title: Trends in drug overdose deaths in England and Wales 1993-98: methadone does not kill more people than heroin.
abstract: OBJECTIVE
  To test the hypothesis that methadone is responsible for a greater increase in overdose deaths than heroin, and causes proportionally more overdose deaths than heroin at weekends.
  
  
  METHODS
  Multivariate analysis of 3961 death certificates mentioning heroin, morphine and/or methadone held on the Office for National Statistics drug-related poisoning mortality database from 1993 to 1998 in England and Wales.
  
  
  METHODS
  Percentage increase in deaths by year by drug, odds ratio (OR) of dying at the weekend from methadone-related overdose compared to dying from heroin/morphine overdose.
  
  
  RESULTS
  From 1993 to 1998, annual opiate overdose deaths increased from 378 to 909. There was a 24.7% (95% confidence interval (CI) 22-28%) yearly increase in heroin deaths compared to 9.4% (95% CI 6-13%) for methadone only. This difference was significant (P < 0.001 by test of interaction) after adjustment for sex, age group, polydrug use, area of residence and underlying cause of death. The largest number of deaths occurred on Saturday (673). The OR of death from methadone overdose on Saturday and Sunday was 1.48 (95% CI 1.29-1.71) for methadone-only deaths compared to dying from heroin/morphine at the weekend after adjustment for other covariates, but the OR was not significant (1.09, 95% CI 0.95-1.25) if the weekend was defined as Friday and Saturday.
  
  
  CONCLUSIONS
  There was no evidence that the threefold increase in deaths over time was due to methadone. There was equivocal support only for the hypothesis that there was an excess of deaths from methadone at weekends. Increased interventions to prevent overdose among injectors in England and Wales are long overdue.
authors.affiliation: Centre for Research on Drugs and Health Behaviour, Social Science and Medicine, Imperial College, London, UK. m.hickman@ic.ac.uk
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.forename: Peter
authors.initials: P
authors.lastname: Madden
authors.forename: John
authors.initials: J
authors.lastname: Henry
authors.forename: Allan
authors.initials: A
authors.lastname: Baker
authors.forename: Chris
authors.initials: C
authors.lastname: Wallace
authors.forename: Jon
authors.initials: J
authors.lastname: Wakefield
authors.forename: Gerry
authors.initials: G
authors.lastname: Stimson
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
mesh_terms: D000293:Adolescent; D000328:Adult; D062787:Drug Overdose / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006556:Heroin Dependence / Q000401:mortality*; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects*; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D009294:Narcotics / Q000009:adverse effects*; D014852:Wales / Q000453:epidemiology
chemical_list: D009294:Narcotics; D008691:Methadone