ArticleBMJ open2015
The relative risk of fatal poisoning by methadone or buprenorphine within the wider population of England and Wales.
Article in BMJ open, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it, 78 citations in OpenAlex.
- Explaining the Differences in Opioid Overdose Deaths between Scotland and England/Wales: Implications for European Opioid Policies.European addiction research · 2021Pooled it
- Routes of non-traditional entry into buprenorphine treatment programs.Substance abuse treatment, prevention, and policy · 2020Pooled it
- Management of opioid use disorders: a national clinical practice guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018Guideline
- Tailored Therapies in Addiction Medicine: Redefining Opioid Use Disorder Treatment with Precision Medicine.Journal of personalized medicine · 2025Review
- Treating Opioid Use Disorder and Opioid Withdrawal in the Context of Fentanyl.Annual review of clinical psychology · 2025Review
- Buprenorphine deaths confirmed by toxicology reveal a low proportion of opioid agonist treatment before death in Finland.International journal of legal medicine · 2024Article
- Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder.Journal of clinical medicine · 2023Article
- Trends in Fatal Poisoning Among Drug Users in France From 2011 to 2021: An Analysis of the DRAMES Register.JAMA network open · 2023Article
- Buprenorphine involvement in opioid overdose deaths: A retrospective analysis of postmortem toxicology in Marion County, Indiana, 2015-2021.Drug and alcohol dependence reports · 2023Article
- Methadone and buprenorphine-related deaths among people prescribed and not prescribed Opioid Agonist Therapy during the COVID-19 pandemic in England.The International journal on drug policy · 2022Article
- Is the Neuroimmune System a Therapeutic Target for Opioid Use Disorder? A Systematic Review.Medical research archives · 2022Article
- Duration of use and outcomes among people with opioid use disorder initiating methadone and buprenorphine in Ontario: a population-based propensity-score matched cohort study.Addiction (Abingdon, England) · 2022Article
- Evaluating how has care been affected by the Ontario COVID-19 Opioid Agonist Treatment Guidance: Patients' and prescribers' experiences with changes in unsupervised dosing.The International journal on drug policy · 2022Article
- Are we ready to manage an opioid epidemic in the intensive care unit?Anaesthesiology intensive therapy · 2022Review
- Maternal Complications and Prescription Opioid Exposure During Pregnancy: Using Marginal Structural Models.Drug safety · 2021Article
- The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis.Metabolites · 2021Article
- Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study.Journal of the American College of Emergency Physicians open · 2020Article
- Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model.Annals of family medicine · 2020Article
- Slow release oral morphine versus methadone for opioid use disorder in the fentanyl era (pRESTO): Protocol for a non-inferiority randomized clinical trial.Contemporary clinical trials · 2020Article
- Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study.BMJ (Clinical research ed.) · 2020Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the population-wide overdose risk emerging from the prescription of methadone and buprenorphine for opioid substitution treatment in England and Wales.
designRetrospective administrative data study.
settingNational databases for England and Wales. PARTICIPANTS/CASES: Drug-related mortality data were drawn from the Office for National Statistics, and prescription data for methadone and buprenorphine were obtained from the National Health Service for the years 2007-2012. During this 6-year period, a total of 2366 methadone-related deaths and 52 buprenorphine-related deaths were registered, corresponding to 17,333,163 methadone and 2,602,374 buprenorphine prescriptions issued. The analysis encompassed poisoning deaths among members of the wider population of England and Wales who consumed, but were not prescribed these medications, in addition to patients prescribed methadone or buprenorphine.
main outcome measuresMortality risk: substance-specific overdose rate per 1000 prescriptions issued; relative risk ratio of methadone in relation to buprenorphine.
resultsDuring the years 2007-2012, the pooled overdose death rate was 0.137/1000 prescriptions of methadone, compared to 0.022/1000 prescriptions of buprenorphine (including buprenorphine-naloxone). The analysis generated a relative risk ratio of 6.23 (95% CI 4.79 to 8.10) of methadone in relation to buprenorphine. UK Borders Agency data were taken into consideration and revealed that only negligible amounts of methadone and buprenorphine were seized on entering UK territory between 2007 and 2012, suggesting domestic diversion.
conclusionsOur analysis of the relative safety of buprenorphine and methadone for opioid substitution treatment reveals that buprenorphine is six times safer than methadone with regard to overdose risk among the general population. Clinicians should be aware of the increased risk of prescribing methadone, and tighter regulations are needed to prevent its diversion.
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