Opioid-dependent patients are 13 times more likely to die than their age- and sex-matched peers in the general population. To examine predictors of long-term mortality, Australian researchers conducted a 10-year follow-up study of 405 heroin-dependent patients who had participated in a randomized trial comparing methadone and buprenorphine.

• Overall mortality was 8.8 deaths per 1000 person-years of follow-up (0.66 during opioid maintenance treatment and 14.3 while out of treatment).
• Each additional opioid maintenance treatment episode lasting more than 7 days decreased mortality by 28%.
• Subjects who were using more heroin at baseline had a 12% lower mortality rate overall, likely because they spent more time in opioid maintenance treatment.

Comments by Michael Levy, PhD
Although some controversy over opioid maintenance therapy exists, the reality is that untreated opioid dependence has a high fatality rate. The selection of the treatment episode as greater than 7 days strongly suggests that opioid maintenance, not detoxification, reduces mortality (also known from the results of published controlled trials). Counselors working with opioid dependent patients should recommend either buprenorphine or methadone as the standard of care, particularly for those patients who cannot achieve abstinence without pharmacological treatment.