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The impact of low-threshold methadone maintenance treatment on mortality in a Canadian setting
Seonaid Nolan1, Kanna Hayashi1, M-J Milloy1
1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
Background:
Methadone maintenance therapy (MMT) is among the most effective treatment modalities available for the management of opioid use disorder. However, the effect of MMT on mortality, and optimal strategies for delivering methadone are less clear. This study sought to estimate the effect of low-threshold MMT and its association with all-cause mortality among persons who inject drugs (PWID) in a setting where methadone is widely available through primary care physicians and community pharmacies at no cost through the setting's universal medical insurance plan.
Methods:
Between May, 1996 and December, 2011 data were collected as part of two prospective cohort studies of PWID in Vancouver, Canada, and were linked to the provincial vital statistics database to ascertain rates and causes of death. The association of MMT with all-cause mortality was estimated using multivariable extended Cox regression with time-dependent variables.
Results:
Of 2335 PWID providing 15027 person-years of observation, 511 deaths were observed for a mortality rate of 3.4 (95% Confidence Interval [CI]: 3.1-3.7) deaths per 100 person-years. After adjusting for potential confounders including age and HIV seropositivity, MMT enrolment was found to be associated with lower mortality (adjusted hazard ratio [AHR]=0.73, 95% CI: 0.61-0.88).
Conclusions:
While observed all-cause mortality rates among PWID in this setting were high, participation in low-threshold MMT was significantly associated with improved survival. These findings add to the known benefits of providing low-threshold MMT on reducing the harms associated with injection drug use.
Insights
Methadone maintenance therapy (MMT) significantly reduces mortality in people who inject drugs (PWID). This study shows low-threshold MMT is associated with improved survival rates in this high-risk population.
Area of Science:
- Addiction Medicine
- Public Health
- Epidemiology
Background:
- Opioid use disorder (OUD) is a significant public health issue.
- Methadone maintenance therapy (MMT) is an effective OUD treatment.
- The impact of MMT on mortality and optimal delivery strategies require further investigation.
Purpose of the Study:
- To estimate the effect of low-threshold MMT on all-cause mortality.
- To examine the association between MMT and survival among persons who inject drugs (PWID).
- To assess MMT in a setting with universal healthcare and readily available methadone.
Main Methods:
- Prospective cohort studies of PWID in Vancouver, Canada (1996-2011).
- Data linkage with provincial vital statistics to determine mortality rates.
- Multivariable extended Cox regression analysis to estimate the association of MMT with mortality.
Main Results:
- A total of 2335 PWID were observed for 15027 person-years, with 511 deaths.
- The observed mortality rate was 3.4 deaths per 100 person-years.
- MMT enrollment was associated with significantly lower mortality (AHR=0.73, 95% CI: 0.61-0.88) after adjustment for confounders.
Conclusions:
- Despite high mortality rates among PWID, low-threshold MMT participation was linked to improved survival.
- These findings reinforce the benefits of accessible MMT in reducing drug-related harms.
- Low-threshold MMT is a crucial strategy for improving outcomes in PWID.
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