Opiate death risk warning

Drug users leaving methadone treatment have an almost four-fold increased risk of dying, a major study has found. Researchers have called for users to be encouraged to stay in treatment and offered post-treatment supervision in a bid to tackle the death toll.

The study, conducted among almost 7,000 drug users over a six-year period, also expressed concern at the high rate of prescription of benzodiazepines — legal tranquillisers — among those on methadone.

The research, to be published in the journal Addiction, said opiate addiction was a “chronic relapsing” problem, with more than half of those studied having five or more treatment episodes. It said few patients were retained in treatment and that they moved “in and out”. The study, conducted by experts from the Royal College of Surgeons and Trinity College, examined rates of mortality among users in methadone treatment and those who had left.

It found the first few weeks after leaving treatment was the most dangerous time for users with a far greater risk of death from taking drugs.

The risk was calculated as four-times greater post treatment, rising to a peak during week three-to-four, when it was nine times greater. The research said opiate users, predominantly heroin and methadone users, had a mortality rate 15 times that of the general population.

The study, funded by the Health Research Board, said that half of the patients were aged under 30 and seven out of 10 were male. It said 213 patients died during the period of the study, 2004 to 2010, and that 78 of these were drug poisonings.

Toxicology on 74 deaths found opiates were found in 72 cases, followed by benzodiazepines in 56 cases.

The authors said these findings were consistent with other studies. They said the number of those receiving methadone who were also co-prescribed benzodiazepines and anti- depressants was high.

It said that 71% were taking benzodiazepines, similar to Scotland (75%), but substantially higher than the US (47%) and Norway (40%).

It said 40% were co-prescribed anti-depressants and 23% were co-prescribed anti-psychotic agents.

The researchers said efforts should be made to “encourage retention in treatment” in primary care, “as those leaving methadone treatment in primary care have almost a four-fold increase in risk of mortality”.

They also called for post-treatment monitoring and follow-up, particularly in the first month after treatment drop out. The authors said the high rate of benzodiazepine prescribing was “a cause of concern”.


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