during detoxification (SMR 2.4, 95% CI 1.5, 3.8) than during MMT (SMR 1.8, 95% CI 1.5, 2.1), especially in the two weeks post-treatment entry (SMR 5.5, 95% CI 2.7, 9.8 versus SMR 2.5, 95% CI 1.7, 4.9). Detoxification and MMT both independently reduced the instantaneous hazard of all-cause and drug-related mortality. MMT preceded by detoxification was associated with lower all-cause and other-cause-specific mortality than MMT alone. Conclusions In people with opiate dependence, detoxification and methadone maintenance treatment both independently reduce the instantaneous hazard of all-cause and drug-related mortality.

The costs of crime during and after publicly funded treatment for opioid use disorders: a population‐level study for the state of California

“…OUD is a chronic, recurrent illness characterized by cyclical episodes of treatment and relapse (61–65) and we interpret these cumulative differences between OAT and detoxification as indicative of the stabilizing effects of OAT, akin to previous results showing that OAT access among HIV positive individuals with OUD increased medication adherence and independently reduced all-cause mortality. (66, 67) Whereas the clinical importance of treatment for OUD in reducing opioid-related mortality, (1, 2) controlling infectious disease, (68) and improving patients’ lives (4–7) has been previously shown, we have demonstrated a compelling case for the importance of evidence-based treatment in reducing the economic burden imposed on society by OUD.…”

“…Specifically, as previously shown within this study’s cohort, the standardized mortality ratio in the two-week period following treatment discontinuation was 31.5 (95%CI: 26.2, 37.5) compared to 1.8 (1.6, 2.1) during treatment and 6.1 (5.7, 6.5) during all out-of-treatment periods. (1) Our observation that individuals with OUD had relatively little exposure to maintenance-oriented treatment over the duration of follow-up, despite its proven effectiveness, further highlights the need to improve treatment-engagement strategies.…”

Six-Year Outcome of Opioid Maintenance Treatment in Heroin-Dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample

“…Noteworthy is that a similar mortality rate was recently reported in a 4.5-year (mean) follow-up study of patients who had been randomized in an opioid treatment programme to receive open-label methadone or buprenorphine/naloxone [26]. Furthermore, Evans et al [39] found a 3.2% mortality rate in 32,322 individuals in pharmacological treatment over a 2.6-year (mean) treatment period; mortality was highest when individuals were out of treatment and during detoxification, particularly in the 2-weeks post-treatment entry. Degenhardt et al [40] estimated the mortality reduction in opioid maintenance therapy to be 29%.…”

Characterizing Long-Term Health Related Quality of Life Trajectories of Individuals With Opioid Use Disorder

“…A more detailed examination with more frequent HRQoL measurements and complete information on medication receipt may further clarify the long-term effects of OAT on HRQoL, in the interest of producing unbiased assessments of competing treatment modalities. It should be clear, however, that the QALY gains derived from the reduction in the risk of mortality attributable to OAT (Degenhardt et al, 2011; Evans et al, 2015; Nosyk, Min, et al, 2015), drive results in economic modeling efforts and underline the importance of this life-saving treatment.…”