title: Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009.
abstract: OBJECTIVE
  We examined the association between the expansion of methadone and buprenorphine treatment and the prevalence of heroin overdose deaths in Baltimore, Maryland from 1995 to 2009.
  
  
  METHODS
  We conducted a longitudinal time series analysis of archival data using linear regression with the Newey-West method to correct SEs for heteroscedasticity and autocorrelation, adjusting for average heroin purity.
  
  
  RESULTS
  Overdose deaths attributed to heroin ranged from a high of 312 in 1999 to a low of 106 in 2008. While mean heroin purity rose sharply (1995-1999), the increasing number of patients treated with methadone was not associated with a change in the number of overdose deaths, but starting in 2000 expansion of opioid agonist treatment was associated with a decline in overdose deaths. Adjusting for heroin purity and the number of methadone patients, there was a statistically significant inverse relationship between heroin overdose deaths and patients treated with buprenorphine (P = .002).
  
  
  CONCLUSIONS
  Increased access to opioid agonist treatment was associated with a reduction in heroin overdose deaths. Implementing policies that support evidence-based medication treatment of opiate dependence may decrease heroin overdose deaths.
authors.affiliation: Friends Research Institute, Baltimore, MD 21201, USA. Rschwartz@friendsresearch.org
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
authors.forename: Jan
authors.initials: J
authors.lastname: Gryczynski
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Sharfstein
authors.forename: Gregory
authors.initials: G
authors.lastname: Warren
authors.forename: Yngvild
authors.initials: Y
authors.lastname: Olsen
authors.forename: Shannon G
authors.initials: SG
authors.lastname: Mitchell
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Jaffe
mesh_terms: D015142:Baltimore / Q000453:epidemiology; D002047:Buprenorphine / Q000009:adverse effects / Q000627:therapeutic use*; D062787:Drug Overdose / Q000401:mortality*; D006556:Heroin Dependence / Q000188:drug therapy / Q000401:mortality* / Q000534:rehabilitation; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D009026:Mortality / Q000639:trends; D009292:Narcotic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000639:trends*
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone