TY - JOUR
T1 - Comparing retention in treatment and mortality in people after initial entry to methadone and buprenorphine treatment
AU - Bell, James
AU - Trinh, Lieu
AU - Butler, Bethany
AU - Randall, Deborah
AU - Rubin, George
PY - 2009
Y1 - 2009
N2 - The purpose of this study is to compare retention in treatment and mortality among people entering methadone and buprenorphine treatment for opioid dependence. First entrants to treatment between June 2002 and June 2006 were identified from the Pharmaceutical Drugs of Abuse System (PHDAS) database. Retention in treatment was compared between methadone and buprenorphine. Names were linked to the NDI database, and ‘good matches’ were identified. Deaths were classified as occurring during induction, maintenance and either post-methadone or post-buprenorphine, depending on the latest episode of treatment prior to death. The numbers of inductions into treatment, of total person-years spent in each treatment, and person-years post-methadone or buprenorphine, were calculated. Risk of death in different periods, and different treatments, was analysed using Poisson regression. A total of 5992 people entered their first episode of treatmentâ€â€3349 (56%) on buprenorphine, 2643 on methadone. Median retention was significantly longer in methadone (271 days) than buprenorphine (40 days). During induction, the risk of death was lower for buprenorphine (relative risk = 0.114, 95% confidence interval = 0.002–0.938, P = 0.02, Fisher’s exact test). Risk of death was lowest during treatment, significantly higher in the first 12 months after leaving both methadone and buprenorphine. Beyond 12 months after leaving treatment, risk of death was non-significantly higher than during treatment. Conclusions Buprenorphine was safer during induction. Despite shorter retention in treatment, buprenorphine maintenance was not associated with higher risk of death.
AB - The purpose of this study is to compare retention in treatment and mortality among people entering methadone and buprenorphine treatment for opioid dependence. First entrants to treatment between June 2002 and June 2006 were identified from the Pharmaceutical Drugs of Abuse System (PHDAS) database. Retention in treatment was compared between methadone and buprenorphine. Names were linked to the NDI database, and ‘good matches’ were identified. Deaths were classified as occurring during induction, maintenance and either post-methadone or post-buprenorphine, depending on the latest episode of treatment prior to death. The numbers of inductions into treatment, of total person-years spent in each treatment, and person-years post-methadone or buprenorphine, were calculated. Risk of death in different periods, and different treatments, was analysed using Poisson regression. A total of 5992 people entered their first episode of treatmentâ€â€3349 (56%) on buprenorphine, 2643 on methadone. Median retention was significantly longer in methadone (271 days) than buprenorphine (40 days). During induction, the risk of death was lower for buprenorphine (relative risk = 0.114, 95% confidence interval = 0.002–0.938, P = 0.02, Fisher’s exact test). Risk of death was lowest during treatment, significantly higher in the first 12 months after leaving both methadone and buprenorphine. Beyond 12 months after leaving treatment, risk of death was non-significantly higher than during treatment. Conclusions Buprenorphine was safer during induction. Despite shorter retention in treatment, buprenorphine maintenance was not associated with higher risk of death.
KW - buprenorphine
KW - heroin
KW - methadone
KW - mortality
UR - http://handle.uws.edu.au:8081/1959.7/502044
M3 - Article
SN - 1360-0443
SN - 0965-2140
VL - 104
SP - 1193
EP - 1200
JO - Addiction
JF - Addiction
IS - 7
ER -