title: Dose-effect relationship between overdose mortality and prescribed methadone dosage in low-threshold maintenance programs.
abstract: The present study evaluates the effectiveness of low-threshold methadone maintenance in reducing overdose mortality. In a prospective cohort study conducted in Amsterdam, 498 Dutch injecting drug users (IDU) provided 1,969 person years of follow-up (1989-1995). Forty-four IDU died in this period, 15 due to illicit drug overdose. Compared to IDU not in maintenance, the adjusted relative risk for overdose mortality among those receiving 5-50 mg, 55-70 mg, and 75+ mg were 0.35, 0.13, and 0.11, respectively (p < .05). Also current injection use and HIV-seropositivity were independent predictors for overdose mortality. Whereas previous studies indicated effectiveness of methadone-assisted detoxification and high-dose maintenance programs in reducing mortality, the present study findings suggest that low-threshold maintenance programs also reduce overdose mortality, with higher dosages being most protective.
authors.affiliation: Municipal Health Service, Division of Public Health and Environment, Amsterdam, The Netherlands. evameijden@GGGD.amsterdam.nl
authors.forename: E J
authors.initials: EJ
authors.lastname: van Ameijden
authors.forename: M W
authors.initials: MW
authors.lastname: Langendam
authors.forename: R A
authors.initials: RA
authors.lastname: Coutinho
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D062787:Drug Overdose / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000627:therapeutic use; D009294:Narcotics / Q000506:poisoning*; D009426:Netherlands / Q000453:epidemiology; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000401:mortality* / Q000534:rehabilitation*; D011446:Prospective Studies; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000401:mortality / Q000534:rehabilitation
chemical_list: D009294:Narcotics; D008691:Methadone