title: Opiate-dependent patients on a waiting list for methadone maintenance treatment are at high risk for mortality until treatment entry.
abstract: OBJECTIVE
  In 2002, our methadone maintenance treatment (MMT) clinic reached full capacity and admission to treatment was delayed for >1 year. In order to evaluate possible impact of the waiting list on mortality risk of the registered patients, we compared survival after the first 2 years, and long-term survival since registration between admitted and not admitted to our MMT (or other treatment facilities) and to those who admitted immediately, before the establishment of the waiting list in 2002.
  
  
  METHODS
  A total of 608 patients registered between 2002 and 2009. Their vital statistics were obtained from the Israeli National Registry (October 2010).
  
  
  RESULTS
  Of the total 608, 366 registrants (60.2%) were admitted to any treatment (194 [53%] to our MMT, 162 [44.3%] to other MMTs and 10 [2.7%] to other facilities) and 242 (39.8%) were not admitted anywhere. Non admission to treatment when it became available was due to inability to contact the patient (116, 47.9%), self-reported drug discontinuation (44, 18.2%), refusal to follow regulations (39, 16.1%), imprisonment (27, 11.2%), violent behavior (1, 0.4%), death (13, 5.4%), and other (2, 0.8%). The mortality rate (available among 583) during the 2 years on the waiting list was higher (5.0/100 person years) for the 225 non admitted applicants than for the 358 admitted (0.42/100 person years, P < 0.0005) and those who were admitted with no delay before 2002 (2.1/100 person years). The long-term survival between those 3 groups did not differ significantly.
  
  
  CONCLUSIONS
  Opiate addicts are at high risk for mortality during prolonged waiting periods for admission to MMT, indicating an urgent need for immediate expansion of MMT availability.
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. einatp@tlvmc.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; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002423:Cause of Death; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D020380:Needs Assessment; D058850:Opiate Substitution Treatment / Q000379:methods / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012307:Risk Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014850:Waiting Lists / Q000401:mortality*
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone