The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales
Objective To examine the population-wide overdose risk emerging from the prescription of methadone and buprenorphine for opioid substitution treatment in England and Wales.Design Retrospective administrative data study.Setting National databases for England and Wales.Participants/cases Drug-related...
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BMJ Publishing Group
2015-05-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/5/5/e007629.full |
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| author | Dave Marteau Rebecca McDonald Kamlesh Patel |
| author_facet | Dave Marteau Rebecca McDonald Kamlesh Patel |
| author_sort | Dave Marteau |
| collection | DOAJ |
| description | Objective To examine the population-wide overdose risk emerging from the prescription of methadone and buprenorphine for opioid substitution treatment in England and Wales.Design Retrospective administrative data study.Setting National databases for England and Wales.Participants/cases Drug-related mortality data were drawn from the Office for National Statistics, and prescription data for methadone and buprenorphine were obtained from the National Health Service for the years 2007–2012. During this 6-year period, a total of 2366 methadone-related deaths and 52 buprenorphine-related deaths were registered, corresponding to 17 333 163 methadone and 2 602 374 buprenorphine prescriptions issued. The analysis encompassed poisoning deaths among members of the wider population of England and Wales who consumed, but were not prescribed these medications, in addition to patients prescribed methadone or buprenorphine.Main outcome measures Mortality risk: substance-specific overdose rate per 1000 prescriptions issued; relative risk ratio of methadone in relation to buprenorphine.Results During the years 2007–2012, the pooled overdose death rate was 0.137/1000 prescriptions of methadone, compared to 0.022/1000 prescriptions of buprenorphine (including buprenorphine-naloxone). The analysis generated a relative risk ratio of 6.23 (95% CI 4.79 to 8.10) of methadone in relation to buprenorphine. UK Borders Agency data were taken into consideration and revealed that only negligible amounts of methadone and buprenorphine were seized on entering UK territory between 2007 and 2012, suggesting domestic diversion.Conclusions Our analysis of the relative safety of buprenorphine and methadone for opioid substitution treatment reveals that buprenorphine is six times safer than methadone with regard to overdose risk among the general population. Clinicians should be aware of the increased risk of prescribing methadone, and tighter regulations are needed to prevent its diversion. |
| format | Article |
| id | doaj-art-1e0b74f9c0d84e90b65bc5f7395f7f78 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2015-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-1e0b74f9c0d84e90b65bc5f7395f7f782025-02-01T15:30:13ZengBMJ Publishing GroupBMJ Open2044-60552015-05-015510.1136/bmjopen-2015-007629The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and WalesDave Marteau0Rebecca McDonald1Kamlesh Patel2Health and Human Development, University of East London, London, UKAddictions Department, Institute of Psychiatry, Psychology & Neuroscience, King`s College London, London, UKHealth and Human Development, University of East London, London, UKObjective To examine the population-wide overdose risk emerging from the prescription of methadone and buprenorphine for opioid substitution treatment in England and Wales.Design Retrospective administrative data study.Setting National databases for England and Wales.Participants/cases Drug-related mortality data were drawn from the Office for National Statistics, and prescription data for methadone and buprenorphine were obtained from the National Health Service for the years 2007–2012. During this 6-year period, a total of 2366 methadone-related deaths and 52 buprenorphine-related deaths were registered, corresponding to 17 333 163 methadone and 2 602 374 buprenorphine prescriptions issued. The analysis encompassed poisoning deaths among members of the wider population of England and Wales who consumed, but were not prescribed these medications, in addition to patients prescribed methadone or buprenorphine.Main outcome measures Mortality risk: substance-specific overdose rate per 1000 prescriptions issued; relative risk ratio of methadone in relation to buprenorphine.Results During the years 2007–2012, the pooled overdose death rate was 0.137/1000 prescriptions of methadone, compared to 0.022/1000 prescriptions of buprenorphine (including buprenorphine-naloxone). The analysis generated a relative risk ratio of 6.23 (95% CI 4.79 to 8.10) of methadone in relation to buprenorphine. UK Borders Agency data were taken into consideration and revealed that only negligible amounts of methadone and buprenorphine were seized on entering UK territory between 2007 and 2012, suggesting domestic diversion.Conclusions Our analysis of the relative safety of buprenorphine and methadone for opioid substitution treatment reveals that buprenorphine is six times safer than methadone with regard to overdose risk among the general population. Clinicians should be aware of the increased risk of prescribing methadone, and tighter regulations are needed to prevent its diversion.https://bmjopen.bmj.com/content/5/5/e007629.full |
| spellingShingle | Dave Marteau Rebecca McDonald Kamlesh Patel The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales BMJ Open |
| title | The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales |
| title_full | The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales |
| title_fullStr | The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales |
| title_full_unstemmed | The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales |
| title_short | The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales |
| title_sort | relative risk of fatal poisoning by methadone or buprenorphine within the wider population of england and wales |
| url | https://bmjopen.bmj.com/content/5/5/e007629.full |
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