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Opioid substitution treatment is linked to reduced risk of death in opioid use disorder

BMJ 2017; 357 doi: (Published 26 April 2017) Cite this as: BMJ 2017;357:j1947
  1. Ajay Manhapra, physician and lecturer1 2,
  2. Robert Rosenheck, professor2,
  3. David A Fiellin, professor2
  1. 1VA Hampton Medical Center, Hampton, VA, USA
  2. 2Yale School of Medicine, New Haven, CT, USA
  1. Correspondence to: A Manhapra

Sustained engagement in treatment is vital, particularly in the first “golden month”

Deaths related to the “epidemic” of opioid use disorder are inescapable realities in communities across North America, with tags like “the American Carnage” and “this generations’ AIDS crisis” in the lay press. Prescription opioids, heroin, and, more recently, fentanyl have all contributed to a precipitous rise in deaths related to opioid overdose.1 The global burden of opioid use disorder also continues to rise. Opioid substitution treatment (or the preferred term opioid agonist treatment2) with long acting opioids such as methadone or buprenorphine, the most effective evidence based approach, has emerged as the prominent tool in response to this public health challenge.3 Long term treatment of opioid use disorder with another opioid might evoke skepticism and concern among policymakers, patients, families, communities, and even physicians, potentially limiting participation in treatment and posing a challenge to public health.

In a linked paper, Sordo and colleagues (doi:10.1136/bmj.j1550) aggregated data on the mortality benefits of engagement with opioid substitution treatment and the harms associated with disengagement.4 Their well conducted systematic review includes …

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