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addicts given methadone maintenance treatment (MT). The street addicts'
mortality rate was 63 times that expected, compared with official statistics
for a group of this age and sex distribution. When 53 patients in MT were
involuntarily expelled from treatment, due to violation of programme rules,
they returned to the high mortality of street addicts (55 times that expected).
A group of 34 rehabilitated patients who left MT with medical consent
retained the low mortality of MT patients (their mortality rate was 4 times
that expected). Despite this great improvement in survival, even patients in
MT showed a moderately elevated mortality (8 times that expected), mainly
due to diseases acquired before entering the treatment programme. It is
concluded that MT exerts a major improvement in the survival of heroin
addicts.

Langendam, M., G. vanBrussel, et al. (2001). "The impact of harm-
reduction-based methadone treatment on mortality among heroin
users." Am J Public Health 91(5): 774-80.

MEDLINE ABSTRACT

OBJECTIVES: The purpose of this study was to investigate the impact of
harm-reduction-based methadone programs on mortality among heroin
users. METHODS: A prospective cohort investigation was conducted
among 827 participants in the Amsterdam Cohort Study. Poisson regression
was used to identify methadone maintenance treatment characteristics
(dosage, frequency of program attendance, and type of program) that are
significantly and independently associated with mortality due to natural
causes and overdose. RESULTS: From 1985 to 1996, 89 participants died
of natural causes, and 31 died as a result of an overdose. After adjustment
for HIV and underweight status, there was an increase in natural-cause
mortality among subjects who left methadone treatment (relative risk [RR]
= 2.38, 95% confidence interval [CI] = 1.28, 4.55). Leaving treatment was
also related to higher overdose mortality, but only among injection drug
users (RR = 4.55, 95% CI = 1.89, 10.00). CONCLUSIONS: Harm-
reduction-based methadone treatment, in which the use of illicit drugs is
tolerated, is strongly related to decreased mortality from natural causes and
from overdoses. Provision of methadone in itself, together with social-
medical care, appears more important than the actual methadone dosage.

Medical Comorbidity References

Garfein, R., D. Vlahov, et al. (1996). "Viral infections in short- term
injection drug users: the prevalence of the hepatitis C, hepatitis B,