ArticleAddiction (Abingdon, England)2018
The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom.
Article in Addiction (Abingdon, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
68 citing papers in PubMed, 7 syntheses or guidelines pooled it, 123 citations in OpenAlex.
- Factors associated with the percentage of individuals who initiate and discontinue naltrexone as a relapse prevention pharmacotherapy in opioid use disorder: A systematic review, meta-analysis and meta-regression.Addiction (Abingdon, England) · 2026Pooled it
- The comparative effects of prenatal exposure to methadone versus buprenorphine for opioid use disorder on neonatal outcomes: a systematic review and meta-analysis.BMC pregnancy and childbirth · 2026Pooled it
- Evidence-based consensus guidelines for the pharmacological management of substance dependence: Recommendations from the British Association for Psychopharmacology.Journal of psychopharmacology (Oxford, England) · 2026Guideline
- Pooled it
- Assessing HIV and overdose risks for people who use drugs exposed to compulsory drug abstinence programs (CDAP): A systematic review and meta-analysis.The International journal on drug policy · 2021Pooled it
- Pooled it
- Global patterns of opioid use and dependence: harms to populations, interventions, and future action.Lancet (London, England) · 2019Pooled it
- Criminal justice outcomes over 5 years after randomization to buprenorphine-naloxone or methadone treatment for opioid use disorder.Addiction (Abingdon, England) · 2019Trial
- Preparing Emergency Medical Services for Prehospital Buprenorphine: Examining a Train-the-Trainer Approach to Strengthening the Overdose Chain of Survival.Journal of the American College of Emergency Physicians open · 2026Article
- Reframing Buprenorphine as a Pharmacologic Modifier of Opioid-Induced Respiratory Depression in the Fentanyl Era.Pharmaceuticals (Basel, Switzerland) · 2026Article
- Private Equity Acquisition and Buprenorphine Prescribing.JAMA network open · 2026Article
- Article
- Buprenorphine enhancesJournal of oral microbiology · 2026Article
- The Socioeconomic Impact of Long-Acting Injectable Buprenorphine.ClinicoEconomics and outcomes research : CEOR · 2026Article
- Optimal provision of opiate substitution therapy and needle and syringe programmes: a multi-method realist evaluation.Health technology assessment (Winchester, England) · 2025Article
- The Effect of Opioid Agonist Treatment on Injection-Related Sequelae: A Population-Based Observational Study.Drug safety · 2025Observational
- Evaluation of a Novel Patient-Centered Methadone Restart Protocol.JAMA network open · 2025Article
- A scoping review of routinely collected linked data in research on gambling harm.NPJ digital medicine · 2025Article
- Community pharmacy attitudes and behaviors following a buprenorphine best practices dissemination.The mental health clinician · 2025Article
- Retention and dropout from sublingual and extended-release buprenorphine treatment: A comparative analysis of data from a nationally representative sample of commercially-insured people with opioid use disorder in the United States.The International journal on drug policy · 2025Article
8 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 4 institutions in 1 country.
Funding
Abstract
aimsTo estimate whether opioid substitution treatment (OST) with buprenorphine or methadone is associated with a greater reduction in the risk of all-cause mortality (ACM) and opioid drug-related poisoning (DRP) mortality.
designCohort study with linkage between clinical records from Clinical Practice Research Datalink and mortality register.
settingUK primary care.
participantsA total of 11 033 opioid-dependent patients who received OST from 1998 to 2014, followed-up for 30 410 person-years. MEASUREMENTS: Exposure to methadone (17 373, 61%) OST episodes or buprenorphine (9173, 39%) OST episodes. ACM was available for all patients; information on cause of death and DRP was available for 5935 patients (54%) followed-up for 16 363 person-years. Poisson regression modelled mortality by treatment period with an interaction between OST type and treatment period (first 4 weeks on OST, rest of time off OST, first 4 weeks off OST, rest of time out of OST censored at 12 months) to test whether ACM or DRP differed between methadone and buprenorphine. Inverse probability weights were included to adjust for confounding and balance characteristics of patients prescribed methadone or buprenorphine.
findingsACM and DRP rates were 1.93 and 0.53 per 100 person-years, respectively. DRP was elevated during the first 4 weeks of OST [incidence rate ratio (IRR) = 1.93 95% confidence interval (CI) = 0.97-3.82], the first 4 weeks off OST (IRR = 8.15, 95% CI = 5.45-12.19) and the rest of time out of OST (IRR = 2.13, 95% CI = 1.47-3.09) compared with mortality risk from 4 weeks to end of treatment. Patients on buprenorphine compared with methadone had lower ACM rates in each treatment period. After adjustment, there was evidence of a lower DRP risk for patients on buprenorphine compared with methadone at treatment initiation (IRR = 0.08, 95% CI = 0.01-0.48) and rest of time on treatment (IRR = 0.37, 95% CI = 0.17-0.79). Treatment duration (mean and median) was shorter on buprenorphine than methadone (173 and 40 versus 363 and 111, respectively). Model estimates suggest that there was a low probability that methadone or buprenorphine reduced the number of DRP in the population: 28 and 21%, respectively.
conclusionsIn UK general medical practice, opioid substitution treatment with buprenorphine is associated with a lower risk of all-cause and drug-related poisoning mortality than methadone. In the population, buprenorphine is unlikely to give greater overall protection because of the relatively shorter duration of treatment.
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