Mortality prior to, during and after opioid maintenance treatment (OMT): A national prospective cross-registry study

University of Oslo, Medical Faculty, Institute of Psychiatry, SERAF - National Centre for Addiction Research, Oslo, Norway.
Drug and Alcohol Dependence (Impact Factor: 3.28). 05/2008; 94(1-3):151-7. DOI: 10.1016/j.drugalcdep.2007.11.003
Source: PubMed

ABSTRACT Opioid maintenance treatment (OMT) is generally considered to reduce mortality in opiate dependents. However, the level of mortality reduction is still uncertain. This study investigates mortality reductions in an "intention-to-treat" perspective including all dropouts. The mortality reducing effects of OMT are examined both within treatment and post-treatment. The study separates overdose and total mortality reductions.
The study is a prospective cross-registry study with up to 7 years follow-up. All opiate dependents in Norway who applied for OMT (a total of 3789 subjects) were cross-linked with data from the death registry from Statistics Norway. Date and cause of death were crossed with dates for initiation and termination of OMT, and subjects' age and gender. A baseline was established from the waiting list mortality rate. Intention-to-treat was investigated by analysing mortality among the entire population that started OMT.
Mortality in treatment was reduced to RR 0.5 (relative risk) compared with pre-treatment. In the "intention-to-treat" perspective, the mortality risk was reduced to RR 0.6 compared with pre-treatment. The patients who left the treatment programme showed a high-mortality rate, particularly males.
OMT significantly reduces risk of mortality also when examined in an intention-to-treat perspective. Studies that evaluate effects of OMT only in patients retained in treatment tend to overestimate benefits. Levels of overdose mortality will influence the risk reduction. Cross-registry studies as the current one are an important supplement to other observational designs in this field.

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Available from: Helge Waal, Jul 20, 2015
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    • "Our findings are consistent with other reports. In a large national study from Norway, of all opiatedependent individuals who applied for opioid maintenance treatment (a total of 3789 subjects), the mortality rate was higher among those on the waiting list between 1 and 365 days compared to the addicts in treatment (Clausen et al., 2008). Another Norwegian study on a small sample reported a higher mortality rate for addicts while they were on the waiting list compared with those in MMT (Blix et al., 1999). "
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    ABSTRACT: OBJECTIVES:: In 2002, our methadone maintenance treatment (MMT) clinic reached full capacity and admission to treatment was delayed for >1 year. In order to evaluate possible impact of the waiting list on mortality risk of the registered patients, we compared survival after the first 2 years, and long-term survival since registration between admitted and not admitted to our MMT (or other treatment facilities) and to those who admitted immediately, before the establishment of the waiting list in 2002. METHODS:: A total of 608 patients registered between 2002 and 2009. Their vital statistics were obtained from the Israeli National Registry (October 2010). RESULTS:: Of the total 608, 366 registrants (60.2%) were admitted to any treatment (194 [53%] to our MMT, 162 [44.3%] to other MMTs and 10 [2.7%] to other facilities) and 242 (39.8%) were not admitted anywhere. Nonadmission to treatment when it became available was due to inability to contact the patient (116, 47.9%), self-reported drug discontinuation (44, 18.2%), refusal to follow regulations (39, 16.1%), imprisonment (27, 11.2%), violent behavior (1, 0.4%), death (13, 5.4%), and other (2, 0.8%). The mortality rate (available among 583) during the 2 years on the waiting list was higher (5.0/100 person years) for the 225 nonadmitted applicants than for the 358 admitted (0.42/100 person years, P < 0.0005) and those who were admitted with no delay before 2002 (2.1/100 person years). The long-term survival between those 3 groups did not differ significantly. CONCLUSIONS:: Opiate addicts are at high risk for mortality during prolonged waiting periods for admission to MMT, indicating an urgent need for immediate expansion of MMT availability.
    Journal of Addiction Medicine 03/2013; DOI:10.1097/ADM.0b013e318287cfc9 · 1.71 Impact Factor
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    • "Commonly it is men in their early to mid-30s who have injected substances over many years who die from an overdose of injected heroin, often in combination with other substances such as alcohol or benzodiazepines [3] [4]. Those who die from an overdose have often experienced previous non-fatal overdoses and are also likely to be out of treatment at the time of death [5] [6] [7]. The majority of these deaths occur at a residential address [8]. "
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    ABSTRACT: Aims: To assess demographic characteristics, treatment utilization and circumstances of death among those who died from drug-induced deaths in an urban setting and to identify possible subpopulations that should be targeted specifically to further develop preventive public health policies. Methods: Subjects (N = 231) who died, from drug-induced deaths, in the Norwegian capital Oslo (2006-2008) were identified through the National Cause of Death Registry. Data on toxicology, prison release and contact with health and social services in Oslo were collected. Results: Majority of cases were men (78%) and the mean age was 37 years. Nearly all cases (90%) were polydrug intoxications. Heroin was implicated in 67%. Residential address was the most common place of death (67%). Most cases (82%) had been in contact with health and social services in the year before death. Women were 4 years older, more often Oslo residents (82% vs. 64%) and fewer died from heroin intoxication. Non-Oslo residents were younger and more likely to have been found outdoors with heroin as the main intoxicant. Other identified subpopulations were those who died after prison release and those discharged from drug treatment. Conclusions: The findings suggest that the majority of cases could have been available for preventive measures through their contacts with health and social services. Yet, the heterogeneity among cases indicates that such measures need to be multifaceted. Finally, it is important for policymakers and health and social workers in various countries to consider subpopulations such as women and non-city residents when developing public health interventions to prevent overdose deaths.
    Scandinavian Journal of Public Health 01/2013; 41(2). DOI:10.1177/1403494812472007 · 3.13 Impact Factor
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    • "Several studies have shown that OMT reduces the risk of death [7] and decreases crime [8] in subjects when compared to illegal heroin use. The World Health Organization (WHO) has published a proposal for the inclusion of methadone as an essential medicine [9], and several Cochrane reviews [10] [11] [12] have assessed the effectiveness of methadone in the treatment of opioid dependence. "
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    ABSTRACT: INTRODUCTION: The use of methadone in opioid maintenance treatment (OMT) is potentially associated with a number of adverse effects and the risk of fatal toxicity. Increased methadone availability may lead to an increase in methadone-related deaths. We have investigated methadone-related deaths in Norway over the period 2000-2006. MATERIALS AND METHODS: Methadone-positive samples over the period 2000-2006 were identified from forensic toxicological investigations, and demographic and toxicological data were retrieved. The cases were cross-linked with the Norwegian Cause of Death Registry and regional OMT registers. RESULTS: A total of 312 individuals had died after taking methadone over the period 2000-2006, predominantly men with a mean age of 36. In 85% of cases (n=264), the deceased had died of a methadone-related intoxication, most often in combination with other drugs, including benzodiazepines, cannabis and other opioids. Only 22% of the deceased had been in OMT at the time of death. A larger proportion of OMT patients had died of causes other than intoxications compared to those not in OMT (30% vs. 8%, respectively), most commonly related to disease. CONCLUSIONS: One methadone-related death occurred, on average, every week over the time period investigated. Only 22% of the deceased were registered in opioid maintenance treatment (OMT) programs. The findings underline the need to control diversion of medication from OMT programs.
    Forensic science international 12/2012; 224(1-3). DOI:10.1016/j.forsciint.2012.11.010 · 2.12 Impact Factor
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