People who are opiate dependent like heroin addicts, will die at a rate of 13 -1 compared to non addicts of the same age/sex. Mind blowing stuff. But there are still many out there who object to substitution treatment despite it being the single most effective treatment for opiate addiction. What would happen though if abstinence based treatment like detox was found to have a higher mortality rate than opioid maintenance treatment (OMT)?
The Boston University has recently released several reports that should make many anti-methadone proponents reassess their ignorant and often arrogant views. Not only do they indicate that methadone and buprenorphine save lives but choosing abstinence/detox over OMT increases the chance of patients dying. The anti Harm Minimisation stooges will undoubtedly still push their naive, ‘drug free’ ideology but the fact is, those on methadone or buprenorphine have a hugely reduced risk of being a mortality statistic.
Isn’t this the goal, to save lives? It’s becoming increasingly obvious that’s not the case for some of the so-called “Tough Love” advocates. Extremist, Salvation Army Major and INCB member, Brian Watters suggested that heroin addiction was a fate worse then death. He also said that addiction was a sin. For the record, Watters is also a DFA director, ex chairman of the Australian National Council on Drugs (ANCD) and one of the 12 members of the UN’s International Narcotics Control Board (INCB) which has come into major criticism for breaching human rights and being a stooge for US drug policy. Many opponents of methadone use Sweden as an example of a successful drug policy which includes a strong preference for abstinence based programs and severe restrictions on how long someone can stay on methadone. What they leave out is the high mortality rate in Sweden compared to countries that endorse methadone.
This report is very specific about what needs to be done to prevent harm—not just to reduce it or minimise it but to prevent it, with the ultimate aim of always making the individual drug free and not sentenced to a lifetime of methadone, which will probably take 46 years off your life expectancy, and not turned into a hag with their teeth falling out. If you think the mouth of a tobacco-smoking person is hideous, look at the mouth of a methadone user.
Bronwyn Bishop - Inquiry Chair: The impact of illicit drug use on families. The winnable war on drugs.
There are many who object to substitution treatment as being a ‘cop out’ for addicts or as a grand plan of industry ‘elitists’ who want full drug legalisation. The claims are varied from an ‘Orwellian addiction swap’ to ‘the federal government trades places with the street dealer, swapping heroin for methadone and feeding the addiction with taxpayer dollars’. Even politicians who have access to vast amounts of research either choose to ignore the evidence and lie to the public or are incapable of separating their personal views from facts. What is worse ... an elected official blatantly deceiving us or an elected official being so obviously clueless and incapable yet still left to manage important issues for us?
Do we want to follow the example of the many US OMT clinics that place restrictions on the period of treatment or set unrealistic dosage levels out of misconceived ideas on how OMT works? OMT was never meant to be a short term treatment but through a haze of Zero Tolerance claptrap, the guidelines have been misinterpreted by many health care providers. It seems logical to end OMT as quickly as possible because of the temptation to have a cured addict, free of physical addiction. Unfortunately, it’s not that simple and the usual consequences are the unnecessary deaths of addicts pushed into a dangerous treatment plan by ignorant and self righteous care providers.
Opioid Maintenance Therapy Saves Lives
Opioid-dependent patients are 13 times more likely to die than their age- and sex-matched peers in the general population. To examine predictors of long-term mortality, Australian researchers conducted a 10-year follow-up study of 405 heroin-dependent patients who had participated in a randomized trial comparing methadone and buprenorphine.
Overall mortality was 8.8 deaths per 1000 person-years of follow-up (0.66 during opioid maintenance treatment and 14.3 while out of treatment).
Each additional opioid maintenance treatment episode lasting more than 7 days decreased mortality by 28%.
Subjects who were using more heroin at baseline had a 12% lower mortality rate overall, likely because they spent more time in opioid maintenance treatment.
Often overlooked in the controversy over opioid substitution therapy is the reality that opioid dependence has a high fatality rate. The current study highlights that opioid maintenance treatment saves lives. The selection of the treatment episode as greater than 7 days strongly suggests that opioid maintenance, not detoxification, reduces mortality. The time is right to promulgate opioid maintenance therapy with either buprenorphine or methadone as the standard-of-care, first-line treatment for opioid dependence.
Peter D. Friedmann, MD, MPH
Reference: Gibson A, Degenhardt L, Mattick RP, et al. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction. 2008;103(3):462–468.
Death Before, During, and After Opioid Maintenance Treatment
To what extent does opioid maintenance therapy (OMT) reduce mortality in patients with dependence? To answer this question, Norwegian researchers linked data from a national death registry to a national database of people who were on a waiting list for OMT, receiving OMT (predominantly methadone), or discontinued OMT. Researchers then compared the risk of death during treatment with the risk before and after treatment among 3789 patients. In some cases, data from the death registry were confirmed with death certificates and autopsy results.
Over 7 years, 213 patients died.
Seventy-nine percent of deaths in the waiting-list group, 27% of deaths in the treatment group, and 61% of deaths in the discontinued-treatment group were attributed to overdose.
Mortality risk (from overdose and other causes) was significantly lower in patients receiving treatment than in patients on the waiting list (relative risk [RR], 0.5; death rates of 1.4 versus 2.4 per 100 person years, respectively).
Risk was highest among men who discontinued treatment (RR, 1.8 compared with men on the waiting list).
With impressive methodological rigor, these investigators provide further strong evidence that OMT lowers the risk of death. Because of the increasing cases of overdose death attributed to physician-prescribed methadone for pain and the potential negative public backlash towards this treatment, these data may play an important role in policy efforts that support the continued use of OMT to reduce mortality risk in people with opioid dependence.
Jeffrey A. Samet, MD, MA, MPH
Reference: Clausen T, Anchersen K, Waal H. Mortality prior to, during, and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug Alcohol Depend. 2008;94(1-3):151-157.