Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies

by | Addiction

http://www.bmj.com/content/357/bmj.j1550

Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids. The induction phase onto methadone treatment and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk. These findings are potentially important, but further research must be conducted to properly account for potential confounding and selection bias in comparisons of mortality risk between opioid substitution treatments, as well as throughout periods in and out of each treatment.

What is already known on this topic

  • Opioid substitution treatment is effective in suppressing illicit opioid use and reducing all cause and overdose mortality

  • Growing evidence suggests that mortality during and after opioid substitution treatment is time varying and differs by type of drug

What this study adds

  • In patients using methadone maintenance treatment there are, on average, 25 fewer deaths/1000 person years than in patients who discontinue it. Mortality risk among opioid users during treatment is less than a third of that expected in the absence of opioid substitution treatment

  • Buprenorphine maintenance treatment is probably also effective in reducing mortality in opioid users, but quantification of averted deaths requires further studies

  • The mortality risk in the induction phase of methadone (first four weeks) is high but seems to decreases substantially during this period, with a further stabilisation at around six deaths/1000 person years in the remaining time in treatment. This did not occur with buprenorphine. The mortality risk in the four weeks immediately after cessation of either treatment is high and could exceed 30 deaths/1000 person years

I have prescribed Buprenorphine for over a decade.  It’s a MUCH better therapy than Methadone.  BUP is properly used in conjunction with the 12-step programs such as NA or AA.  Medication does NOT cure addiction, there is NO CURE for addiction, however addiction can be CONTROLLED.  The purpose of medication is to keep the afflicted comfortable enough to attend meetings and recover.

The US has a ridiculous limit on the amount of addicts a physician can treat with BUP.  This is ridiculous!  Physicians are not limited for any other disease that they treat.  BUP saves lives!  Patients need to stay on it for as long as they think that they need it.  I’ve had patients stay on it for years, going to meetings and working the program.  Why argue with success?  If the medication is working, why stop the therapy? To allow a different patient to be on that physicians “BUP Census”?

Crazy!

BUP is also a great pain medication for those with chronic pain, the side effect/benefit is that for those who try to abuse opiates while on BUP, the BUP blocks the euphoric effect of opiates; “They sure don’t make heroin like they used to!”

Dr. Raymond Oenbrink
Latest posts by Dr. Raymond Oenbrink (see all)