Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies
Luis Sordo,Luis Sordo,Gregorio Barrio,María J. Bravo,B. Iciar Indave,Louisa Degenhardt,Louisa Degenhardt,Lucas Wiessing,Marica Ferri,Roberto Pastor-Barriuso +9 more
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TLDR
Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids.Abstract:
Objective To compare the risk for all cause and overdose mortality in people with opioid dependence during and after substitution treatment with methadone or buprenorphine and to characterise trends in risk of mortality after initiation and cessation of treatment.
Design Systematic review and meta-analysis.
Data sources Medline, Embase, PsycINFO, and LILACS to September 2016.
Study selection Prospective or retrospective cohort studies in people with opioid dependence that reported deaths from all causes or overdose during follow-up periods in and out of opioid substitution treatment with methadone or buprenorphine.
Data extraction and synthesis Two independent reviewers performed data extraction and assessed study quality. Mortality rates in and out of treatment were jointly combined across methadone or buprenorphine cohorts by using multivariate random effects meta-analysis.
Results There were 19 eligible cohorts, following 122 885 people treated with methadone over 1.3-13.9 years and 15 831 people treated with buprenorphine over 1.1-4.5 years. Pooled all cause mortality rates were 11.3 and 36.1 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 3.20, 95% confidence interval 2.65 to 3.86) and reduced to 4.3 and 9.5 in and out of buprenorphine treatment (2.20, 1.34 to 3.61). In pooled trend analysis, all cause mortality dropped sharply over the first four weeks of methadone treatment and decreased gradually two weeks after leaving treatment. All cause mortality remained stable during induction and remaining time on buprenorphine treatment. Overdose mortality evolved similarly, with pooled overdose mortality rates of 2.6 and 12.7 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 4.80, 2.90 to 7.96) and 1.4 and 4.6 in and out of buprenorphine treatment.
Conclusions Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids. The induction phase onto methadone treatment and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk. 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.read more
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Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study.
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TL;DR: It is more difficult to initiate patients to XR-NTX than BUP-NX, and this negatively affected overall relapse, but once initiated, both medications were equally safe and effective.
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TL;DR: Treatment with buprenorphine or methadone was associated with reductions in overdose and serious opioid-related acute care use compared with other treatments, and strategies to address the underuse of MOUD are needed.
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Louisa Degenhardt,Jason Grebely,Jack Stone,Matthew Hickman,Peter Vickerman,Brandon D.L. Marshall,Julie Bruneau,Frederick L. Altice,Graeme Henderson,Afarin Rahimi-Movaghar,Sarah Larney +10 more
TL;DR: Opioid agonist treatment can be highly effective in reducing illicit opioid use and improving multiple health and social outcomes, by reducing overall mortality and key causes of death, including overdose, suicide, HIV, hepatitis C virus, and other injuries.
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Julie Bruneau,Keith Ahamad,Marie-Ève Goyer,Ginette Poulin,Peter Selby,Benedikt Fischer,T. Cameron Wild,Evan Wood +7 more
TL;DR: Opioid use disorder is one of the most challenging forms of addiction facing the Canadian health care system, and a major contributor to the marked rises in opioid-related morbidity and death that Canada has been experiencing.
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