Comparing retention in treatment and mortality in people after initial entry to methadone and buprenorphine treatment
Bell J et al. - Buprenorphine was safer during induction. Despite shorter retention in treatment, buprenorphine maintenance was not associated with higher risk of death. Methods- First entrants to treatment between June 2002 and June 2006 were identified from the PHDAS database.
- Retention in treatment was compared between methadone and buprenorphine.
- Names were linked to the NDI database, and `good matches' were identified.
- Deaths were classified as occurring during induction, maintenance and either post-methadone or post-buprenorphine, depending on the latest episode of treatment prior to death.
- The numbers of inductions into treatment, of total person-years spent in each treatment, and person-years post-methadone or buprenorphine, were calculated.
- Risk of death in different periods, and different treatments, was analysed using Poisson regression.
Results- A total of 5992 people entered their first episode of treatment—3349 (56%) on buprenorphine, 2643 on methadone.
- Median retention was significantly longer in methadone (271 days) than buprenorphine (40 days).
- During induction, the risk of death was lower for buprenorphine (relative risk=0.114, 95% confidence interval=0.002-0.938, P=0.02, Fisher's exact test).
- Risk of death was lowest during treatment, significantly higher in the first 12 months after leaving both methadone and buprenorphine.
- Beyond 12 months after leaving treatment, risk of death was non-significantly higher than during treatment.
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