Cited by 1,816Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesHIV, Drug Use, Sexual Risk

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Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies.

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Sordo, Luis, Barrio, Gregorio, Bravo, Maria J, Indave, B Iciar, Degenhardt, Louisa, Wiessing, Lucas, Ferri, Marica, Pastor-Barriuso, Roberto·2017·BMJ

DOI 10.1136/bmj.j1550PMC PMC5421454

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Abstract

Objective To compare the risk for all cause and overdose mortality in people with opioid dependence during and after substitution treatment with methadone or buprenorphine and to characterise trends in risk of mortality after initiation and cessation of treatment. Design Systematic review and meta-analysis. Data sources Medline, Embase, PsycINFO, and LILACS to September 2016. Study selection Prospective or retrospective cohort studies in people with opioid dependence that reported deaths from all causes or overdose during follow-up periods in and out of opioid substitution treatment with methadone or buprenorphine. Data extraction and synthesis Two independent reviewers performed data extraction and assessed study quality. Mortality rates in and out of treatment were jointly combined across methadone or buprenorphine cohorts by using multivariate random effects meta-analysis. Results There were 19 eligible cohorts, following 122 885 people treated with methadone over 1.3-13.9 years and 15 831 people treated with buprenorphine over 1.1-4.5 years. Pooled all cause mortality rates were 11.3 and 36.1 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 3.20, 95% confidence interval 2.65 to 3.86) and reduced to 4.3 and 9.5 in and out of buprenorphine treatment (2.20, 1.34 to 3.61). In pooled trend analysis, all cause mortality dropped sharply over the first four weeks of methadone treatment and decreased gradually two weeks after leaving treatment. All cause mortality remained stable during induction and remaining time on buprenorphine treatment. Overdose mortality evolved similarly, with pooled overdose mortality rates of 2.6 and 12.7 per 1000 person years in and out of methadone treatment (unadjusted out-to-in rate ratio 4.80, 2.90 to 7.96) and 1.4 and 4.6 in and out of buprenorphine treatment. Conclusions Retention in methadone and buprenorphine treatment is associated with substantial reductions in the risk for all cause and overdose mortality in people dependent on opioids. The induction phase onto methadone treatment and the time immediately after leaving treatment with both drugs are periods of particularly increased mortality risk, which should be dealt with by both public health and clinical strategies to mitigate such risk. These findings are potentially important, but further research must be conducted to properly account for potential confounding and selection bias in comparisons of mortality risk between opioid substitution treatments, as well as throughout periods in and out of each treatment.

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Fig 1 Selection process of cohort studies on mortality among people receiving opioid substitution treatmentCC BY-NC · PubMed Central

Fig 2 All cause mortality rates in and out of opioid substitution treatment with methadone or buprenorphine and overall pooled all cause mortality rates, 1974-2016. Area of each square is proportional to study weight in meta-analysis. Horizontal lines represent exact 95% confidence intervals based on Poisson distribution. Diamonds represent pooled all cause mortality rates during periods in and out of treatment across all methadone or buprenorphine cohorts estimated from bivariate random effects meta-analysis on log transformed rates in both treatment periodsCC BY-NC · PubMed Central

Fig 3 Overdose mortality rates in and out of opioid substitution treatment with methadone or buprenorphine and overall pooled overdose mortality rates, 1974-2016. Area of each square is proportional to study weight in meta-analysis. Horizontal lines represent exact 95% confidence intervals based on Poisson distribution. Diamonds represent pooled overdose mortality rates during periods in and out of treatment across all methadone cohorts estimated from bivariate random effects meta-analysis on log transformed rates in both treatment periodsCC BY-NC · PubMed Central

Fig 4 All cause mortality rates by time interval in and out of opioid substitution treatment with methadone or buprenorphine and pooled all cause mortality rates, 2009-16. Mortality data were disaggregated into first four weeks and remaining follow-up in and out of treatment in all cohort studies except Degenhardt et al,6 which reported mortality before and after two weeks of treatment initiation and cessation. High risk cohort of Nosyk et al36 (injectors positive for HIV receiving highly active antiretroviral therapy) was excluded from meta-analysis. Area of each square is proportional to study weight in meta-analysis. Horizontal lines represent exact 95% confidence intervals based on Poisson distribution. Diamonds represent pooled all cause mortality rates before and after four weeks in and out of treatment across methadone or buprenorphine cohorts estimated from multivariate random effects meta-analysis on log transformed rates in four time-by-treatment intervalsCC BY-NC · PubMed Central

Fig 5 All cause mortality rates by time since treatment initiation and cessation in methadone cohorts and pooled all cause mortality risk trends, 2009-16. High risk cohort of Nosyk et al36 (injectors positive for HIV receiving highly active antiretroviral therapy) was excluded from meta-regression. Area of each circle is proportional to weight of each time interval in meta-regression. Pooled trends in all cause mortality risk (solid lines) and their 95% confidence intervals (shaded regions) over time in and out of methadone treatment were estimated from bivariate random effects meta-regression of log transformed rates on quadratic linear spline function of log time with knot at four weeksCC BY-NC · PubMed Central

Fig 6 Overdose mortality rates by time interval in and out of opioid substitution treatment with methadone or buprenorphine and pooled overdose mortality rates, 2002-16. Mortality data were disaggregated into first four weeks and remaining follow-up in and out of treatment in all cohort studies except Buster et al,7 which reported mortality before and after two weeks of treatment initiation and cessation. Area of each square is proportional to study weight in meta-analysis. Horizontal lines represent exact 95% confidence intervals based on Poisson distribution. Diamonds represent pooled overdose mortality rates before and after four weeks in and out of treatment across methadone cohorts estimated from multivariate random-effects meta-analysis on log transformed rates in four time-by-treatment intervalsCC BY-NC · PubMed Central

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Morozova, O., Crawford, F. W., Cohen, T., Paltiel, A. D., & Altice, F. L. (2019) · Addiction · doi:10.1111/add.14797 · Cited by 30
“This is a conservative assumption given costs associated with higher rates of overdose and emergency room utilization among untreated POUD compared to those receiving OAT [37].”
Result
Evaluation of a personally-tailored opioid overdose prevention education and naloxone distribution intervention to promote harm reduction and treatment readiness in individuals actively using illicit opioids
Winhusen, T. M., Wilder, C. M., Lyons, M. S., Theobald, J., Kropp, F. B., & Lewis, D. F. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108265 · Cited by 30
At the intersection of sleep deficiency and opioid use: mechanisms and therapeutic opportunities
Greenwald, M. K., Moses, T. E. H., & Roehrs, T. (2021) · Translational research · doi:10.1016/j.trsl.2021.03.006 · Cited by 29
Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series
Spadaro, A., Faude, S., Perrone, J., Thakrar, A. P., Lowenstein, M., Delgado, M. K., & Kilaru, A. S. (2023) · Journal of the American College of Emergency Physicians Open · doi:10.1002/emp2.12880 · Cited by 29
Dissemination of Contingency Management for the Treatment of Opioid Use Disorder
DeFulio, A. (2023) · Perspectives on Behavior Science · doi:10.1007/s40614-022-00328-z · Cited by 28
“Medications such as methadone and buprenorphine (Suboxone®) are effective in promoting abstinence from illicit opioids and preventing drug overdose (Sordo et al., 2017; Strain et al., 1994).”
Background
“Just give them a choice”: Patients' perspectives on starting medications for opioid use disorder in the ED
Schoenfeld, E. M., Westafer, L. M., Beck, S. A., Potee, B. G., Vysetty, S., Simon, C., Tozloski, J. M., Girardin, A. L., & Soares, W. E. (2022) · Academic Emergency Medicine · doi:10.1111/acem.14507 · Cited by 29
“Additionally, participants felt that: (1) both buprenorphine and methadone should be offered; (2) because “one person's pro is another person's con,” clinicians will need to understand the facets of the options; (3) clinicians will need to have these conversations without appearing judgmental; and (4) many patients ma…”
Background
Impact of fentanyl use on initiation and discontinuation of methadone and buprenorphine/naloxone among people with prescription‐type opioid use disorder: secondary analysis of a Canadian treatment trial
Socias, M. E., Wood, E., Foll, B. L., Lim, R., Choi, J. C., Mok, W. Y., Bruneau, J., Rehm, J. T., Wild, T. C., Bozinoff, N., et al. (2022) · Addiction · doi:10.1111/add.15954 · Cited by 32
Transitioning off methadone: A qualitative study exploring why patients discontinue methadone treatment for opioid use disorder
Thakrar, A. P., Pytell, J. D., Stoller, K. B., Walters, V., Weiss, R. D., & Chander, G. (2023) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2023.209055 · Cited by 29
Very early disengagement and subsequent re-engagement in primary care Office Based Opioid Treatment (OBOT) with buprenorphine
Hui, D. S. C., Weinstein, Z., Cheng, D. M., Quinn, E. K., Kim, H. W., LaBelle, C. T., & Samet, J. H. (2017) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2017.05.010 · Cited by 28
“(Bart, 2012; Dunn, Sigmon, Strain, Heil, & Higgins, 2011; Fudala et al., 2003; Kakko, Svanborg, Kreek, & Heilig, 2003; Sordo et al., 2017) Successful buprenorphine treatment retention is associated with reduced mortality, improved social function, decreased illicit drug use, and improved quality of…”
Background
Opioid use disorder in primary care: PEER umbrella systematic review of systematic reviews.
Korownyk, C. S., Perry, D., Ton, J., Kolber, M. R., Garrison, S., Thomas, B., Allan, G. M., Dugré, N., Finley, C. R., Ting, R., et al. (2019) · Europe PMC (PubMed Central) · Cited by 29
Managing Pain in the Setting of Opioid Use Disorder
Marie, B. S., & Broglio, K. (2019) · Pain Management Nursing · doi:10.1016/j.pmn.2019.08.003 · Cited by 31
“Buprenorphine may be a safer option than methadone owing to its ceiling effect (Sordo et al., 2017), decreased risk of QTc”
Background
Methadone and buprenorphine-related deaths among people prescribed and not prescribed Opioid Agonist Therapy during the COVID-19 pandemic in England
Aldabergenov, D., Reynolds, L., Scott, J., Kelleher, M., Strang, J., Copeland, C. S., & Kalk, N. J. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103877 · Cited by 28
Harm-Reduction Interventions
Hedrich, D., & Hartnoll, R. (2020) · Textbook of Addiction Treatment · doi:10.1007/978-3-030-36391-8_52 · Cited by 38
Review of Case Narratives from Fatal Overdoses Associated with Injectable Naltrexone for Opioid Dependence
Saucier, R., Wolfe, D., & Dasgupta, N. (2018) · Drug Safety · doi:10.1007/s40264-018-0653-3 · Cited by 28
Methadone maintenance treatment and mortality in people with criminal convictions: A population-based retrospective cohort study from Canada
Russolillo, A., Moniruzzaman, A., & Somers, J. M. (2018) · PLoS Medicine · doi:10.1371/journal.pmed.1002625 · Cited by 28
Using routinely collected data to understand and predict adverse outcomes in opioid agonist treatment: Protocol for the Opioid Agonist Treatment Safety (OATS) Study
Larney, S., Hickman, M., Fiellin, D. A., Dobbins, T., Nielsen, S., Jones, N. R., Mattick, R. P., Ali, R. L., & Degenhardt, L. J. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-025204 · Cited by 30
“26–28 Additional adverse outcomes during OAT may include non-fatal overdoses, accidents 29 or cardiac problems resulting from QT interval prolongation.”
Background
Challenges on the road to recovery: Exploring attitudes and experiences of clients in a community-based buprenorphine program in Baltimore City
Truong, C., Krawczyk, N., Dejman, M., Marshall-Shah, S., Tormohlen, K. N., Agus, D., & Bass, J. (2019) · Addictive Behaviors · doi:10.1016/j.addbeh.2019.01.020 · Cited by 28
