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Objectives. The purpose of this study was to investigate the impact of harm-reduction-based methadone programs on mortality among heroin users.
Methods. A prospective cohort investigation was conducted among 827 participants in the Amsterdam Cohort Study. Poisson regression was used to identify methadone maintenance treatment characteristics (dosage, frequency of program attendance, and type of program) that are significantly and independently associated with mortality due to natural causes and overdose.
Results. From 1985 to 1996, 89 participants died of natural causes, and 31 died as a result of an overdose. After adjustment for HIV and underweight status, there was an increase in natural-cause mortality among subjects who left methadone treatment (relative risk [RR] = 2.38, 95% confidence interval [CI] = 1.28, 4.55). Leaving treatment was also related to higher overdose mortality, but only among injection drug users (RR= 4.55, 95% CI= 1.89, 10.00).
Conclusions. Harm-reduction-based methadone treatment, in which the use of illicit drugs is tolerated, is strongly related to decreased mortality from natural causes and from overdoses. Provision of methadone in itself, together with social-medical care, appears more important than the actual methadone dosage. (Am J Public Health. 2001;91:774-780)
Users of illicit drugs are at increased risk of premature mortality.1-3 The most important natural causes of death among such individuals are infections (e.g., AIDS, hepatitis, endocarditis), which are acquired mainly through nonsterile injection practices and needle sharing. Common nonnatural causes of death are overdose, suicide, violence, and accidents.4-6 The HIV epidemic has contributed greatly to increased mortality in this population,7-10 but in most countries, overdose is the leading cause of death among drug users.11
Methadone is widely used for detoxification, but it is also used as maintenance treatment to prevent withdrawal symptoms. When administered in adequate dosages, it can relieve the "narcotic hunger" or craving for heroin. Randomized controlled trials and observational studies have shown that methadone maintenance can reduce heroin use, crime, and injection-related risk behaviors. 12 Opiate-- dependent drug users who receive methadone maintenance treatment appear to have a reduced risk of dying in comparison with drug users who have never been treated with methadone and drug users who have left methadone treatment.13 16
The literature on the association between mortality and treatment is...