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Mortality prior to, during and after opioid maintenance treatment (OMT): A national prospective cross-registry study
Abstract
Background Opioid maintenance treatment (OMT) is generally considered to reduce mortality in opiate dependents. However, the level of mortality reduction is still uncertain. This study investigates mortality reductions in an "intention-to-treat" perspective including all dropouts. The mortality reducing effects of OMT are examined both within treatment and post-treatment. The study separates overdose and total mortality reductions.Methods The study is a prospective cross-registry study with up to 7 years follow-up. All opiate dependents in Norway who applied for OMT (a total of 3789 subjects) were cross-linked with data from the death registry from Statistics Norway. Date and cause of death were crossed with dates for initiation and termination of OMT, and subjects' age and gender. A baseline was established from the waiting list mortality rate. Intention-to-treat was investigated by analysing mortality among the entire population that started OMT.Results Mortality in treatment was reduced to RR 0.5 (relative risk) compared with pre-treatment. In the "intention-to-treat" perspective, the mortality risk was reduced to RR 0.6 compared with pre-treatment. The patients who left the treatment programme showed a high-mortality rate, particularly males.Conclusions OMT significantly reduces risk of mortality also when examined in an intention-to-treat perspective. Studies that evaluate effects of OMT only in patients retained in treatment tend to overestimate benefits. Levels of overdose mortality will influence the risk reduction. Cross-registry studies as the current one are an important supplement to other observational designs in this field.
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“dropout from opioid substitution treatment is associated with relapse and an increased risk of overdose and death (Clausen et al., 2008; Zhang et al., 2003).”
From Feasibility and acceptability of mindful recovery opioid use care continuum (M-ROCC): A concurrent mixed methods study (2021) · cites this paper as Clausen et al., 2008
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Self-citation
Metadata
- Authors
- Clausen, T., Anchersen, K., & Waal, H.
- Affiliations
- University of Oslo (NO)
- Corresponding author
- Clausen, Thomas
- ORCID
- Clausen, Thomas
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2008-04
- Volume
- 94
- Issue
- 1-3
- Pages
- 151-157
- ISSN
- 0376-8716 (ISSN-L)
- OpenAlex
- W2032728846
- Cited by
- 287
- References
- 34
- Citations by year
- 2026: 7 · 2025: 1 · 2024: 12 · 2023: 10 · 2022: 9 · 2021: 24 · 2020: 15 · 2019: 18 · 2018: 16 · 2017: 13 · 2016: 15 · 2015: 21 · 2014: 17 · 2013: 30 · 2012: 14
- FWCI
- 14.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- opioid maintenance treatment, opioid use disorder, mortality reduction, drug overdose deaths, intention-to-treat analysis, treatment discontinuation
- MeSH terms
- Adult, Buprenorphine, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Male, Methadone, Opioid-Related Disorders, Narcotics, Prospective Studies, Registries, Time Factors, Drug Overdose
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