Death Before, During, and After Opioid Maintenance Treatment

To what extent does opioid maintenance therapy (OMT) reduce mortality in patients with dependence? To answer this question, Norwegian researchers linked data from a national death registry to a national database of people who were on a waiting list for OMT, receiving OMT (predominantly methadone), or discontinued OMT. Researchers then compared the risk of death during treatment with the risk before and after treatment among 3789 patients. In some cases, data from the death registry were confirmed with death certificates and autopsy results.

• Over 7 years, 213 patients died.

• Seventy-nine percent of deaths in the waiting-list group, 27% of deaths in the treatment group, and 61% of deaths in the discontinued-treatment group were attributed to overdose.

• Mortality risk (from overdose and other causes) was significantly lower in patients receiving treatment than in patients on the waiting list (relative risk [RR], 0.5; death rates of 1.4 versus 2.4 per 100 person years, respectively).

• Risk was highest among men who discontinued treatment (RR, 1.8 compared with men on the waiting list).

Comments:

With impressive methodological rigor, these investigators provide further strong evidence that OMT lowers the risk of death. Because of the increasing cases of overdose death attributed to physician-prescribed methadone for pain and the potential negative public backlash towards this treatment, these data may play an important role in policy efforts that support the continued use of OMT to reduce mortality risk in people with opioid dependence.

Jeffrey A. Samet, MD, MA, MPH

Reference:

Clausen T, Anchersen K, Waal H. Mortality prior to, during, and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug Alcohol Depend. 2008;94(1-3):151-157.