title: Exposure to opioid maintenance treatment reduces long-term mortality.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Ten-year longitudinal follow-up of mortality among participants in a randomized trial of methadone versus buprenorphine maintenance treatment.
  
  
  METHODS
  Recruitment through three clinics for a randomized trial of buprenorphine versus methadone maintenance.
  
  
  METHODS
  A total of 405 heroin-dependent (DSM-IV) participants aged 18 years and above who consented to participate in original study.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Australia. amy.gibson@med.unsw.edu.au
authors.forename: Amy
authors.initials: A
authors.lastname: Gibson
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.forename: Richard P
authors.initials: RP
authors.lastname: Mattick
authors.forename: Robert
authors.initials: R
authors.lastname: Ali
authors.forename: Jason
authors.initials: J
authors.lastname: White
authors.forename: Susannah
authors.initials: S
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D002047:Buprenorphine / Q000627:therapeutic use*; D002423:Cause of Death; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000401:mortality / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone