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Heroin Addiction and Related Clinical Problems: 2008, 10, 2 (pages: 21 - 26)

Health care utilization and morbidity associated with Methadone and Buprenorphine Treatment

Bell J., Butler B.

Summary: Background: Methadone and buprenorphine treatment reduce the high mortality associated with heroin addiction, but even in-treatment, Standardised Mortality Rates are high. Aim: This study investigates the nature of morbidity associated with methadone and buprenorphine treatment, and investigates predictors of health care utilization among people in a variety of treatment settings. Methods: Collation of data from earlier studies, and from published reports. Findings: In a recent study of an entry cohort, the SMR was 5.52 [4.62, 5.65]; suicide and overdose accounted for 2/3 of the mortality, but allowing for this, mortality rates remain elevated. Cancer, heart disease and respiratory disease were the three major contributors to mortality. Taken in conjunction with a recent study of medical co-morbidity, this suggests that alcohol, tobacco and other drug use represent the major factors contributing to serious illness in treated opioid addicts. In addition, side-effects of treatment may themselves contribute to some morbidity. Lack of access to health care does not appear to be a contributing factor, as opioid users consult doctors (other than their methadone doctors) at rates far higher than the general population. Predictors of doctor attendance “outside” doctors were psychological distress, and benzodiazepine use. Adjusting for these factors, we found evidence that quality of methadone treatment was a significant predictor of doctor attendance, with better clinical care being associated with less outside doctor attendance. Conclusion: There is a paradox; heroin users have significant physical illness, but their attendance for health care tends to be driven by psychological distress, and can be improved by good care within treatment programs. The priority in addressing health problems of stabilised heroin users is dealing with alcohol and tobacco problems.