“Medication-assisted therapies (MAT) for OUD have been found to be safe, significantly reduce risk of overdose, increase treatment adherence, and decrease transmission of infectious disease (Voklow, Frieden, Hyde, & Cha, 2014; Sordo et al., 2017; Mattick, Breen, Kimber, & Davoli, 2009; Tsui, Evans & Lum, 2014; Metzger…”
Background
Incidence and predictors of drug overdoses among a cohort of >10,000 patients treated for substance use disorder
Thylstrup, B., Seid, A. K., Tjagvad, C., & Hesse, M. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.107714 · Cited by 28
Discharges “Against Medical Advice” in Patients With Opioid-related Hospitalizations
Santos, C. J., Shofer, F. S., Lowenstein, M., & Perrone, J. (2020) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000688 · Cited by 28
“methadone and buprenorphine – improve a number of outcomes including reductions in overdose and all-cause mortality, illicit drug use, and transmission of infectious disease (Mattick et al., 2009; Mattick et al., 2014; Volkow et al., 2014; Alderks, 2017; Sordo et al., 2017).”
Background
Retention of opioid agonist treatment prescribers across New South Wales, Australia, 2001–2018: Implications for treatment systems and potential impact on client outcomes
Jones, N. R., Nielsen, S., Farrell, M., Ali, R. L., Gill, A., Larney, S., & Degenhardt, L. J. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108464 · Cited by 28
“The risk of death is halved while on OAT as compared to out-of-treatment (Degenhardt et al., 2019; Sordo et al., 2017), survival benefits increase with cumulative exposure to treatment (Kimber et al.”
Background
Experiences with an Addiction Consultation Service on Care Provided to Hospitalized Patients with Opioid use Disorder: A Qualitative Study of Hospitalists, Nurses, Pharmacists, and Social Workers
Callister, C., Lockhart, S., Holtrop, J. S., Hoover, K., & Calcaterra, S. L. (2021) · Substance Abuse · doi:10.1080/08897077.2021.1975873 · Cited by 28
Modeling the population‐level impact of opioid agonist treatment on mortality among people accessing treatment between 2001 and 2020 in New South Wales, Australia
Chaillon, A., Bharat, C., Stone, J., Jones, N., Degenhardt, L. J., Larney, S., Farrell, M., Vickerman, P. T., Hickman, M., Martin, N. K., et al. (2021) · Addiction · doi:10.1111/add.15736 · Cited by 28
Buprenorphine implementation at syringe service programs following waiver of the Ryan Haight Act in the United States
Lambdin, B. H., Bluthenthal, R. N., Tookes, H. E., Wenger, L. D., Morris, T., LaKosky, P. A., & Kral, A. H. (2022) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2022.109504 · Cited by 28
“Buprenorphine, a MOUD approved by the US Food and Drug Administration in 2002, has a strong evidence-base and has been shown to reduce opioid overdose mortality (US Department of Health and Human Services, 2020; Sordo et al., 2017).”
Background
Attitudes toward opioid use disorder medications: Results from a U.S. national study of individuals who resolved a substance use problem.
Bergman, B. G., Ashford, R. D., & Kelly, J. F. (2019) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000325 · Cited by 28
“Opioid use disorder (OUD) agonist medications, such as methadone, and partial agonist medications, such as buprenorphine (typically prescribed in a formulation with naloxone that can be taken sublingually, marketed in the United States as Suboxone), reduce the likelihood of illicit opioid use and opioid-involved overd…”
Background
The association between buprenorphine treatment duration and mortality: a multi‐site cohort study of people who discontinued treatment
Glanz, J. M., Binswanger, I. A., Clarke, C. L., Nguyen, A. P., Ford, M. A., Ray, G. T., Xu, S., Hechter, R. C., Yarborough, B. J. H., Roblin, D. W., et al. (2022) · Addiction · doi:10.1111/add.15998 · Cited by 27
“Published studies have documented higher mortality in the first 4 weeks off treatment [5]; therefore, Kaplan – Meier curves for all-cause mortality were generated to visually examine the survival probabilities across groups over time.”
Influential
The projected costs and benefits of a supervised injection facility in Seattle, WA, USA
Hood, J. E., Behrends, C. N., Irwin, A., Schackman, B. R., Chan, D., Hartfield, K., Hess, J., Banta‐Green, C. J., Whiteside, L., Finegood, B., et al. (2019) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2018.12.015 · Cited by 27
Get Waivered: A Resident-Driven Campaign to Address the Opioid Overdose Crisis
Martin, A., Kunzler, N. M., Nakagawa, J., Lee, B., Wakeman, S. E., Weiner, S. G., & Raja, A. S. (2019) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2019.04.035 · Cited by 27
From restrictive to more liberal: variations in mortality among patients in opioid maintenance treatment over a 12-year period
Bukten, A., Stavseth, M. R., & Clausen, T. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4382-9 · Cited by 27
“In a recent meta-analysis, Sordo and colleagues [14] synthesised evidence from cohort studies Table 2 All cause and cause-specific mortality rates, before, during and after treatment; crude mortality rates (CMR) per 1000 person-years and 95% confidence interval”
BackgroundResult
Acceptability and efficacy of naltrexone for criminal justice‐involved individuals with opioid use disorder: a systematic review and meta‐analysis
Bahji, A., Carlone, D., & Altomare, J. (2019) · Addiction · doi:10.1111/add.14946 · Cited by 27
The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US
Stahler, G. J., & Mennis, J. L. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108067 · Cited by 27
Barriers to Medications for Opioid Use Disorder Among Veterans Involved in the Legal System: a Qualitative Study
Finlay, A. K., Morse, E. F., Stimmel, M. A., Taylor, E. N., Timko, C., Harris, A. H. S., Smelson, D. A., Yu, M., Blue‐Howells, J., & Binswanger, I. A. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-020-05944-6 · Cited by 27
Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine
Tiako, M. J. N., Culhane, J. F., South, E. C., Srinivas, S. K., & Meisel, Z. F. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.29043 · Cited by 27
