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Methadone maintenance treatment, criminality and overdose-related deaths. An ecological study, 1983-1999
Gérard Niveau1, Anne-Laure Rougemont, Romano La Harpe
1Institut Universitaire de Médecine Légale, Av. de Champel 9, 1211 Geneva 4, Switzerland. Gerard.Niveau@hcuge.ch
Background:
Methadone maintenance treatments (MMTs) are the commonest substitution treatments offered to opiate addiction in Switzerland, in order to reduce criminal behaviour, infectious disease transmission and overdose death.
Method:
To investigate the relationship between the increase in the number of methadone maintenance treatments, criminal activity of addicts and overdose-related deaths, an ecological study was undertaken in the Canton of Geneva, from 1983 to 1999.
Results:
The regular and extensive increase in the number of MMTs is not significantly associated, during the 1983-1999 period, with a fall either in drug addict incarcerations or in overdose-related deaths. However, a slight decrease is observed in the number of imprisoned opiate addicts since 1994, and a marked decrease is seen in overdose deaths from 1997 on. An important and stable number of these deaths is due to methadone itself.
Conclusion:
Public health objectives to diminish delinquency and overdose deaths cannot solely be fulfilled by extensive use of MMTs. A positive result could appear when access to MMT is highly favoured. This hypothesis must be proved correct by observational studies conducted on a general population.