Opioid Agonist Treatment: Does it Reduce Mortality Risk?

Opioid agonist treatment is associated with lower rates of mortality among patients with opioid dependence, according to the results of a recent study.

“Opioid agonist treatment (OAT) is an effective treatment for opioid dependence; however, there has not yet been a systematic review on the relationship between OAT and specific causes of mortality,” the researchers wrote.

They conducted their study using data from 15 randomized controlled trials including 3852 participants and 36 primary cohort studies including 749,634 participants. The main outcomes were all-cause and cause-specific mortality by setting and participant characteristics.

Overall, the rate of all-cause mortality during OAT was more than half of that seen during time out of OAT among the cohort studies (rate ratio [RR] 0.47; 95% CI 0.42-0.53). This remained consistent across sex, age, geographic location, HIV status, and hepatitis C status, and results did not differ between methadone and buprenorphine (RR 0.47 vs 0.34, respectively).

Risk of suicide, cancer, drug-related, alcohol-related, and cardiovascular-related mortality were all lower during OAT. All-cause mortality was 6 times higher during the 4 weeks after OAT cessation and was twice as high for the remainder of time not on OAT.

“This systematic review and meta-analysis found that OAT was associated with lower rates of mortality. However, access to OAT remains limited, and insurance coverage remains low. Work to improve access globally may have important population-level benefits.”

—Michael Potts

Reference

Santo Jr T, Clark B, Hickman M, et al. Association of opioid agonist treatment with all-cause mortality and specific causes of death among people with opioid dependence. Published online June 2, 2021. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2021.0976