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Research Summary

Risk of Death during Opioid Agonist Treatment in UK Primary-Care Practices

In the United Kingdom, opioid agonist treatment (OAT) with methadone or buprenorphine is delivered mainly in primary care. The greatest risk of overdose death with OAT is seen at the beginning and end of treatment. In this study, investigators measured the association between OAT delivered in UK primary care and all-cause mortality at the beginning of, and following, OAT. The sample included 5577 patients who received at least 1 prescription for methadone or buprenorphine between 1990 and 2005.

  • Three percent of patients (n=178) died during OAT or within a year of their last prescription. Of these, 35% (n=62) died during treatment.
  • The crude mortality rate for patients not receiving treatment was almost double that of patients receiving OAT (1.3 versus 0.7 per 100 person-years).
  • After adjusting for demographic characteristics, comorbid conditions, and calendar year, the mortality rate ratio was twice as high (2.3) among patients not receiving treatment.
  • The adjusted mortality rate ratio was 2–3 times higher in the first 4 weeks of OAT but 8–9 times higher in the first 4 weeks after stopping treatment (greater than at any time for patients receiving treatment).


Overall, risk of death during OAT was less than the risk of death off treatment. Although this study failed to assess cause of death, results suggest standardized induction protocols for OAT, especially for methadone, are of paramount importance. Jeanette M. Tetrault, MD


Cornish R, Macleod J, Strang J, et al. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ. 2010;341:c5475.