Opioid maintenance treatment reduces mortality
The effect of opioid maintenance treatment (OMT) on overdose mortality varies both between and within countries. Consequently, treatment programs need to be evaluated in different treatment settings and over time within settings.
On this background, researchers from SERAF evaluated variations in mortality in a national programme: from the initial rollout as restrictive and low-capacity to its gradual change into more liberal and higher-volume.
The study is a 12-year prospective longitudinal cohort study including all persons (n = 6871) applying for and entering OMT in Norway (1997–2009), followed until 2009 or until death.
The results demonstrated that OMT significantly reduces risk of mortality compared to being outside of treatment. The reduction in overdose death was most substantial during the initial phase of the Norwegian OMT-programme: still, overdose deaths were more than halved in all calendar-periods throughout observation.
Some international studies have seen an increased risk in overdose death during the induction of indicating that patients are especially vulnerable during periods of treatment transition. The results in this study showed no elevated risk of overdose death in the first weeks of treatment, nor in the first weeks after treatment cessation.
It is likely that an integrated treatment approach, combining psychosocial support with pharmacological therapy as well as treatment delivery and initiation in specialized centres at the secondary care level is protective of overdose mortality risk during treatment induction.