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Heroin Addiction and Related Clinical Problems: 2017, 19, N3 (pages: 65 - 72)

Incidence of Cancer and Cancer Related Mortality in Opiate Dependent Patients Treated with Methadone, Buprenorphine or Implant Naltrexone as Compared with Non-Opiate Using Controls

Kelty E., Dobbins T., and Hulse G.

Summary: Background: Cancer has been identified as a common cause of mortality in opiate dependent patients. Aim: To examine and compare the incidence of cancer and cancer mortality in opiate dependent patients treated with methadone, buprenorphine or implant naltrexone to a cohort of controls taken from the general population. Methods: The study was a retrospective longitudinal follow up using routinely collected cancer and mortality data. Participants included opiate dependent patients treated for the first time with methadone (n=2,227), buprenorphine (n=1,954) or implant naltrexone (n=958) between 2001 and 2010 in Western Australia (WA) and a sex and age matched cohort of controls selected from the WA electoral roll. Incidence of cancer and cancer related mortality in the four groups were analyzed using Cox proportional hazard regression. Results: Rates of cancer in opiate patients treated with methadone (HR:0.81, CI:0.49-1.34), buprenorphine (HR:0.74, CI:0.41-1.33) and naltrexone (HR:0.65, CI:0.28–1.50) participants were not significantly different to the control cohort. Rates of respiratory cancer were elevated in patients initially treated with methadone (HR:7.53, CI:1.46–38.93) and naltrexone (HR:7.65, CI:1.07–54.48). Mortality rates in patients diagnosed with cancer were significantly elevated in patients treated in methadone (HR:3.19, CI:1.07–9.53), while both buprenorphine (HR:3.07, CI:0.78–12.15) and naltrexone (HR:3.73, CI:0.77–18.02) were not dissimilar to the controls. Conclusions: While rates of cancer were not significantly different to the control, poor survival may attribute to high rates of cancer related mortality.