Opioid Substitution Rx Lowers Mortality Risk for Abusers

Death risk higher in first two weeks of treatment but overall is lower than risk out of treatment
By Lindsey Marcellin
HealthDay Reporter

WEDNESDAY, Oct. 27 (HealthDay News) -- Despite increased risk during the first two weeks, the risk of death during opioid substitution therapy is lower, overall, than the risk of death out of treatment, according to research published online Oct. 26 in BMJ.

Rosie Cornish, of the University of Bristol in the United Kingdom, and colleagues conducted a prospective cohort study of mortality rates before, during, and after opiate substitution therapy in opiate abusers. The study included 5,577 patients followed until one year after their last opiate-substitute prescription expired, date of death prior to this, or date of transfer from the practice.

The researchers found that the overall crude mortality rates were 0.7 per 100 person-years on opiate substitution therapy and 1.3 per 100 person-years off treatment. During the first two weeks of substitution therapy, the mortality rate was triple that at any other time during treatment. After stopping treatment, the mortality rate was elevated nine-fold over baseline treatment mortality risk in the first two weeks, then gradually declined. After a year of substitution therapy, the researchers estimate that opiate abusers have an 85 percent chance that their overall mortality risk will be reduced.

"Closer supervision of induction of treatment alongside the development of more effective methods of preventing relapse may mitigate these effects, and further research should consider these questions," the authors write.

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