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Methadone adherence may lower mortality rates in opioid-dependent convicts

Adherence to methadone was linked to significantly lower mortality rates among Canadian convicted offenders with opioid dependence, findings published in PLOS Medicine showed.

“Despite evidence that prevention and treatment options (eg, methadone) may reduce the risk of death among opioid-dependent individuals, there remain significant barriers and underutilization of substitution treatment options for offenders,” Angela Russolillo, PhD, from Simon Fraser University in Canada, and colleagues wrote.

“Factors such as stigma, insufficient pharmacotherapy knowledge, concerns related to medication diversion and poor links between corrections and community-based care providers can restrict access to methadone maintenance treatment and continuity of care for offenders with opioid dependence whether they are sentenced to custody or community settings, as well as following the completion of sentencing,” they continued.

In this retrospective cohort study, researchers examined the link between adherence to methadone maintenance treatment and overdose fatality and other causes of mortality using population-level administrative data of 14,530 individuals in British Columbia with a history of conviction and who were prescribed methadone between 1998 and Mar. 31, 2015. The investigators compared overall and cause-specific mortality rates between periods when methadone was and was not dispensed. Methadone was analyzed as a time-varying exposure.

During a median follow-up of 6.9 years, 1,275 participants died during the observation period and the all-cause mortality rate was 11.2 per 1,000 person-years. Independent of potential confounders, analysis showed that participants were significantly less likely to die from both nonexternal (adjusted HR = 0.27; 95% CI, 0.23-0.33) and external (aHR = 0.41; 95% CI, 0.33-0.51) causes during periods they adhered to methadone.

In total, 504 deaths were attributed to external causes or morbidity and mortality, 27.8% of which were attributable to accidental poisoning (overdose) and 4.2% to intentional self-harm. In addition, infectious disease-related mortality was five times lower (aHR = 0.2; 95% CI, 0.13-0.3), and overdose mortality was almost three times lower (aHR = 0.39; 95% CI, 0.3-0.5) when participants were medicated with methadone. When the authors performed a competing risk regression, they observed a similar pattern of results.

However, the authors noted that using a Canadian offender population may limit the generalizability of these findings and the observation period used in this study represented community-based methadone prescribing, which may neglect prescriptions administered during hospital separations. Future research is needed to address these potential limitations.

“Our results expand on this work to show that mortality risk is elevated among methadone recipients with any exposure to the corrections system — where the majority are not exposed to custody — and over periods of time that greatly exceed their time under correctional supervision,” Russolillo and colleagues wrote. “Efforts to make methadone treatment more accessible, integrated, and comprehensive may yield additional life-saving benefits.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.