An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam
ABSTRACT Aims It has been suggested that starting and temporarily discontinuing methadone treatment is related to an increased risk in overdose mortality. This study describes the incidence of overdose mortality in relation to time after (re)entering or leaving treatment. Design A dynamic cohort of...
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| Veröffentlicht in: | Addiction (Abingdon, England) England), 2002-08, Vol.97 (8), p.993-1001 |
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| creator | Buster, Marcel C. A. Brussel, Giel H. A. van Brink, Wim van den |
| description | ABSTRACT
Aims It has been suggested that starting and temporarily discontinuing methadone treatment is related to an increased risk in overdose mortality. This study describes the incidence of overdose mortality in relation to time after (re)entering or leaving treatment.
Design A dynamic cohort of 5200 Amsterdam methadone clients was observed during treatment and (a maximum of 1 year) after treatment.
Findings Between 1986 and 1998, 29 729 person‐years (py) and 68 overdose deaths were recorded, leading to an overdose mortality rate of 2.3/1000 py (2.2 during and 2.4 after treatment). A modest increase was observed during the first 2 weeks after (re)entering treatment; 6.0/1000 py (rate ratio: 2.9; 95% confidence interval 1.4; 5.8). Directly after leaving treatment no increase was observed.
Conclusions Inhaling heroin, common among Amsterdam heroin users, is thought to account for low OD mortality rates both during and after treatment. Accumulation of methadone, inadequate assessment of tolerance of known clients re‐entering treatment and concurrent periods of stress or extreme heroin use when entering treatment are mentioned as possible explanations of the increased risk within the first 2 weeks. An Australian study reported a much higher increase. The modest increase in Amsterdam is explained by low background risk of overdose mortality, low starting dosage and the low threshold to treatment. |
| doi_str_mv | 10.1046/j.1360-0443.2002.00179.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_61494238</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>39143346</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5259-a9bf00d0387a82434a8d3addfbad70fb30939663dab8f57e780f5614eed0a93e3</originalsourceid><addsrcrecordid>eNqNkU1v1DAQhi0EokvhLyBf4JYwiZ04lristtAirYqEQBytSTym2eaj2Nl299_jdFfbY7nYM57nnfHoZYxnkGYgy0-bNBMlJCClSHOAPAXIlE53L9jiVHjJFqDLIskzCWfsTQgbAFCVlq_ZWRYfZQn5gu2XA2-HxhMGigEf78nbMcb96Cfs2mnP7da3wx8-3RB3rQ8Tz_kD0W3g6CbynIZ4zsDouafklPY03aAdB-JT7D71sTAPWPYhAhb7t-yVwy7Qu-N9zn59_fJzdZWsv19-Wy3XSVPkhU5Q1w7AgqgUVrkUEisr0FpXo1XgagFa6LIUFuvKFYpUBa4oM0lkAbUgcc4-Hvre-fHvlsJk-jY01HU40LgNJrJa5qJ6FiyU0BKK8llQ6EwKIWewOoCNH0Pw5Mydb3v0e5OBmY00GzP7ZWa_zGykeTTS7KL0_XHGtu7JPgmPzkXgwxHA0GDnPA5NG564uFClYN7q84F7aDva__cHzPLiIgZRnhzkbbRtd5KjvzWlEqowv68vzWqlfuRrKc21-AeQ5sj0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>39143346</pqid></control><display><type>article</type><title>An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam</title><source>MEDLINE</source><source>Wiley Journals</source><source>Sociological Abstracts</source><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><creator>Buster, Marcel C. A. ; Brussel, Giel H. A. van ; Brink, Wim van den</creator><creatorcontrib>Buster, Marcel C. A. ; Brussel, Giel H. A. van ; Brink, Wim van den</creatorcontrib><description>ABSTRACT
Aims It has been suggested that starting and temporarily discontinuing methadone treatment is related to an increased risk in overdose mortality. This study describes the incidence of overdose mortality in relation to time after (re)entering or leaving treatment.
