Published 17 June 2009, doi:10.1136/bmj.b2225
Cite this as: BMJ 2009;338:b2225

Research

Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study

¹ Division of Community Health Sciences, University of Dundee, Dundee DD2 4BF, ² Section of Psychiatry and Behavioural Sciences, Division of Pathology and Neuroscience, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, ³ Department of General Practice and Family Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland

Objective To assess predictors of mortality in a population of people prescribed methadone.

Design Retrospective cohort study.

Setting Geographically defined population in Tayside, Scotland.

Participants 2378 people prescribed and dispensed liquid methadone between January 1993 and February 2004.

Main outcome measures All cause mortality (primary outcome) and drug dependent cause specific mortality (secondary outcome) by means of Cox proportional hazards models during 12 years of follow-up.

Results Overall, 181 (8%) people died. Overuse of methadone (adjusted hazard ratio 1.67, 95% confidence interval 1.05 to 2.67), history of psychiatric admission (2.47, 1.67 to 3.66), and increasing comorbidity measured as Charlson index 3 (1.20, 1.15 to 1.26) were all associated with an increase in all cause mortality. Longer duration of use (adjusted hazard ratio 0.95, 0.94 to 0.96), history of having urine tested (0.33, 0.22 to 0.49), and increasing time since last filled prescription were protective in relation to all cause mortality. Drug dependence was identified as the principal cause of death in 60 (33%) people. History of psychiatric admission was significantly associated with drug dependent death (adjusted hazard ratio 2.41, 1.25 to 4.64), as was history of prescription of benzodiazepines (4.35, 1.32 to 14.30).

Conclusions Important elements of care in provision of methadone maintenance treatment are likely to influence, or be a marker for, a person’s risk of death.

© McCowan et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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