The role of methadone in drug-related deaths in the west of Scotland

Seymour, Alison; Black, Marjorie; Jay, Jane; Cooper, Gail; Weir, Christopher J.; Oliver, John S.

doi:10.1046/j.1360-0443.2003.00425.x

Cited by 69 publications

(44 citation statements)

References 32 publications

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“…Adoption of more rigorous supervision and control procedures in accordance with evidence-based OMT guidelines should be considered but without impeding treatment engagement or reducing accessibility and attractiveness of OMT [43,44] . So far, national strategies to improve provision of MMT and reduce the number of methadone-related overdose deaths have been successfully introduced in other countries [39,41] .…”

Section: Discussionmentioning

confidence: 99%

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Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

et al. 2016

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Background/Aims: Increasing rates of overdose deaths involving opioid maintenance treatment (OMT) medications and particularly methadone have been observed concurrently with the implementation of liberal OMT strategies (i.e. minimum of control and high doses prescribed). This study examined methadone-related overdose deaths in a liberal OMT programme. Methods: Drug-overdose deaths (n = 130) with detection of methadone in Copenhagen, Aarhus, and Odense Municipality, Denmark, during the period 2008-2011 were identified from a registry. Cases with and without prescribed methadone as OMT were compared. Treatment delivery strategy among OMT-prescribed methadone cases was investigated. Results: Methadone was detected in 130 overdose deaths (71.4% of all overdose deaths). Among these, 63.1% were receiving methadone maintenance treatment. Of these, 79.3% had co-detection of benzodiazepines. Concomitant detection of heroin, non-prescribed benzodiazepines, and younger age were associated with having non-prescribed methadone in the toxicological findings (adjusted OR 3.1, 4.0 and 9.5, respectively). Of the decedents, 43.8% were prescribed a higher methadone dose than recommended (>120 mg daily), of which 80.0% did not have supervised intake of methadone. Conclusions: Liberal OMT access does not necessarily prevent overdose deaths overall. Prescription of higher doses of methadone combined with benzodiazepines may result in an increased risk of overdose for individuals in as well as outside OMT.

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Section: Discussionmentioning

confidence: 99%

“…Too low doses and too high doses of prescribed methadone are associated with increased risk of overdose death [38,39] . In the 2 municipalities included in this study where data was available, the mean methadone dose prescribed to all individuals receiving MMT was 125 mg daily [40] .…”

Section: Discussionmentioning

confidence: 99%

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

et al. 2016

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“…20 The second strand of research is looking at the negative consequences of illicit use, mainly in the form of methadone-and buprenorphine-related mortality among users not in treatment. 6,8,[26][27][28][29][30][31][32] The majority of such fatalities are caused by polyintoxication involving a broad array of different substances, often sedatives and alcohol. 6,29,31,32 Such deaths have made up a significant percentage of the opioid-related mortality in some countries, not least Sweden; since 2011 the combined number of methadone-and buprenorphine-related fatalities have exceeded heroin-related deaths.…”

Section: Introductionmentioning

confidence: 99%

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

Johnson

Richert

2014

Journal of Psychoactive Drugs

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BackgroundDiversion-patients who sell or share their medication-is a hotly debated but relatively unresearched phenomenon. We have investigated the prevalence of self-reported diversion of methadone and buprenorphine at OST programs in Sweden. We have also examined if demographic, treatment, and social factors can be associated with an increased risk of diversion. MethodsStructured interviews were conducted with 411 patients from eleven OST programs. A standardized questionnaire with 106 close-and five open-ended questions were used. 280 interviews were done on site, by the researchers, while 131 interviews were conducted by specially trained patients through privileged access interviewing. The data were analyzed through frequency-and averages-calculations, cross-tabulations, and logistic regression analysis. ResultsIn total, 24.1% (n=99) of the patients reported diversion in the past month. 67.6% (n=277) stated that they had diverted at some point. The peer interviews showed significantly higher levels of diversion (37.4% past month) compared with the researcher interviews (17.2%).Neither demographic factors, dosages, nor collection routines were associated with diversion.The likelihood of diversion was higher for patients on mono-buprenorphine (OR=5.64) and buprenorphine-naloxone (OR=2.10), than among methadone patients. Other factors which increased the likelihood of diversion were current illicit drug use (OR=5.60), having had 3 patients as a primary source of illicit methadone or buprenorphine prior to treatment (OR=3.39), and mainly socializing with active drug users (OR=2.12). ConclusionSelf-reported diversion was considerably higher than in previous studies. This is most likely due to the new methodological strategy we used, but may also partly be explained by low availability of OST in Sweden, leading to a high demand for the substances by heroin users outside treatment. Efforts to decrease diversion should primarily focus on psychosocial and lifestyle-changing interventions, and expanded access to treatment, rather than on control measures.

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“…For instance, injection of crushed buprenorphine tablets and methadone syrup appear riskier than oral intake, as is concomitant intake of other substances, particularly benzodiazepines (Kintz, 2001;Mégarbane et al, 2006;Nielsen et al, 2008;Renard et al, 2008). Even though buprenorphine is generally considered safer than methadone (Bernard et al, 2013;Ernst et al, 2002;Heinemann et al, 2000;Seymour et al, 2003;Vormfelde et al, 2001), there have been reported fatalities after buprenorphine snorting or injecting (Ferrant, 2011;Tracqui et al, 1998). Further, fatalities have also been reported after highdose buprenorphine consumption regardless of intake mode, especially when combined with benzodiazepines and alcohol (Häkkinen et al, 2012;Lai et al, 2006;Schifano et al, 2005;Seldén et al, 2012).…”

Section: Introductionmentioning

confidence: 96%

Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses

Bretteville-Jensen¹,

Lillehagen²,

Gjersing³

et al. 2015

Drug and Alcohol Dependence

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Background and aims: Diversion of opioid substitution drugs (OSD) is of public concern. This study examined the prevalence, frequency, and predictors of illicit OSD use in a group of injecting drug users (IDUs) and assessed if such use was associated with non-fatal overdoses.Methods: Semi-annual cross-sectional interviews conducted in Oslo, Norway, (2006Norway, ( -2013, from 1,355 street-recruited IDUs. Hurdle, logistic, and multinomial regression models were employed.Results: Overall, 27% reported illicit OSD use in the past four weeks; 16.8% methadone, 12.5% buprenorphine, and 2.9% both drugs. Almost 1/10 reported at least one non-fatal overdose in the past four weeks, and roughly 1/3 reported such experience in the past year. Use of additional drugs tended to be equally, or more prevalent among illicit OSD users than other IDUs. In terms of illicit OSD use being a risk factor for non-lethal overdoses, our results showed significant associations only for infrequent buprenorphine use (using once or less than once per week). Other factors associated with non-fatal overdoses included age, education, homelessness, as well as the benzodiazepines, stimulants, and heroin use. Conclusions:Users of diverted OSD may represent a high-risk population, as they used more additional drugs and used them more frequently than other IDUs. However, illicit OSD use may be less harmful than previously assumed. After accounting for an extensive set of covariates, only infrequent illicit buprenorphine use, but not methadone use, was associated with non-fatal overdoses.

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The role of methadone in drug-related deaths in the west of Scotland

Cited by 69 publications

References 32 publications

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses

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