Drug-Addicted Patients Vulnerable to Overdose Death in the 4 Weeks Following Medication-Free Treatment

People with drug addiction may be particularly vulnerable to overdose following a period of abstinence. In this prospective study from Norway, investigators examined mortality rates among 276 patients with drug addiction admitted to either medication-free inpatient treatment (MFIT) or therapeutic community (TC) programs. Deaths and causes of death were ascertained from Norway’s National Death Register over a mean of 8 years. Mortality rates were calculated as deaths per 100 person-years at risk. Investigators compared rates in the first 4 weeks following MFIT/TC participation with the remainder of the observation period via rate ratio. Bivariate analyses were conducted to adjust for patient characteristics. Mean time in inpatient treatment was 54 weeks (range, 0–172 weeks) with 41% of patients completing treatment versus dropping out.

• Thirty-six deaths (13% of patients) occurred over the follow-up period (2.1 deaths per 100 person-years): 24 by overdose, 7 by violent death (including traffic accidents), and 5 by unknown causes.

• Mortality rates were highest in the first 4 weeks after leaving treatment (rate ratio, 15.7). All 6 deaths in that period were due to opioid overdose.

• There was no association between mortality rate and length of time in MFIT/TC, drop-out from treatment, or history of overdose.

Comments:

As previously documented among inmates with drug addiction following prison release, the 4-week window following treatment exit represents a particularly vulnerable period for potentially fatal overdose. Although substitution therapy is available in Norway (under stringent rules), the authors do not provide a comparison of overdose rates among these participants. Effective treatment and overdose-prevention programs (both for patients who complete treatment and for those who drop out) are needed to prevent premature mortality.

Hillary Kunins, MD, MPH, MS

Reference:

Ravndal E, Amundsen EJ. Mortality among drug users after discharge from inpatient treatment: an 8-year prospective study. Drug Alcohol Depend. 2010;108(1–2):65–9.