Opioid Agonist Treatments and Heroin Overdose Deaths in Baltimore, Maryland, 1995–2009

Schwartz, Robert P.; Gryczynski, Jan; O’Grady, Kevin E.; Sharfstein, Joshua M.; Warren, Gregory; Olsen, Yngvild; Mitchell, Shannon Gwin; Jaffe, Jerome H.

doi:10.2105/ajph.2012.301049

Cited by 240 publications

(166 citation statements)

References 41 publications

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“…Both buprenorphine and methadone treatment are associated with reduced overdose risk and improved maternal and fetal outcomes in pregnancy (19,44,51,72). Despite strong evidence supporting the use of buprenorphine and methadone, fewer than 1 million Americans are receiving these treatments (87).…”

Section: Tertiary Preventionmentioning

confidence: 99%

The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

Kolodny

Courtwright

Hwang

et al. 2015

Annu. Rev. Public Health

1,193

874

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Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use. A multifaceted public health approach that utilizes primary, secondary, and tertiary opioid addiction prevention strategies is required to effectively reduce opioid-related morbidity and mortality. We describe the scope of this public health crisis, its historical context, contributing factors, and lines of evidence indicating the role of addiction in exacerbating morbidity and mortality, and we provide a framework for interventions to address the epidemic of opioid addiction.

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Section: Tertiary Preventionmentioning

confidence: 99%

The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

Kolodny

Courtwright

Hwang

et al. 2015

Annu. Rev. Public Health

1,193

874

View full text Add to dashboard Cite

show abstract

“…In patients undergoing treatment for opioid use disorders, methadone therapy is associated with several improved outcomes, including retention in drug treatment as well as reduced opioid use, and some observational studies have observed reductions in allcause mortality and risk of death from overdose (Esteban et al, 2003;Gibson et al, 2008;Huang & Lee, 2013;Langendam, van Brussel, Coutinho, & van Ameijden, 2001;Mattick, Breen, Kimber, & Davoli, 2009;Perry et al, 2013;Schwartz et al, 2013). On the basis of its effectiveness, the World Health Organization added methadone to its list of essential medicines in 2005.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Opioid-Related Death During Methadone Therapy

Leece

Cavacuiti

Macdonald

et al. 2015

Journal of Substance Abuse Treatment

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We aimed to examine pharmacologic, demographic and medical comorbidity risk factors for opioid-related mortality among patients currently receiving methadone for an opioid use disorder. We conducted a population-based, nested case-control study linking healthcare and coroner's records in Ontario, Canada, from January 31, 1994 to December 31, 2010. We included social assistance recipients receiving methadone for an opioid use disorder. Within this group, cases were those who died of opioid-related causes. For each case, we identified up to 5 controls matched on calendar quarter. The primary analysis examined the association between use of psychotropic drugs (benzodiazepines, antidepressants or antipsychotics) and opioid-related mortality. Secondary analyses examined the associations between baseline characteristics, health service utilization, comorbidities and opioid-related mortality. Among 43,545 patients receiving methadone for an opioid use disorder, we identified 175 (0.4%) opioid-related deaths, along with 873 matched controls. Psychotropic drug use was associated with a two fold increased risk of opioid-related death (adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.2 to 3.5). Specifically, benzodiazepines (adjusted OR 1.6; 95% CI 1.1 to 2.5) and antipsychotics (adjusted OR 2.3; 95% CI 1.5 to 3.5) were independently associated with opioid-related death. Other associated factors included chronic lung disease (adjusted OR 1.7; 95% CI 1.2 to 2.6), an alcohol use disorder (adjusted OR 1.9; 95% CI 1.2 to 3.2), mood disorders (adjusted OR 1.8; 95% CI 1.0 to 3.2), and a history of heart disease (adjusted OR 5.3; 95% CI 2.0 to 14.0). Psychotropic drug use is associated with opioid-related death in patients receiving methadone. Mindfulness of these factors may reduce the risk of death among methadone recipients.

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“…Even under ideal conditions, PDMPrelated reductions in OA deaths appear to be similar to those reported for laws and policies that increase access to the overdose reversal medication naloxone, for example, and lower than those associated with increased access to medical cannabis [2,17,18]. They are far lower than those associated with opioid agonist and partial agonist treatment [19]. These interventions also have the benefit of reducing mortality related to all opioids, not just OAssomething that has not been shown to be true for PDMPs.…”

mentioning

confidence: 58%

Commentary on Pardo (2017) and Moyo et al. (2017): Much still unknown about prescription drug monitoring programs

Davis

2017

Addiction

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Opioid Agonist Treatments and Heroin Overdose Deaths in Baltimore, Maryland, 1995–2009

Abstract: Increased access to opioid agonist treatment was associated with a reduction in heroin overdose deaths. Implementing policies that support evidence-based medication treatment of opiate dependence may decrease heroin overdose deaths.

Cited by 240 publications

References 41 publications

The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

Predictors of Opioid-Related Death During Methadone Therapy

Commentary on Pardo (2017) and Moyo et al. (2017): Much still unknown about prescription drug monitoring programs

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