This cohort is likely to represent the majority of opioid dependent people in that State during this period, perhaps as high as 80%.
To my mind, the strongest argument for methadone and buprenorphine has been overdose prevention–that dead addicts can’t recover and drug-free treatment isn’t going to work for everyone at every point in time. If I’m the parent of a heroin addict and they’ve refused drug-free treatment or relapsed after high quality drug free treatment of the adequate dose and duration, maintenance might look like the least bad option. At least they’ll be alive, right? (Of course, my concern is that these drugs have become the first line treatment and access to better options is diminishing.)
So, what did they find in this cohort?
Well, 8.8% of the cohort died. (9.4% of men.)
There were 3,685 deaths in the cohort between 1985 and 2005 for a crude mortality rate of 894 per 100,000py (95% CI: 865, 923) (Table 1).
How did they die?
The majority of deaths were drug-related (n=1932; 52%), with most of these (n=1574; 82% of all drug-related deaths) coded as accidental opioid deaths. The bulk of remaining deaths were due to unintentional injuries (n=975; 26% of all deaths) and suicide (n=484; 13% of all deaths).
Did they at least live long lives?
Using the Australian life tables approach, there was an estimated 160,055 Years of Potential Life Lost (YPLL) in this cohort, an average of 44 YPLL per person who died, and 29 years of YPLL before age 65 (Table 4). Just under half (45%) of the YPLL were due to accidental opioid-related deaths (an average loss of 46 years of potential life, or 31 years prior to age 65). Motor vehicle accidents accounted for the highest average YPLL, 47 years, or 33 years before age 65.
How does this compare with the rest of the population?
The overall age-, sex- and year-standardised mortality ratio was 6.5 (95% CI: 6.3-6.7) indicating that our cohort had 6.5 times the rate of mortality than that expected in the population.
Is this unique to Australia?
The average of 44 years of potential life lost for each fatality in the cohort highlights the fact that deaths in opioid users often occur at a young age. This was particularly the case for avoidable causes of death such as drug overdose and injuries. The pattern of YPLL was broadly similar to previous analyses of a Californian male cohort (n=581) in the US, followed from 1962 to 1997 (10). Both studies found that opioid overdoses were the largest contributor to YPLL but suicides made a larger contribution to YPLL in our cohort, and homicide a larger contribution in the Californian cohort.
Now, this doesn’t mean that methadone doesn’t reduce death rates. It means that the death rate is still very high.
It also means that quality of life questions shouldn’t be dismissed with snarky quips like, “What kind of QOL do dead people have?“, because methadone patients die in large numbers too.
I’ll also throw in a reminder from a previous post about were I stand on ORT:
Just to be sure that my position is understood. I’m not advocating the abolition of methadone.
Here’s something I wrote in a previous post: “All I want is a day when addicts are offered recovery oriented treatment of an adequate duration and intensity. I have no problem with drug-assisted treatment being offered. Give the client accurate information and let them choose.”
Another: “Once again, I’d welcome a day when addicts are offered recovery oriented treatment of an adequate duration and intensity and have the opportunity to choose for themselves.”
I’ve posted several times recently on the problem of opioid over-prescription and overdose.
Some might assume that I want some regulatory or statutory intervention to address the issue. Truth is, I’ve got more questions than answers and I would not support a response that forces us to choose between treating pain and preventing addiction and overdose.
It appears that opioids are a great solution to acute pain but a lousy treatment option for chronic pain. (Though, they may be the least bad option.)
I’m not an expert on policy in this area, just an observer. But, my first thought is that The Joint Commission played a huge role in shifting pain treatment and that they may be a good way to change the behavior of prescribers and health systems.
The current state of pain management is especially bad for addicts. It leads to bad care, neglect and stigma. Even addicts who really want non-opioid, but effective, pain management get brushed off as drug-seeking.
This feels like I’m stating the obvious, but it would seem that we need more education research on non-opioid treatment options, better access to the ones that already exist and better engagement strategies for the existing behavioral strategies.
Popular Science has a chart with US overdose deaths by drug:
…the rate of reported overdoses the U.S. more than doubled between 1999 and 2010. About half of those additional deaths are in the pharmaceuticals category, which the CDC has written about before. Nearly three-quarters of the pharmaceuticals deaths are opioid analgesics—prescription painkillers like OxyContin and Vicodin. And while cocaine, heroin and alcohol are all responsible for enough deaths to warrant their own stripes on the chart, many popular illegal drugs—including marijuana and LSD—are such a tiny blip as to be invisible.
…the number of clients receiving methadone on the survey reference date increased from about 227,000 in 2003 to over 306,000 in 2011
The percentage of OTPs offering buprenorphine increased from 11 percent in 2003 to 51 percent in 2011; the percentage of facilities without OTPs offering buprenorphine increased from 5 percent in 2003 to 17 percent in 2011
The numbers of clients receiving buprenorphine on the survey reference date increased between 2004 and 2011: at OTPs, from 727 clients in 2004 to 7,020 clients in 2011, and at facilities without OTPs, from 1,670 clients in 2004 to 25,656 clients in 2011
Read our position on buprenorphine maintenance here.
This has gotten a lot of press. There’s naloxone distribution doubt this will reduce overdose deaths. However, some pretty important questions remain:
What happens after the overdose?
What services/interventions might have prevented the overdose in the first place?
The article references placing defibrillators in public places. What happens after someone is saved by one of those defibrillators? An ambulance comes and takes them to receivetreatment. (Often treatment that costs tens of thousands of dollars.)
0 = Number of times the word “treatment/treat/treatable” appears in the article
0 = Number of times the word “recovery/recover” appears in the article
So … dead addict don’t recover, but why do we seem to care so little about treating what nearly killed the patient?
Overdoses of drugs, particularly prescription painkillers and heroin, have overtaken AIDS to become the leading cause of death of homeless adults, according to a study of homeless residents of Boston released on Monday.
The finding came from a five-year study of homeless adults who received treatment from the Boston Health Care for the Homeless Program, though its broad conclusions apply to homeless populations in many urban parts of the United States, the study’s author and homeless advocates said.
The tripling in the rate of death by drug overdose reflects an overall rise in pain-killer abuse, said Dr. Travis Baggett of Massachusetts General Hospital, the lead author of the study, to be published next month in the journal JAMA Internal Medicine.
“This trend is happening across the country, in non-homeless populations too,” Baggett said. “Homeless people tend to experience in a magnified way the health issues that are going on the general population.”
The study, which tracked 28,033 homeless adults from 2003 through 2008, found that of the 17 percent who died during the study period died of drug overdoses while 6 percent died of causes related to HIV, the virus that causes AIDS.
UPDATE: Mark pulled the video. Hopefully it’s only temporary.
My job allows me to meet some really wonderful people. Sadly, I meet some of them under really terrible circumstances. Mark Rudolph is one of those people. He lost his son to opiate addiction 5 years ago and has chosen to make meaning of it by educating others about opiate addiction in the “safe” suburbs and supporting families dealing with addiction.
Saving lives is good an important, but something about this feels like building an addition on a house in hell.
Naloxone is a medication administered usually by injection which rapidly reverses the effects of opiate-type drugs such as heroin, including the respiratory depression which can cause what are normally referred to as ‘overdose’ deaths. … The 16 pilot projects trained 495 carers (family members, partners and other carers) to respond to an overdose using basic life support techniques, and all but one also trained them to administer naloxone.
Saving lives is a good thing, but what else might be done to prevent overdoses? Why this?
Yesterday’s post asked, “at what cost?” What are the costs of this to the family members?