Re-thinking patient stability for methadone in opioid treatment programs during a global pandemic: Provider perspectives
Hatch‐Maillette, M. A., Peavy, K. M., Tsui, J. I., Banta‐Green, C. J., Woolworth, S., & Grekin, P. (2020) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2020.108223 · Cited by 27
Overcoming Barriers to Treatment of Opioid Use Disorder
Olsen, Y. K., Fitzgerald, R. M., & Wakeman, S. E. (2021) · JAMA · doi:10.1001/jama.2021.1741 · Cited by 27
Linking MATTERS: Barriers and Facilitators to Implementing Emergency Department-Initiated Buprenorphine-Naloxone in Patients with Opioid Use Disorder and Linkage to Long-Term Care
Sokol, R. G., Tammaro, E., Kim, J. Y., & Stopka, T. J. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1906280 · Cited by 27
“…disorder (MOUD), such as buprenorphine-naloxone (B/N), methadone, and naltrexone, have been proven to cut mortality rates by more than three-fold (Sordo et al., 2017), only two in five patients with opioid use disorder (OUD) receive these evidence-based treatments (Larochelle et al., 2018;…”
Background
Rhode Island's Opioid Overdose Hospital Standards and Emergency Department Naloxone Distribution, Behavioral Counseling, and Referral to Treatment
Samuels, E. A., Wentz, A. E., McCormick, M., McDonald, J., Marshall, B. D. L., Friedman, C., Koziol, J. A., & Alexander-Scott, N. E. (2021) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2021.02.004 · Cited by 27
Examining differences in retention on medication for opioid use disorder: An analysis of Ohio Medicaid data
Zhang, P., Tossone, K., Ashmead, R., Bickert, T., Bailey, E., Doogan, N., Mack, A., Schmidt, S., & Bonny, A. E. (2021) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2021.108686 · Cited by 27
Improving equity and access to buprenorphine treatment through telemedicine at syringe services programs
Lambdin, B. H., Kan, D., & Kral, A. H. (2022) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-022-00483-1 · Cited by 27
“Buprenorphine, a MOUD approved by the US Food and Drug Administration in 2002, has a strong evidence-base showing reductions in opioid use and opioid overdose mortality [2, 3].”
Background
Estimated Costs and Outcomes Associated With Use and Nonuse of Medications for Opioid Use Disorder During Incarceration and at Release in Massachusetts
Chatterjee, A., Weitz, M., Savinkina, A. A., Macmadu, A., Madushani, R. W. M. A., Potee, R. A., Ryan, D., Murphy, S. M., Walley, A. Y., & Linas, B. P. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.7036 · Cited by 27
Hospital-based clinicians lack knowledge and comfort in initiating medications for opioid use disorder: opportunities for training innovation
Jakubowski, A. U., Singh‐Tan, S., Torres‐Lockhart, K., Nahvi, S., Stein, M., Fox, A. D., & Lu, T. Y. (2023) · Addiction Science & Clinical Practice · doi:10.1186/s13722-023-00386-x · Cited by 27
“Differences between initiators and non‐initiators Among those who had initiated buprenorphine and/or methadone, the median number of patients initiated was 2 [Q1, Q3] = [1, 2] for buprenorphine and 3 [Q1, Q3] = [1, 5] for methadone.”
Background
Long‐Term Retention in an Outpatient Behavioral Health Clinic With Buprenorphine
Montalvo, C., Stankiewicz, B., Brochier, A., Henderson, D. C., & Borba, C. P. C. (2019) · American Journal on Addictions · doi:10.1111/ajad.12896 · Cited by 26
Methadone treatment of arrestees: A randomized clinical trial
Schwartz, R. P., Kelly, S. M., Mitchell, S. G., O’Grady, K. E., Sharma, A., & Jaffe, J. H. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.107680 · Cited by 26
“, 2009) and reduced drug-related mortality (Sordo et al., 2017).”
Psychosocial intervention utilization and substance abuse treatment outcomes in a multisite sample of individuals who use opioids
Harvey, L. M., Fan, W., Cano, M. Á., Vaughan, E. L., Arbona, C., Essa, S., Sanchez, H. F., & de Dios, M. A. (2020) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2020.01.016 · Cited by 26
Diagnosis and Management of Opioid Use Disorder in Hospitalized Patients
Herscher, M., Fine, M., Navalurkar, R., Hirt, L., & Wang, L. (2020) · Medical Clinics of North America · doi:10.1016/j.mcna.2020.03.003 · Cited by 26
Causes, Nature and Toxicology of Fentanyl-Associated Deaths: A Systematic Review of Deaths Reported in Peer-Reviewed Literature
Cheema, E. U., McGuinness, K., Hadi, M. A., Paudyal, V., Elnaem, M. H., Alhifany, A. A., Elrggal, M. E., & Hamid, A. A. (2020) · Journal of Pain Research · doi:10.2147/jpr.s280462 · Cited by 28
Emergency department‐initiated buprenorphine protocols: A national evaluation
Guo, C. Z., D’Onofrio, G., Fiellin, D. A., Edelman, E. J., Hawk, K. F., Herring, A. A., McCormack, R. P., Perrone, J., & Cowan, E. A. (2021) · Journal of the American College of Emergency Physicians Open · doi:10.1002/emp2.12606 · Cited by 26
Opioid agonist treatment (OAT) experiences and release plans among federally incarcerated individuals with opioid use disorder (OUD) in Ontario, Canada: a mixed-methods study
Russell, C., Nafeh, F., Pang, M., MacDonald, S. F., Derkzen, D. M., Rehm, J. T., & Fischer, B. (2022) · BMC Public Health · doi:10.1186/s12889-022-12685-0 · Cited by 26
“Furthermore, correctional populations face high odds of substance userelated relapse and overdose upon release, which can be mediated by OAT provision [48, 60].”
Background
Folate Status as a Nutritional Indicator among People with Substance Use Disorder; A Prospective Cohort Study in Norway
Bemanian, M., Vold, J. H., Chowdhury, R., Aas, C. F., Gjestad, R., Johansson, K. A., & Fadnes, L. T. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095754 · Cited by 26
Analysis of Stimulant Prescriptions and Drug-Related Poisoning Risk Among Persons Receiving Buprenorphine Treatment for Opioid Use Disorder
Mintz, C. M., Xu, K. Y., Presnall, N. J., Hartz, S. M., LEVIN, F. R., Scherrer, J. F., Bierut, L. J., & Grucza, R. A. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.11634 · Cited by 26

