Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study.
OBJECTIVE
To assess predictors of mortality in a population of people prescribed methadone.


METHODS
Retrospective cohort study.


METHODS
Geographically defined population in Tayside, Scotland.


METHODS
2378 people prescribed and dispensed liquid methadone between January 1993 and February 2004.


METHODS
All cause mortality (primary outcome) and drug dependent cause specific mortality (secondary outcome) by means of Cox proportional hazards models during 12 years of follow-up.


RESULTS
Overall, 181 (8%) people died. Overuse of methadone (adjusted hazard ratio 1.67, 95% confidence interval 1.05 to 2.67), history of psychiatric admission (2.47, 1.67 to 3.66), and increasing comorbidity measured as Charlson index >or=3 (1.20, 1.15 to 1.26) were all associated with an increase in all cause mortality. Longer duration of use (adjusted hazard ratio 0.95, 0.94 to 0.96), history of having urine tested (0.33, 0.22 to 0.49), and increasing time since last filled prescription were protective in relation to all cause mortality. Drug dependence was identified as the principal cause of death in 60 (33%) people. History of psychiatric admission was significantly associated with drug dependent death (adjusted hazard ratio 2.41, 1.25 to 4.64), as was history of prescription of benzodiazepines (4.35, 1.32 to 14.30).


CONCLUSIONS
Important elements of care in provision of methadone maintenance treatment are likely to influence, or be a marker for, a person's risk of death.
McCowan
C
C
Division of Community Health Sciences, University of Dundee, Dundee DD2 4BF.
Kidd
B
B
Fahey
T
T
D000293:Adolescent; D000328:Adult; D004812:Epidemiologic Methods; D005194:Family Practice; D005260:Female; D006556:Heroin Dependence / Q000401:mortality* / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008691:Methadone / Q000506:poisoning*; D008875:Middle Aged; D009294:Narcotics / Q000506:poisoning*; D055553:Prescription Drugs / Q000506:poisoning; D012606:Scotland / Q000453:epidemiology; D055815:Young Adult
D009294:Narcotics; D055553:Prescription Drugs; D008691:Methadone