title: 15-Year survival and retention of patients in a general hospital-affiliated methadone maintenance treatment (MMT) center in Israel.
abstract: We have extended our previous 10-year follow-up study of MMT retention for another 5 years and added data on survival of all patients ever admitted to our MMT clinic (6/1993 to 6/2007). Data were calculated from admission to MMT until leaving, death, or study closure (6/2008). Ninety-four of a total of 613 patients (4711.6 person-years [py]) died. Cancer was the primary cause of death for those who remained in treatment, and overdose for those who left MMT. Longer survival (p=0.051) with a trend for a lower mortality rate (p=0.08) was noted among the 464 patients who stayed in treatment > or =1 year (1.8/100 py), compared with the 149 patients who left MMT <1 year (2.6/100 py). Predictors of survival in multivariate analyses were younger age (<40 years) at admission, living with a spouse/partner, being hepatitis B sera-negative, not abusing benzodiazepines on admission (interaction effect), not being referred directly from hospitalization to MMT, and not leaving the MMT program for hospitalization. The two latter variables also predicted longer retention, as did a high methadone dose (> or =100mg/d), no opiate and, no benzodiazepine abuse after 1 year and either having any DSM-IV-TR Axis I, or no Axis I&II psychiatric diagnoses. Unlike retention, mortality was associated with pre-treatment severity and comorbidities thus only partially reflects MMT outcome (opiate abstinence and treatment success). Benzodiazepine abuse reduced both retention and survival, emphasizing the high priority that should be given to stopping it.
authors.affiliation: Dr. Miriam & Sheldon G. Adelson Clinic for Drug Abuse, Treatment & Research, 1 Henrietta Szold Street, Tel-Aviv 64924, Israel. einatp@tasmc.health.gov.il
authors.forename: Einat
authors.initials: E
authors.lastname: Peles
authors.forename: Shaul
authors.initials: S
authors.lastname: Schreiber
authors.forename: Miriam
authors.initials: M
authors.lastname: Adelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000401:mortality* / Q000534:rehabilitation* / Q000628:therapy; D010349:Patient Compliance; D012153:Retention, Psychology; D012720:Severity of Illness Index; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000401:mortality / Q000534:rehabilitation / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D009294:Narcotics; D001569:Benzodiazepines; D008691:Methadone