Stephen Magura on Sam Schildhaus and Bernard Dugoni's “Premature Death as the Ultimate Failure: Predictors of Death in the US Drug User Treatment Population” A Little More Treatment, Please!

Abstract

The research on long-term public health effects of drug user treatment continues to be quite sparse. By “longterm” I mean longer than one-year follow-up (!), although most research these days is less than even that. Thus it is welcome to see an analysis of a major national study of drug user treatment that provides new information on an important public health outcome—premature death—at a follow-up five years after discharge from treatment. Most of the data we have on premature death among treatment clients are derived from follow-ups of methadone maintenance patients; these studies, conducted in a variety of countries, strongly support the value of continued methadone maintenance in reducing death rates compared with individuals who leave methadone “against medical advice,” or opioid addicts who do not receive methadone (e.g., Cousins et al., 2011; Huang et al., 2011; Magura and Rosenblum, 2001; Woody et al., 2007). The present paper includes clients in a full range of drug user treatments, finding that treatment completion is associated with a lower rate of premature death. The strength of the analysis is the strong set of relevant controls included for possible confounds in this relationship, including the client’s age, type of substance, gender, months of treatment, and type of treatment. Although the study data cannot explain exactly why treatment completion exerts this protective effect—this would be a promising avenue for further research—the study does suggest that success in any of several major treatment modalities has an enduring effect on an important public health metric. Clearly this adds to justification for