Design A dynamic cohort of 5200 Amsterdam methadone clients was observed during treatment and (a maximum of 1 year) after treatment.
Findings Between 1986 and 1998, 29 729 person‐years (py) and 68 overdose deaths were recorded, leading to an overdose mortality rate of 2.3/1000 py (2.2 during and 2.4 after treatment). A modest increase was observed during the first 2 weeks after (re)entering treatment; 6.0/1000 py (rate ratio: 2.9; 95% confidence interval 1.4; 5.8). Directly after leaving treatment no increase was observed.
Conclusions Inhaling heroin, common among Amsterdam heroin users, is thought to account for low OD mortality rates both during and after treatment. Accumulation of methadone, inadequate assessment of tolerance of known clients re‐entering treatment and concurrent periods of stress or extreme heroin use when entering treatment are mentioned as possible explanations of the increased risk within the first 2 weeks. An Australian study reported a much higher increase. The modest increase in Amsterdam is explained by low background risk of overdose mortality, low starting dosage and the low threshold to treatment.</description><identifier>ISSN: 0965-2140</identifier><identifier>EISSN: 1360-0443</identifier><identifier>DOI: 10.1046/j.1360-0443.2002.00179.x</identifier><identifier>PMID: 12144602</identifier><identifier>CODEN: ADICE5</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Addiction ; Adult ; Amsterdam ; Amsterdam, Netherlands ; Biological and medical sciences ; Cohort Studies ; Cohort study ; Death ; Dependency rehabilitation ; Desintoxication. Drug withdrawal ; Drug abuse ; Drug Addiction ; Drug addicts ; Drug Overdose - mortality ; Drugs ; Female ; Health ; Heroin ; Heroin - poisoning ; Heroin Dependence - mortality ; Heroin Dependence - rehabilitation ; Humans ; Male ; Medical sciences ; Medical treatment ; Methadone ; Methadone - therapeutic use ; Methadone Maintenance ; Mortality ; Mortality Rates ; Narcotics - therapeutic use ; Netherlands ; Netherlands - epidemiology ; overdose ; Overdoses ; Predictors ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Recurrence ; Relapse ; Social problems ; Time Factors ; Treatment ; Treatment Outcomes ; Treatments</subject><ispartof>Addiction (Abingdon, England), 2002-08, Vol.97 (8), p.993-1001</ispartof><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5259-a9bf00d0387a82434a8d3addfbad70fb30939663dab8f57e780f5614eed0a93e3</citedby><cites>FETCH-LOGICAL-c5259-a9bf00d0387a82434a8d3addfbad70fb30939663dab8f57e780f5614eed0a93e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1360-0443.2002.00179.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1360-0443.2002.00179.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,31000,33775,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13838708$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12144602$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Buster, Marcel C. A.</creatorcontrib><creatorcontrib>Brussel, Giel H. A. van</creatorcontrib><creatorcontrib>Brink, Wim van den</creatorcontrib><title>An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam</title><title>Addiction (Abingdon, England)</title><addtitle>Addiction</addtitle><description>ABSTRACT
Aims It has been suggested that starting and temporarily discontinuing methadone treatment is related to an increased risk in overdose mortality. This study describes the incidence of overdose mortality in relation to time after (re)entering or leaving treatment.
Design A dynamic cohort of 5200 Amsterdam methadone clients was observed during treatment and (a maximum of 1 year) after treatment.
Findings Between 1986 and 1998, 29 729 person‐years (py) and 68 overdose deaths were recorded, leading to an overdose mortality rate of 2.3/1000 py (2.2 during and 2.4 after treatment). A modest increase was observed during the first 2 weeks after (re)entering treatment; 6.0/1000 py (rate ratio: 2.9; 95% confidence interval 1.4; 5.8). Directly after leaving treatment no increase was observed.
