Aim To assess whether risk of death increases during periods of treatment transition, and investigate the impact of supervised methadone consumption on drug-related and all-cause mortality. Design National Irish cohort study. Setting Primary care. Participants A total of 6983 patients on a national methadone treatment register aged 16–65 years between 2004 and 2010. Measurement Drug-related (primary outcome) and all-cause (secondary outcome) mortality rates and rate ratios for periods on and off treatment; and the impact of regular supervised methadone consumption.Results Crude drug-related mortality rates were 0.24 per 100 person-years on treatment and 0.39 off treatment, adjusted mortality rate ratio 1.63 [95% confidence interval (CI) = 0.66–4.00]. Crude all-cause mortality rate per 100 person-years was 0.51 on treatment versus 1.57 off treatment, adjusted mortality rate ratio 3.64 (95% CI = 2.11–6.30). All-cause mortality off treatment was 6.36 (95% CI = 2.84–14.22) times higher in the first 2 weeks, 9.12 (95% CI = 3.17–26.28) times higher in weeks 3–4, compared with being 5 weeks or more in treatment. All-cause mortality was lower in those with regular supervision (crude mortality rate 0.60 versus 0.81 per 100 person-years) although, after adjustment, insufficient evidence exists to suggest that regular supervision is protective (mortality rate ratio = 1.23, 95% CI = 0.67–2.27). Conclusions Among primary care patients undergoing methadone treatment, continuing in methadone treatment is associated with a reduced risk of death. Patients' risk of all-cause mortality increases following treatment cessation, and is highest in the initial 4-week period.
47. Characterizing pain and associated coping strategies in methadone and buprenorphine-maintained patients
Kelly E. Dunn, Patrick H. Finan, D. Andrew Tompkins, Michael Fingerhood, Eric C. Strain
Drug and Alcohol Dependence 2015:157;143-149 Abstract
BackgroundChronic pain is common among patients receiving opioid maintenance treatment (OMT) for opioid use disorder. To aid development of treatment recommendations for coexisting pain and opioid use disorder, it is necessary to characterize pain treatment needs and assess whether needs differ as a function of OMT medication.MethodsA point-prevalence survey assessing pain and engagement in coping strategies was administered to 179 methadone and buprenorphine-maintained patients.ResultsForty-two percent of participants were categorized as having chronic pain. Methadone patients had greater severity of pain relative to buprenorphine patients, though both groups reported high levels of interference with daily activities, and participants with pain attended the emergency room more frequently relative to participants without pain. Only 2 coping strategies were being utilized by more than 50% of participants (over-the-counter medication, prayer).ConclusionsResults indicate that pain among OMT patients is common, severe, and of significant impairment. Methadone patients reported greater severity pain, particularly worse pain in the past 24 h, though interference from pain in daily activities did not vary as a function of OMT. Most participants with pain were utilizing few evidenced-based pain coping strategies. Increasing OMT patient access to additional pain treatment strategies is an opportunity for immediate intervention, and similarities across OMT type suggest interventions do not need to be customized to methadone vs. buprenorphine patients.
48. Concomitant use of benzodiazepine and alcohol in methadone-maintained patients from the ANRS–Methaville trial: Preventing the risk of opioid overdose in patients who failed with buprenorphine
Perrine Roux, Caroline Lions, Laurent Michel, Antoine Vilotitch, Marion Mora, Gwenaelle Maradan, Fabienne Marcellin, Bruno Spire, Morel Alain, Carrieri M. Patrizia and and the ANRS Methaville Study Group
Drug and Alcohol Review 2016:35(1);61-69
Introduction and Aims Concomitant elevated alcohol consumption and use of benzodiazepines (BZD) during methadone treatment is widespread and particularly worrying because of the increased risk of overdose. Using concomitant binge drinking and use of BZD as a proxy of overdose risk, we aimed to study whether buprenorphine switchers were at higher risk of overdose during methadone treatment. Design and Methods The French National Agency for Research for Aids and Viral Hepatitis –Methaville multisite randomised trial enrolled 195 patients to assess the feasibility of initiating methadone in primary care by comparing it with methadone initiation in specialised centres. We selected 174 patients with available data on BZD use and alcohol binge drinking at baseline and 12 months, accounting for 318 visits. The outcome was defined to take into account an overdose risk gradient as follows: no BZD use, BZD use without and with binge drinking during the previous month. To identify factors associated with the outcome, we performed a mixed multinomial logistic regression analysis. Results At baseline, 26% of the sample reported BZD use alone while 16% reported BZD use and binge drinking. Half of the sample (51%) was switching from buprenorphine treatment. After multivariate analysis, employment, depressive symptoms and switching treatment from buprenorphine to methadone [odds ratio (95% confidence interval) 5.38 (1.74–16.62)] remained associated with BZD use and binge drinking.
Discussion and Conclusions As well as the importance of identifying socially vulnerable and depressed methadone-maintained patients, clinicians should be aware that patients who fail buprenorphine treatment and switch to methadone require greater clinical monitoring and management to avoid the risk of overdose.
Keywords: drug overdose; methadone; benzodiazepine; alcohol drinking; buprenorphine
49. Treating codeine dependence with buprenorphine: Dose requirements and induction outcomes from a retrospective case series in New South Wales, Australia
Suzanne Nielsen, Raimondo Bruno, Bridin Murnion, Adrian Dunlop, Louisa Degenhardt, Apo Demirkol, Peter Muhleisen and Nicholas Lintzeris