Abstract
BackgroundAs the effect of opioid maintenance treatment (OMT) on overdose mortality varies both between and within countries, treatment programs need to be evaluated in different treatment settings and over time within settings. We evaluated variations in mortality in a national programme: from the initial rollout as restrictive and low-capacity to its gradual change into more liberal and higher-volume.MethodsA 12-year prospective longitudinal cohort study including all persons (n = 6871) applying for and entering OMT in Norway (1997–2009). We followed all patients until 2009 or until death. We used crude mortality rates (CMR) to calculate overdose and all-cause mortality among patients in OMT before, during and after treatment, during a 12-year time-period. We also calculated variations in overdose and all-cause mortality over the course of treatment and after treatment termination. We fitted proportional hazards models with covariates to the data.ResultsOMT significantly reduces risk of mortality compared to being outside of treatment. The reduction in overdose death was most substantial during the initial phase of the Norwegian OMT-programme, still; we consistently find that overdose deaths were more than halved in all calendar-periods throughout observation. We did not find an elevated risk of overdose death in the first weeks of treatment, nor in the first weeks after treatment cessation.ConclusionIn Norway, OMT reduces overall mortality. Reduction in mortality is likely dependent of both treatment delivery and characteristics of the at-risk population.
Highlights
As the effect of opioid maintenance treatment (OMT) on overdose mortality varies both between and within countries, treatment programs need to be evaluated in different treatment settings and over time within settings
All-cause mortality was reduced to two thirds of pre-treatment levels (Rate Ratio 0.66, 95% CI 0.52–0.83) and overdose death was reduced to about one third (Rate Ratio 0.36, 95% CI 0.03–3.90) respectively
Overdose mortality accounted for almost 70% of all deaths, and the all-cause crude mortality rates (CMR) was 33.7/10000PY
Summary
As the effect of opioid maintenance treatment (OMT) on overdose mortality varies both between and within countries, treatment programs need to be evaluated in different treatment settings and over time within settings. People with opioid dependence are nearly 15 times more likely to die than their peers [6], and drug overdose is Opioid use disorder is a complex health condition that often requires long-term treatment and care, and according to the World Health Organization, opioid agonist maintenance treatment often in terms of methadone and buprenorphine formulations, combined with psychosocial assistance, is the treatment of choice [8]. Opioid maintenance treatment (OMT) is a well-established treatment approach for opioid dependence and has proven effects on a number of outcomes including both social variables such as criminality [10] and health related variables such as morbidity [3]. Not least does several studies and meta-analysis agree that overdose mortality is reduced during OMT [11,12,13,14,15]
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