Methadone maintenance treatment, criminality and overdose-related deaths. An ecological study, 1983-1999.
BACKGROUND
Methadone maintenance treatments (MMTs) are the commonest substitution treatments offered to opiate addiction in Switzerland, in order to reduce criminal behaviour, infectious disease transmission and overdose death.


METHODS
To investigate the relationship between the increase in the number of methadone maintenance treatments, criminal activity of addicts and overdose-related deaths, an ecological study was undertaken in the Canton of Geneva, from 1983 to 1999.


RESULTS
The regular and extensive increase in the number of MMTs is not significantly associated, during the 1983-1999 period, with a fall either in drug addict incarcerations or in overdose-related deaths. However, a slight decrease is observed in the number of imprisoned opiate addicts since 1994, and a marked decrease is seen in overdose deaths from 1997 on. An important and stable number of these deaths is due to methadone itself.


CONCLUSIONS
Public health objectives to diminish delinquency and overdose deaths cannot solely be fulfilled by extensive use of MMTs. A positive result could appear when access to MMT is highly favoured. This hypothesis must be proved correct by observational studies conducted on a general population.
Niveau
Gérard
G
Institut Universitaire de Médecine Légale, Av. de Champel 9, 1211 Geneva 4, Switzerland. Gerard.Niveau@hcuge.ch
Rougemont
Anne-Laure
AL
La Harpe
Romano
R
D003415:Crime / Q000639:trends*; D062787:Drug Overdose / Q000401:mortality*; D003932:Heroin / Q000009:adverse effects; D006801:Humans; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D015995:Prevalence; D013557:Switzerland / Q000453:epidemiology
D003932:Heroin; D008691:Methadone