Opioid Agonist Treatments and Heroin Overdose Deaths in Baltimore, Maryland, 1995―2009

• Published in: American journal of public health (1971) 2013-05, Vol.103 (5), p.917-922
• Main Authors: SCHWARTZ, Robert P, GRYCZYNSKI, Jan, O'GRADY, Kevin E, SHARFSTEIN, Joshua M, WARREN, Gregory, OLSEN, Yngvild, MITCHELL, Shannon G, JAFFE, Jerome H
• Format: Article
• Language: English
• Subjects: Baltimore - epidemiology; Biological and medical sciences; Buprenorphine - adverse effects; Buprenorphine - therapeutic use; Cities; Drug abuse; Drug overdose; Drug Overdose - mortality; Epidemiology; Fatalities; General aspects; Health facilities; Heroin; Heroin Dependence - drug therapy; Heroin Dependence - mortality; Heroin Dependence - rehabilitation; Humans; Intoxication; Linear Models; Longitudinal Studies; Medicaid; Medical examiners; Medical sciences; Methadone; Methadone - adverse effects; Methadone - therapeutic use; Miscellaneous; Mortality; Mortality - trends; Narcotic Antagonists - adverse effects; Narcotic Antagonists - therapeutic use; Narcotics; Opiate Substitution Treatment - trends; Outpatient care facilities; Patients; Pharmacists; Physicians; Prescriptions; Primary care; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Research and Practice; Substance abuse treatment; Time series
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2012.301049

We examined the association between the expansion of methadone and buprenorphine treatment and the prevalence of heroin overdose deaths in Baltimore, Maryland from 1995 to 2009. We conducted a longitudinal time series analysis of archival data using linear regression with the Newey-West method to correct SEs for heteroscedasticity and autocorrelation, adjusting for average heroin purity. Overdose deaths attributed to heroin ranged from a high of 312 in 1999 to a low of 106 in 2008. While mean heroin purity rose sharply (1995-1999), the increasing number of patients treated with methadone was not associated with a change in the number of overdose deaths, but starting in 2000 expansion of opioid agonist treatment was associated with a decline in overdose deaths. Adjusting for heroin purity and the number of methadone patients, there was a statistically significant inverse relationship between heroin overdose deaths and patients treated with buprenorphine (P = .002). Increased access to opioid agonist treatment was associated with a reduction in heroin overdose deaths. Implementing policies that support evidence-based medication treatment of opiate dependence may decrease heroin overdose deaths.