title: Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-10.
abstract: OBJECTIVE
  To estimate mortality rates among treated opioid-dependent individuals by cause and in relation to the general population, and to estimate the instantaneous effects of opioid detoxification and maintenance treatment (MMT) on the hazard of all-cause and cause-specific mortality.
  
  
  METHODS
  Population-based treatment cohort study.
  
  
  METHODS
  Linked mortality data on all individuals first enrolled in publicly funded pharmacological treatment for opioid dependence in California, USA from 2006 to 2010.
  
  
  METHODS
  A total of 32 322 individuals, among whom there were 1031 deaths (3.2%) over a median follow-up of 2.6 years (interquartile range = 1.4-3.7).
  
  
  METHODS
  The primary outcome was mortality, indicated by time to death, crude mortality rates (CMR) and standardized mortality ratios (SMR).
  
  
  RESULTS
  Individuals being treated for opioid dependence had a more than fourfold increase of mortality risk compared with the general population [SMR = 4.5, 95% confidence interval (CI) = 4.2, 4.8]. Mortality risk was higher (1) when individuals were out-of-treatment (SMR = 6.1, 95% CI = 5.7, 6.5) than in-treatment (SMR = 1.8, 95% CI = 1.6, 2.1) and (2) during detoxification (SMR = 2.4, 95% CI = 1.5, 3.8) than during MMT (SMR = 1.8, 95% CI = 1.5, 2.1), especially in the 2 weeks post-treatment entry (SMR = 5.5, 95% CI = 2.7, 9.8 versus SMR = 2.5, 95% CI = 1.7, 4.9). Detoxification and MMT both independently reduced the instantaneous hazard of all-cause and drug-related mortality. MMT preceded by detoxification was associated with lower all-cause and other cause-specific mortality than MMT alone.
  
  
  CONCLUSIONS
  In people with opiate dependence, detoxification and methadone maintenance treatment both independently reduce the instantaneous hazard of all-cause and drug-related mortality.
authors: UCLA Integrated Substance Abuse Programs, Los Angeles, CA, USA.
authors: Elizabeth
authors: E
authors: Evans
authors: UCLA Integrated Substance Abuse Programs, Los Angeles, CA, USA.
authors: Libo
authors: L
authors: Li
authors: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
authors: Jeong
authors: J
authors: Min
authors: UCLA Integrated Substance Abuse Programs, Los Angeles, CA, USA.
authors: David
authors: D
authors: Huang
authors: UCLA Integrated Substance Abuse Programs, Los Angeles, CA, USA.
authors: Darren
authors: D
authors: Urada
authors: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: Lei
authors: L
authors: Liu
authors: UCLA Integrated Substance Abuse Programs, Los Angeles, CA, USA.
authors: Yih-Ing
authors: YI
authors: Hser
authors: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Simon Fraser University, Faculty of Health Sciences, Barnaby, BC, Canada.
authors: Bohdan
authors: B
authors: Nosyk
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000401:mortality*; D009293:Opioid-Related Disorders / Q000401:mortality* / Q000534:rehabilitation; D012307:Risk Factors; D055815:Young Adult
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: Administrative data; detoxification and maintenance treatment; longitudinal design; mortality; opioid dependence
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