Exposure to opioid maintenance treatment reduces long-term mortality.
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.
Gibson
Amy
A
National Drug and Alcohol Research Centre, UNSW, Australia. amy.gibson@med.unsw.edu.au
Degenhardt
Louisa
L
Mattick
Richard P
RP
Ali
Robert
R
White
Jason
J
O'Brien
Susannah
S
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
D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone