To examine the population-wide overdose risk emerging from the prescription of methadone and buprenorphine for opioid substitution treatment in England and Wales. Patients who received only psychological support for opioid dependence in England appear to be at greater risk of fatal opioid poisoning than those who received opioid agonist pharmacotherapy.
The increased risk when out of treatment was greater for men (aHR 1.88, 95% CI 1.67–2.12), illicit drug injectors (aHR 2.27, 95% CI 1.97–2.62), and those reporting problematic alcohol use (aHR 2.37, 95% CI 1.90–2.98).Conclusions Risk when enrolled only in a psychological intervention was double that during OAP (aHR 2.07, 95% CI 1.75–2.46). DRP risk increased while patients were not enrolled in any treatment (adjusted hazard ratio 1.73, 95% CI 1.55–1.92). Data were analysed using survival methods.SettingAll services in England that provide publicly-funded, structured, treatment for illicit opioid users.ParticipantsAdults treated for opioid dependence during April 2005 to March 2009: 151,983 individuals 69% male median age 32.6 with 442,950 person-years of observation.MeasurementsThe outcome was fatal DRP occurring during periods in or out of treatment, with adjustment for age, gender, substances used, injecting status, and CJS referral.FindingsThere were 1,499 DRP deaths (3.4 per 1,000 person-years, 95% CI 3.2–3.6). AimsTo compare the change in illicit opioid users’ risk of fatal drug-related poisoning (DRP) associated with opioid agonist pharmacotherapy (OAP) and psychological support, and investigate the modifying effect of patient characteristics, criminal justice system (CJS) referral, and treatment completion.DesignNational data linkage cohort study of the English National Drug Treatment Monitoring System and the Office for National Statistics national mortality database.
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