Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain

• Published in: Addiction (Abingdon, England) England), 2005-07, Vol.100 (7), p.981-989
• Main Authors: Brugal, M. T., Domingo-Salvany, A., Puig, R., Barrio, G., García de Olalla, P., De La Fuente, L.
• Format: Article
• Language: English
• Subjects: Acquired Immunodeficiency Syndrome - mortality; Addiction; Addictive behaviors; Adolescent; Adult; Adult and adolescent clinical studies; AIDS; Barcelona; Biological and medical sciences; Cohort analysis; Drug abusers; Drug Overdose - mortality; Drugs; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Health; Heroin; Heroin Dependence - mortality; Heroin Dependence - rehabilitation; heroin mortality; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Medical treatment; Methadone; Methadone - therapeutic use; methadone treatments; Middle Aged; Mortality; Narcotics - therapeutic use; Overconsumption; overdose mortality; Overdoses; Program Evaluation; Proportional Hazards Models; Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Social problems; Spain; Spain - epidemiology; Substance Abuse, Intravenous - complications; Substance use; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/j.1360-0443.2005.01089.x

ABSTRACT Aims  To assess the relationship between methadone treatment (MT) and overdose and HIV/AIDS mortality among heroin users resident in Barcelona city. Design  All patients who started treatment in any treatment centre between 1992  and 1997 were included in a cohort the first time they were  admitted for heroin addiction treatment. Follow‐up controls were carried out every 9 months, on average, until 31 December 1999. Variables, both constant and varying over time, were fitted into Cox regression models. Findings  The study recruited 5049 patients, which provided 23 048.2 person‐years. Fifty per cent were in MT during the study period; of the total cohort 1005 patients died: 38.4% due to AIDS, 34.7% to overdose and 27% to other causes. Overall mortality decreased from 5.9 deaths per 100 person‐years in 1992 to 1.6 in 1999. Globally, life expectancy at birth was 39 years, 38 years lower than that of the general population. The main factor for overdose mortality was not being in MT at the time of death [relative ratio (RR) = 7.1]; other factors were being a current injector at baseline and being HIV positive. For AIDS mortality, the main factor was the calendar year (RR for 1996 versus 1999 = 4.6), the next major factor was more than 10 years of heroin consumption, followed by not being in MT, being unemployed, then having a prison record. Conclusions  The observed mortality decline could be linked to the effectiveness of low‐threshold MT. The life expectancy of heroin users increased by 21 years during the study period.