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Addiction. 2015 Jun;110(6):996-1005. doi: 10.1111/add.12863. Epub 2015 Mar 15.

Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-10.

Author information

1
UCLA Integrated Substance Abuse Programs, Los Angeles, CA, USA.
2
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
3
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
4
Simon Fraser University, Faculty of Health Sciences, Barnaby, BC, Canada.

Abstract

AIMS:

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.

DESIGN:

Population-based treatment cohort study.

SETTING:

Linked mortality data on all individuals first enrolled in publicly funded pharmacological treatment for opioid dependence in California, USA from 2006 to 2010.

PARTICIPANTS:

A total of 32 322 individuals, among whom there were 1031 deaths (3.2%) over a median follow-up of 2.6 years (interquartile range = 1.4-3.7).

MEASUREMENTS:

The primary outcome was mortality, indicated by time to death, crude mortality rates (CMR) and standardized mortality ratios (SMR).

FINDINGS:

Individuals being treated for opioid dependence had a more than fourfold increase of mortality risk compared with the general population [SMR = 4.5, 95% confidence interval (CI) = 4.2, 4.8]. Mortality risk was higher (1) when individuals were out-of-treatment (SMR = 6.1, 95% CI = 5.7, 6.5) than in-treatment (SMR = 1.8, 95% CI = 1.6, 2.1) and (2) during detoxification (SMR = 2.4, 95% CI = 1.5, 3.8) than during MMT (SMR = 1.8, 95% CI = 1.5, 2.1), especially in the 2 weeks post-treatment entry (SMR = 5.5, 95% CI = 2.7, 9.8 versus SMR = 2.5, 95% CI = 1.7, 4.9). 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.

CONCLUSIONS:

In people with opiate dependence, detoxification and methadone maintenance treatment both independently reduce the instantaneous hazard of all-cause and drug-related mortality.

KEYWORDS:

Administrative data; detoxification and maintenance treatment; longitudinal design; mortality; opioid dependence

PMID:
25644938
PMCID:
PMC4452110
DOI:
10.1111/add.12863
[Indexed for MEDLINE]
Free PMC Article

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