Study: Retention in Opioid Replacement Therapy Reduces Risk Of Death
A new study published in the BMJ found that retention during methadone and buprenorphine opioid replacement therapy is linked to a notable decline in the risk of death among those who are opioid dependent.
The goal of the research was to compare the risks of all-cause mortality and overdose deaths for those who are opioid dependent both during and after methadone or buprenorphine opioid replacement therapy.
For the study, researchers analyzed 19 studies from numerous journal using terms associated with opioid dependence, substitution therapy, death, and cohort studies.
Cohort studies are a kind of medical research used to investigate the causes of disease(s) and identify links between risk factors and health outcomes.
For each cohort study, investigator tallied death rates from overall causes and overdoses while both in and out of therapy. All research examined opioid dependence and reported deaths from all causes or overdose during follow-ups for both in and out of substitution therapy for either drug.
In total, nearly 123,000 patients were treated with methadone for over one year to almost 14 years. Another 15,000+ were treated with buprenorphine for over one year to four and a half years.
In total, the overall death rates were estimated at 11 and 36 deaths per 1,000 years of compiled treatment, in and out of methadone treatment respectively. This data indicates the risk of overdose is higher after therapy than during therapy.
For buprenorphine treatment, overdose deaths increased in the first month after therapy cessation, and the overall death rate (from all causes) was 32 in the first four weeks.
In the remaining time without therapy, the overall death rate was 10.9 and there were no notable differences found in the first month of therapy and the time remaining in the recovery facility.
The combined trend analysis revealed that comprehensively-caused mortality dropped significantly over the first month of methadone treatment and continued to drop steadily in the two weeks following therapy.
Death rates from all causes continued to be stable during initiation and the remaining time on buprenorphine medication. The results were similar for overdose deaths.
According to study authors, the beginning phase of methadone therapy and the period following therapy cessation for both medications are “periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk.”
The Bottom Line
This research discovered that the death risk among those dependent on opioids in treatment is less than one-third of what would be expected in the absence of opioid therapy. Retention in these treatments is associated with significant reductions in the risk for deaths related to overdoses and all other causes.
“These findings are potentially important, but further research must be conducted to properly account for potential confounding and selection bias in comparisons of mortality risk between opioid substitution treatments, as well as throughout periods in and out of each treatment.”
~ G. Nathalee Serrels, M.A., Psychology