To estimate mortality rates among treated opioid-dependent
individuals by cause and in relation to the general population, and to estimate
the instantaneous effects of opioid detoxification and maintenance treatment
(MMT) on the hazard of all-cause and cause-specific mortality.
Population-based treatment cohort study.
Linked mortality data on all individuals first enrolled in
publicly-funded pharmacological treatment for opioid dependence in California,
USA from 2006 to 2010.
32,322 individuals, among whom there were 1,031 deaths
(3.2%) over a median follow-up of 2.6 years (interquartile range: 1.4 - 3.7).
The primary outcome was mortality, indicated by time to
death, crude mortality rates (CMR), and standardized mortality ratios (SMR).
Individuals being treated for opioid dependence had a more
than four-fold increase of mortality risk compared with the general population. Mortality risk was higher when individuals were
out-of-treatment than in-treatment and during detoxificationthan
during MMT, especially in the two weeks
post-treatment entry. Detoxification and MMT both independently reduced the instantaneous
hazard of all-cause and drug-related mortality. MMT preceded by detoxification
was associated with lower all-cause and other-cause-specific mortality than MMT
alone.
In people with opiate dependence, detoxification and
methadone maintenance treatment both independently reduce the instantaneous
hazard of all-cause and drug-related mortality.
Below: Crude mortality rates by cause of death according to in-treatment and out-of-treatment periods
ˆ overdose (accidental poisoning by alcohol or other drugs), other drug-related (harmful alcohol or drug use or dependence)
+ suicide (intentional self-harm or self-poisoning), homicide, injury (accidental injury, traffic accidents)
# cancer, respiratory disease, liver disease, diabetes, infections/parasites, endometriosis, digestive disease, renal disease, central nervous system, other, and unknown
See Appendix 1 for ICD-10 codes incldued in each category of mortality.
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By:
2British Columbia Centre for Excellence in HIV/AIDS
3Northwestern University Feinberg School of Medicine
4Simon Fraser University, Faculty of Health Sciences
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