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Opiate-Dependent Patients on a Waiting List for Methadone Maintenance Treatment Are at High Risk for Mortality Until Treatment Entry

Peles, Einat PhD; Schreiber, Shaul MD; Adelson, Miriam MD

Journal of Addiction Medicine:
doi: 10.1097/ADM.0b013e318287cfc9
Original Research
Abstract

Objectives: In 2002, our methadone maintenance treatment (MMT) clinic reached full capacity and admission to treatment was delayed for >1 year. In order to evaluate possible impact of the waiting list on mortality risk of the registered patients, we compared survival after the first 2 years, and long-term survival since registration between admitted and not admitted to our MMT (or other treatment facilities) and to those who admitted immediately, before the establishment of the waiting list in 2002.

Methods: A total of 608 patients registered between 2002 and 2009. Their vital statistics were obtained from the Israeli National Registry (October 2010).

Results: Of the total 608, 366 registrants (60.2%) were admitted to any treatment (194 [53%] to our MMT, 162 [44.3%] to other MMTs and 10 [2.7%] to other facilities) and 242 (39.8%) were not admitted anywhere. Nonadmission to treatment when it became available was due to inability to contact the patient (116, 47.9%), self-reported drug discontinuation (44, 18.2%), refusal to follow regulations (39, 16.1%), imprisonment (27, 11.2%), violent behavior (1, 0.4%), death (13, 5.4%), and other (2, 0.8%). The mortality rate (available among 583) during the 2 years on the waiting list was higher (5.0/100 person years) for the 225 nonadmitted applicants than for the 358 admitted (0.42/100 person years, P < 0.0005) and those who were admitted with no delay before 2002 (2.1/100 person years). The long-term survival between those 3 groups did not differ significantly.

Conclusions: Opiate addicts are at high risk for mortality during prolonged waiting periods for admission to MMT, indicating an urgent need for immediate expansion of MMT availability.

Author Information

From Dr Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research (EP, SS and MA) and the Department of Psychiatry (SS), Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Send correspondence and reprint requests to Einat Peles, PhD, Henrietta Szold Street, Tel Aviv, 64924 Israel. E-mail: einatp@tlvmc.gov.il.

The authors declare no conflicts of interest.

Received October 12, 2012

Accepted January 14, 2013

© 2013 American Society of Addiction Medicine