Conclusions Inhaling heroin, common among Amsterdam heroin users, is thought to account for low OD mortality rates both during and after treatment. Accumulation of methadone, inadequate assessment of tolerance of known clients re‐entering treatment and concurrent periods of stress or extreme heroin use when entering treatment are mentioned as possible explanations of the increased risk within the first 2 weeks. An Australian study reported a much higher increase. The modest increase in Amsterdam is explained by low background risk of overdose mortality, low starting dosage and the low threshold to treatment.</description><subject>Addiction</subject><subject>Adult</subject><subject>Amsterdam</subject><subject>Amsterdam, Netherlands</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Cohort study</subject><subject>Death</subject><subject>Dependency rehabilitation</subject><subject>Desintoxication. Drug withdrawal</subject><subject>Drug abuse</subject><subject>Drug Addiction</subject><subject>Drug addicts</subject><subject>Drug Overdose - mortality</subject><subject>Drugs</subject><subject>Female</subject><subject>Health</subject><subject>Heroin</subject><subject>Heroin - poisoning</subject><subject>Heroin Dependence - mortality</subject><subject>Heroin Dependence - rehabilitation</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medical treatment</subject><subject>Methadone</subject><subject>Methadone - therapeutic use</subject><subject>Methadone Maintenance</subject><subject>Mortality</subject><subject>Mortality Rates</subject><subject>Narcotics - therapeutic use</subject><subject>Netherlands</subject><subject>Netherlands - epidemiology</subject><subject>overdose</subject><subject>Overdoses</subject><subject>Predictors</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Recurrence</subject><subject>Relapse</subject><subject>Social problems</subject><subject>Time Factors</subject><subject>Treatment</subject><subject>Treatment Outcomes</subject><subject>Treatments</subject><issn>0965-2140</issn><issn>1360-0443</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>BHHNA</sourceid><recordid>eNqNkU1v1DAQhi0EokvhLyBf4JYwiZ04lristtAirYqEQBytSTym2eaj2Nl299_jdFfbY7nYM57nnfHoZYxnkGYgy0-bNBMlJCClSHOAPAXIlE53L9jiVHjJFqDLIskzCWfsTQgbAFCVlq_ZWRYfZQn5gu2XA2-HxhMGigEf78nbMcb96Cfs2mnP7da3wx8-3RB3rQ8Tz_kD0W3g6CbynIZ4zsDouafklPY03aAdB-JT7D71sTAPWPYhAhb7t-yVwy7Qu-N9zn59_fJzdZWsv19-Wy3XSVPkhU5Q1w7AgqgUVrkUEisr0FpXo1XgagFa6LIUFuvKFYpUBa4oM0lkAbUgcc4-Hvre-fHvlsJk-jY01HU40LgNJrJa5qJ6FiyU0BKK8llQ6EwKIWewOoCNH0Pw5Mydb3v0e5OBmY00GzP7ZWa_zGykeTTS7KL0_XHGtu7JPgmPzkXgwxHA0GDnPA5NG564uFClYN7q84F7aDva__cHzPLiIgZRnhzkbbRtd5KjvzWlEqowv68vzWqlfuRrKc21-AeQ5sj0</recordid><startdate>200208</startdate><enddate>200208</enddate><creator>Buster, Marcel C. A.</creator><creator>Brussel, Giel H. A. van</creator><creator>Brink, Wim van den</creator><general>Blackwell Science Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8BJ</scope><scope>FQK</scope><scope>JBE</scope><scope>7QJ</scope><scope>7U3</scope><scope>BHHNA</scope></search><sort><creationdate>200208</creationdate><title>An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam</title><author>Buster, Marcel C. A. ; Brussel, Giel H. A. van ; Brink, Wim van den</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5259-a9bf00d0387a82434a8d3addfbad70fb30939663dab8f57e780f5614eed0a93e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Addiction</topic><topic>Adult</topic><topic>Amsterdam</topic><topic>Amsterdam, Netherlands</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Cohort study</topic><topic>Death</topic><topic>Dependency rehabilitation</topic><topic>Desintoxication. Drug withdrawal</topic><topic>Drug abuse</topic><topic>Drug Addiction</topic><topic>Drug addicts</topic><topic>Drug Overdose - mortality</topic><topic>Drugs</topic><topic>Female</topic><topic>Health</topic><topic>Heroin</topic><topic>Heroin - poisoning</topic><topic>Heroin Dependence - mortality</topic><topic>Heroin Dependence - rehabilitation</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medical treatment</topic><topic>Methadone</topic><topic>Methadone - therapeutic use</topic><topic>Methadone Maintenance</topic><topic>Mortality</topic><topic>Mortality Rates</topic><topic>Narcotics - therapeutic use</topic><topic>Netherlands</topic><topic>Netherlands - epidemiology</topic><topic>overdose</topic><topic>Overdoses</topic><topic>Predictors</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Recurrence</topic><topic>Relapse</topic><topic>Social problems</topic><topic>Time Factors</topic><topic>Treatment</topic><topic>Treatment Outcomes</topic><topic>Treatments</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Buster, Marcel C. A.</creatorcontrib><creatorcontrib>Brussel, Giel H. A. van</creatorcontrib><creatorcontrib>Brink, Wim van den</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Social Services Abstracts</collection><collection>Sociological Abstracts</collection><jtitle>Addiction (Abingdon, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Buster, Marcel C. A.</au><au>Brussel, Giel H. A. van</au><au>Brink, Wim van den</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam</atitle><jtitle>Addiction (Abingdon, England)</jtitle><addtitle>Addiction</addtitle><date>2002-08</date><risdate>2002</risdate><volume>97</volume><issue>8</issue><spage>993</spage><epage>1001</epage><pages>993-1001</pages><issn>0965-2140</issn><eissn>1360-0443</eissn><coden>ADICE5</coden><abstract>ABSTRACT
Aims It has been suggested that starting and temporarily discontinuing methadone treatment is related to an increased risk in overdose mortality. This study describes the incidence of overdose mortality in relation to time after (re)entering or leaving treatment.
Design A dynamic cohort of 5200 Amsterdam methadone clients was observed during treatment and (a maximum of 1 year) after treatment.
Findings Between 1986 and 1998, 29 729 person‐years (py) and 68 overdose deaths were recorded, leading to an overdose mortality rate of 2.3/1000 py (2.2 during and 2.4 after treatment). A modest increase was observed during the first 2 weeks after (re)entering treatment; 6.0/1000 py (rate ratio: 2.9; 95% confidence interval 1.4; 5.8). Directly after leaving treatment no increase was observed.
Conclusions Inhaling heroin, common among Amsterdam heroin users, is thought to account for low OD mortality rates both during and after treatment. Accumulation of methadone, inadequate assessment of tolerance of known clients re‐entering treatment and concurrent periods of stress or extreme heroin use when entering treatment are mentioned as possible explanations of the increased risk within the first 2 weeks. An Australian study reported a much higher increase. The modest increase in Amsterdam is explained by low background risk of overdose mortality, low starting dosage and the low threshold to treatment.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>12144602</pmid><doi>10.1046/j.1360-0443.2002.00179.x</doi><tpages>9</tpages></addata></record> |
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| subjects | Addiction Adult Amsterdam Amsterdam, Netherlands Biological and medical sciences Cohort Studies Cohort study Death Dependency rehabilitation Desintoxication. Drug withdrawal Drug abuse Drug Addiction Drug addicts Drug Overdose - mortality Drugs Female Health Heroin Heroin - poisoning Heroin Dependence - mortality Heroin Dependence - rehabilitation Humans Male Medical sciences Medical treatment Methadone Methadone - therapeutic use Methadone Maintenance Mortality Mortality Rates Narcotics - therapeutic use Netherlands Netherlands - epidemiology overdose Overdoses Predictors Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Recurrence Relapse Social problems Time Factors Treatment Treatment Outcomes Treatments |
| title | An increase in overdose mortality during the first 2 weeks after entering or re-entering methadone treatment in Amsterdam |
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