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 The study involved 14,530 people with criminal convictions who had
been prescribed methadone in British Columbia. Researchers collected
data from 1998 to 2015; during that time, 1,275 study participants
died.
Half the participants stayed in the study for at least seven years.
Overall, people were 59 percent less likely to die of so-called
external causes like overdoses, injuries, poisoning, falls, and
assaults during periods when they were in methadone treatment than
at other times, the study found. During treatment periods, they were
also 73 percent less likely to die of natural causes like chronic
health problems or acute illnesses.
"Deaths related to overdose were one third as likely when patients
were on methadone, and deaths from infectious diseases were one
fifth as likely," said senior study author Julian Somers of Simon
Fraser University in Burnaby, British Columbia.
"When people aren't taking methadone then they are probably using
other opiates, with unknown purity and in forms that deliver faster
effects and at higher doses, increasing the risk of overdose,"
Somers said by email.
Amid a worsening opioid epidemic in North America, individuals with
criminal histories are among the most vulnerable to overdose deaths,
researchers note in PLOS Medicine. Even when they're not
incarcerated, they often have limited access to addiction treatment
and methadone programs.
Somers and colleagues examined data on prescriptions, convictions
and deaths from all causes.
The annual death rate from all causes was roughly 11 fatalities for
every 1,000 participants.
The study wasn't a controlled experiment designed to prove whether
or how methadone treatment might reduce the risk of death from
overdoses or other causes. It's also possible that results might
look different outside of Canada in countries without universal
health care, or in people without criminal histories.
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Still, it's possible that methadone treatment protected against
deaths from causes beyond just overdoses because of the numerous
ways substance programs can impact people's day-to-day lives, said
lead study author Angela Russolillo, also of Simon Fraser
University. For people with criminal histories, treatment might
reduce their risk of infections, homelessness, and criminal
behavior.
"Individuals with criminal histories often come from marginalized
backgrounds, are suffering from a number of complex health and
social challenges, with increased rates of mortality unrelated to
drug use," Russolillo said by email. "Methadone may serve as a small
piece of the puzzle to improving survival outcomes among this, or
similarly marginalized, populations."
Methadone occupies the same opioid receptors sites in the brain as
heroin and other opioids and this makes the effects of using other
opioids less rewarding, noted Wayne Hall, author of an accompanying
editorial and a substance abuse and addiction researcher at the
University of Queensland in Australia and Kings College London in
the UK.
Regular methadone doses also prevent withdrawal symptoms, which
might in turn make people less likely to seek heroin or other
illegal drugs, Hall said by email.
"This enables them to live more stable lives and take advantage of
opportunities for rehabilitation, e.g., treating depression,
obtaining employment, etc.," Hall said. "These programs also allow
patients to have other conditions properly treated (e.g., hepatitis
B and C and HIV/AIDS, depression, etc.) and they enable patients to
improve their diet and lifestyle and reconnect with friends and
families which improves their mental health."
SOURCE: http://bit.ly/2mZ0ng8 PLOS Medicine, online July 31, 2018.
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