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Type: Journal article
Title: Exposure to opioid maintenance treatment reduces long-term mortality
Author: Gibson, A.
Degenhardt, L.
Mattick, R.
Ali, R.
White, J.
O'Brien, S.
Citation: Addiction, 2008; 103(3):462-468
Publisher: Blackwell Publishing Ltd
Issue Date: 2008
ISSN: 0965-2140
Statement of
Amy Gibson, Louisa Degenhardt, Richard P. Mattick, Robert Ali, Jason White & Susannah O’Brien
Abstract: AIMS: To (i) examine the predictors of mortality in a randomized study of methadone versus buprenorphine maintenance treatment; (ii) compare the survival experience of the randomized subject groups; and (iii) describe the causes of death. DESIGN: Ten-year longitudinal follow-up of mortality among participants in a randomized trial of methadone versus buprenorphine maintenance treatment. SETTING: Recruitment through three clinics for a randomized trial of buprenorphine versus methadone maintenance. PARTICIPANTS: A total of 405 heroin-dependent (DSM-IV) participants aged 18 years and above who consented to participate in original study. MEASUREMENTS: Baseline data from original randomized study; dates and causes of death through data linkage with Births, Deaths and Marriages registries; and longitudinal treatment exposure via State health departments. Predictors of mortality examined through survival analysis. FINDINGS: There was an overall mortality rate of 8.84 deaths per 1000 person-years of follow-up and causes of death were comparable with the literature. Increased exposure to episodes of opioid treatment longer than 7 days reduced the risk of mortality; there was no differential mortality among methadone versus buprenorphine participants. More dependent, heavier users of heroin at baseline had a lower risk of death, and also higher exposure to opioid treatment. Older participants randomized to buprenorphine treatment had significantly improved survival. Aboriginal or Torres Strait Islander participants had a higher risk of death. CONCLUSIONS: Increased exposure to opioid maintenance treatment reduces the risk of death in opioid-dependent people. There was no differential reduction between buprenorphine and methadone. Previous studies suggesting differential effects may have been affected by biases in patient selection.
Keywords: Buprenorphine; longitudinal; maintenance treatment; methadone; mortality; opioid dependence; RCT.
RMID: 0020083693
DOI: 10.1111/j.1360-0443.2007.02090.x
Appears in Collections:Pharmacology publications

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