Risk of drug-related mortality during periods of transition in methadone maintenance treatment: A cohort study

Cousins, Gráinne; Teljeur, Conor; Mondaini, Nicola; McCowan, Colin; Dimitrov, Borislav D.; Fahey, Tom

doi:10.1016/j.jsat.2011.05.001

Cited by 91 publications

(83 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the benefits of AOD treatments are evident, studies also show that drug users experience elevated mortality risk within the four weeks immediately following treatment cessation (Clausen et al, 2008;Cousins et al, 2011;Degenhardt et al, 2009). To date research on this phenomenon has largely focussed on opioid-users engaged in pharmacotherapy (Clausen et al, 2008;Davoli et al, 2007;Degenhardt et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, Ledberg (2017) reported mortality rates in a sample of opiate users undergoing methadone maintenance treatment was significantly increased compared to the general population, both during periods of treatment and when not in treatment. While mortality risk is higher among opioid pharmacotherapy clients in the first two to four weeks following treatment cessation (Clausen, Anchersen, & Waal, 2008;Cousins et al, 2011;Degenhardt et al, 2009) the initial four weeks of pharmacotherapy induction is also a time of elevated risk compared with remaining time in treatment. Similar patterns of elevated mortality risk immediately following treatment cessation have been noted in other drug using cohorts.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Yet, there is also risk associated with treatment engagement and drug use cessation. Evidence suggests that among opioid, heroin and alcohol treatment attendees in particular, mortality rates peak within the first four weeks following treatment cessation (Buster, Brussel, & Brink, 2002;Cousins et al, 2011;Degenhardt et al, 2009;Strang et al, 2003) Examination of mortality outcomes for drug users indicates that treatment engagement is protective against premature mortality; that is mortality rates are lower when users are in treatment than prior to or indeed following treatment cessation (Darke, Mills, Ross, & Teesson, 2011;Degenhardt et al, 2009). The period immediately after discharge from residential detoxification (Strang et al, 2003) or following incarceration (Farrell & Marsden, 2008;Ødegård, Amundsen, Kielland, & Kristoffersen, 2010;Seaman, Brettle, & Gore, 1998), has been associated with sharply elevated overdose fatality risk.…”

Section: Accepted Manuscript 1 Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Exploring mortality among drug treatment clients: The relationship between treatment type and mortality

Lloyd

Zahnow

Barratt

et al. 2017

Journal of Substance Abuse Treatment

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscript 1 Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Exploring mortality among drug treatment clients: The relationship between treatment type and mortality

Lloyd

Zahnow

Barratt

et al. 2017

Journal of Substance Abuse Treatment

View full text Add to dashboard Cite

“…We first adjusted for sex, age, calendar year, comorbidity score and geographical region following earlier analyses 20, 21, 44, 45. Comorbidity was calculated based upon 17 chronic illnesses and their associated weights, as defined by Khan et al .…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

“…Unplanned exit from treatment can lead to relapse to drug use, injecting and other high risk behaviours [17]. There is also a greater risk of drug-mediated mortality in the 30 days after dropout or discharge from MMT [18]. However, a significant proportion of opiate-dependent patients fail to remain in methadone treatment over a sustained period of time.…”

Section: Introductionmentioning

confidence: 99%

Demographic and clinical factors predicting retention in methadone maintenance: results from an Irish cohort

Darker

Kelly

et al. 2015

Ir J Med Sci

View full text Add to dashboard Cite

Background Retention in Methadone Maintenance Treatment (MMT) is superior to that of other therapies for opioid addiction, but with international retention rates around 50 % after 1 year of treatment, there remains a need for improved retention rates. Aims This study aimed to explore the demographic and clinical factors predicting retention in MMT. Methods Face-to-face surveys with MMT patients in a Dublin methadone clinic were conducted. Retention was assessed by the presence and duration of breaks in treatment at any stage. Results 189 patients participated in the study. 46 % (n = 87) reported having at least one break in treatment, and the median duration of a break was 3 months. Age, current methadone dose and prescription of antipsychotic medication were significant predictors of retention. Patients who were older, single, living in their own home, on a higher dose of methadone, or taking antipsychotic medications had fewer breaks in treatment. Males tended to have significantly longer breaks. Patients reported that the main reasons for breaks were relapse into drug use (21.8 %, n = 19), incarceration (11.4 %, n = 10), weary of MMT (13.7 %, n = 12) or problems at the clinic (10.3 %, n = 9). Factors enabling regular attendance included wanting to get or stay clean (37.5 %, n = 51), avoidance of withdrawal symptoms (16.1 %, n = 22), methadone dependence (13.9 %, n = 19) and services provided (10.2 %, n = 14). Conclusion Patients who were older, single, living in their own home, on a higher dose of methadone, or taking antipsychotic medications had fewer breaks in treatment.

show abstract

Risk of drug-related mortality during periods of transition in methadone maintenance treatment: A cohort study

Cited by 91 publications

References 32 publications

Exploring mortality among drug treatment clients: The relationship between treatment type and mortality

Exploring mortality among drug treatment clients: The relationship between treatment type and mortality

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

Demographic and clinical factors predicting retention in methadone maintenance: results from an Irish cohort

Contact Info

Product

Resources

About