Authors: Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R.
Affiliations: Universidad Complutense de Madrid (ES)
Instituto de Salud Carlos III (ES)
The University of Melbourne (AU)
European Monitoring Centre for Drugs and Drug Addiction (PT)
Corresponding author: Barrio, Gregorio
ORCID: Sordo, Luis
Barrio, Gregorio
Degenhardt, Louisa
Wiessing, Lucas
Ferri, Marica
Venue: BMJ
Publisher: BMJ
Published: 2017-04-26
Volume: 357
Pages: j1550
ISSN: 1756-1833 (ISSN-L)
0959-8138
DOI: 10.1136/bmj.j1550
PMC: PMC5421454
OpenAlex: W2608446001
Cited by: 1,816
References: 76
Citations by year: 2026: 156 · 2025: 194 · 2024: 201 · 2023: 239 · 2022: 228 · 2021: 261 · 2020: 213 · 2019: 187 · 2018: 99 · 2017: 32
FWCI: 23.58
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
www.bmj.org/licenses/tdm/1.0/terms-and-conditions.html (tdm)
Locations: BMJ (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-sa)
Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
HighWire Press Open Archive (submittedVersion)
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 substitution therapy, methadone, buprenorphine, opioid use disorder, all-cause mortality, drug overdose deaths, treatment retention, treatment discontinuation, harm reduction, opioid antagonists
MeSH terms: Buprenorphine, Humans, Methadone, Opioid-Related Disorders, Narcotics, Risk, Opiate Substitution Treatment, Drug Overdose

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Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies.

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