Benefits of retention in methadone maintenance and chronic medical conditions as risk factors for premature death among older heroin addicts.
BACKGROUND
Methadone maintenance treatment reduces rates of premature mortality in heroin addicts. However, few published studies have addressed the effectiveness of treatment, mortality rates, or causes of death in older (geriatric) patients maintained on methadone. Identifying risk factors for premature mortality and potential targets for early intervention may reduce rates of premature mortality in older patients maintained on methadone.


METHODS
We conducted a retrospective chart review for patients enrolled in the methadone maintenance program at the Atlanta Veterans Affairs Medical Center. We reviewed the charts of 91 patients and collected the following information: demographics (age, gender, marital status, and race); composite score at admission on the Addiction Severity Index (ASI); most recent ASI score for alcohol use, drug use, and medical, psychiatric, family, legal, and employment problems; results of urine drug screens for opiates, cocaine, and benzodiazepines (first 4 screens after admission and last 4 screens); dose and duration of methadone treatment; HIV and hepatitis B and C status; tobacco smoking; presence of diabetes mellitus, hypertension, heart disease, chronic obstructive pulmonary disease, or cancer; history of intravenous drug use; and missed primary care appointments (last five appointments).


RESULTS
A statistically significant association was found between diabetes mellitus and between liver and gastrointestinal cancer and premature mortality in this sample of older patients maintained on methadone (OR=30.79, p=0.008 for diabetes mellitus; OR=19.91, p=0.017 for cancer). Patients who remained in treatment showed statistically significant improvement in ASI scores for problems related to drug use and for psychiatric, medical, and legal problems. They showed a nonsignificant trend toward reduction of problems associated with alcohol use. The group of patients who dropped out of methadone treatment did not show statistically significant improvement on any area of the ASI except family problems. The group who remained in treatment also showed a statistically significant reduction in drug use when results of the first four and last four urine drug screens for opiates, cocaine, and benzodiazepines were compared (p<0.0001 for opiates and cocaine, p=0.02 for benzodiazepines).On the other hand, the group who dropped out of methadone treatment did not show any statistically significant reduction in drug use based on urine screens (p=0.05 for opiates, p=0.38 for cocaine, and p=0.53 for benzodiazepines).


CONCLUSIONS
The results presented here suggest potential targets for intervention related to lifestyle risk factors and comorbid medical conditions, such as nicotine dependence and diabetes mellitus, that may have the potential to improve health outcomes for older patients with opioid dependence.
Fareed
Ayman
A
Department of Psychiatry, Emory University, School of Medicine, USA. ayman.fareed@va.gov
Casarella
Jennifer
J
Amar
Richard
R
Vayalapalli
Sreedevi
S
Drexler
Karen
K
D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D002908:Chronic Disease / Q000401:mortality*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality; D005845:Georgia; D006556:Heroin Dependence / Q000401:mortality* / Q000534:rehabilitation*; D006801:Humans; D008019:Life Style; D008113:Liver Neoplasms / Q000401:mortality; D008134:Long-Term Care; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015813:Substance Abuse Detection; D016896:Treatment Outcome
D009294:Narcotics; D008691:Methadone