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One-year mortality rates following methadone treatment discharge
1Department of Psychiatry, University of Pennsylvania, Philadelphia, USA. Zanis@research.TRC.upenn.edu
Insights
Methadone program patients who drop out or are unfavorably discharged face significantly higher mortality rates, particularly from heroin overdose. Retaining these at-risk individuals in treatment is crucial for reducing preventable deaths.
Area of Science:
- Addiction medicine
- Public health
- Clinical toxicology
Background:
- Methadone maintenance treatment (MMT) is a cornerstone for opioid use disorder management.
- Patient retention in MMT is critical for treatment success and harm reduction.
- Understanding mortality risks associated with treatment dropout is essential for public health interventions.
Purpose of the Study:
- To assess the mortality rate among patients in a methadone program over a one-year period.
- To compare mortality between patients remaining in treatment and those discharged.
- To identify causes of death and risk factors associated with treatment cessation.
Main Methods:
- A cohort of 507 patients in a methadone program was followed for one year.
- Mortality data were collected for patients actively in treatment (n=397) and those discharged (n=110).
- Causes of death were investigated for all deceased patients.
Main Results:
- The mortality rate was significantly higher among discharged patients (8.2%) compared to those in treatment (1%).
- Heroin overdose was a leading cause of death among discharged patients (6 out of 9 deaths).
- All recorded deaths occurred in patients who had dropped out or were unfavorably discharged, not while actively in treatment.
Conclusions:
- Patients discontinuing methadone treatment, especially those with unfavorable discharge or dropout, experience elevated mortality risks, particularly from overdose.
- Strategies to improve retention in methadone treatment for at-risk patients, even those with suboptimal response, are vital.
- Public health efforts should focus on supporting vulnerable patients to remain engaged in treatment to prevent premature mortality.
Objectives:
Mortality among 507 patients in a methadone program over a 1-year period was assessed.
Methods:
Mortality was determined for patients in treatment (n = 397), and 12 months later for those discharged (n = 110).
Results:
Of discharged patients, 8.2% (9/110) had died, of which six were caused by heroin overdose. None of the discharged clients were in treatment at the time of death. All deaths were among clients who either dropped out of treatment or were discharged unfavorably from the program. Comparatively, only 1% (4/397) of patients died while enrolled in treatment.
Conclusion:
Death rates, especially overdose, are high among patients who are unfavorably discharged or drop out of methadone treatment. Efforts should be made to retain these at-risk patients in methadone treatment even though treatment response may be suboptimal.