ArticleBMJ (Clinical research ed.)2020
Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study.
Article in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 120 papers, 6 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
120 citing papers in PubMed, 6 syntheses or guidelines pooled it, 194 citations in OpenAlex.
- Evidence-based consensus guidelines for the pharmacological management of substance dependence: Recommendations from the British Association for Psychopharmacology.Journal of psychopharmacology (Oxford, England) · 2026Guideline
- Opioid agonist therapy for opioid use disorder in primary versus specialty care.The Cochrane database of systematic reviews · 2025Pooled it
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2022Guideline
- Factors Associated with Long-Term Retention in Buprenorphine-Based Addiction Treatment Programs: a Systematic Review.Journal of general internal medicine · 2022Pooled it
- A systematic review of menstrual hygiene management (MHM) during humanitarian crises and/or emergencies in low- and middle-income countries.Frontiers in public health · 2022Pooled it
- Pooled it
- Effects of the Communities That HEAL intervention on initiation, retention, and linkage to medications for opioid use disorder (MOUD): A cluster randomized wait-list controlled trial.Drug and alcohol dependence · 2025Trial
- Non-adherence to treatment and concurrent opioid use among people on methadone maintenance treatment using methamphetamine in Vietnam.Journal of substance use and addiction treatment · 2025Trial
- Impact of fentanyl use on initiation and discontinuation of methadone and buprenorphine/naloxone among people with prescription-type opioid use disorder: secondary analysis of a Canadian treatment trial.Addiction (Abingdon, England) · 2022Trial
- Efficacy of Analgesic Propofol/Esketamine and Propofol/Fentanyl for Painless Induced Abortion: A Randomized Clinical Trial.BioMed research international · 2022Trial
- Remotely delivered incentives to promote buprenorphine treatment engagement in out-of-treatment adults with opioid use disorder.Drug and alcohol dependence · 2021Trial
- Pharmacological Management of Opioid Use Disorder: A Systematic Review and Network Meta-Analysis: Prise en charge pharmacologique du trouble de l'usage des opiacés : revue systématique et méta-analyse en réseau.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2026Review
- Strategies to increase medications for opioid use disorder in hospital settings in the USA: protocol for a scoping review.BMJ open · 2026Article
- Association between early methadone dose titration and treatment discontinuation and opioid toxicity: A retrospective cohort study.PLoS medicine · 2026Article
- Impact of opioid agonist therapies on non-fatal and fatal overdose: treatment patterns among individuals with opioid use disorder in Ontario, Canada.Frontiers in public health · 2026Article
- Article
- A methodological framework for constructing opioid agonist therapy episodes in administrative health data.BMC methods · 2026Article
- Real-world effectiveness of medication-assisted treatment and psychotherapy for opioid use disorder: a national multi-health care organization analysis.Frontiers in psychiatry · 2026Article
- Editorial: Emerging treatment approaches for substance use disorders.Frontiers in psychiatry · 2026Article
- Practical guidance for navigating buprenorphine discontinuation.Harm reduction journal · 2025Review
60 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
9 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare the risk of mortality among people with opioid use disorder on and off opioid agonist treatment (OAT) in a setting with a high prevalence of illicitly manufactured fentanyl and other potent synthetic opioids in the illicit drug supply.
designPopulation based retrospective cohort study.
settingIndividual level linkage of five health administrative datasets capturing drug dispensations, hospital admissions, physician billing records, ambulatory care reports, and deaths in British Columbia, Canada.
participants55 347 people with opioid use disorder who received OAT between 1 January 1996 and 30 September 2018.
main outcome measuresAll cause and cause specific crude mortality rates (per 1000 person years) to determine absolute risk of mortality and all cause age and sex standardised mortality ratios to determine relative risk of mortality compared with the general population. Mortality risk was calculated according to treatment status (on OAT, off OAT), time since starting and stopping treatment (1, 2, 3-4, 5-12, >12 weeks), and medication type (methadone, buprenorphine/naloxone). Adjusted risk ratios compared the relative risk of mortality on and off OAT over time as fentanyl became more prevalent in the illicit drug supply.
results7030 (12.7%) of 55 347 OAT recipients died during follow-up. The all cause standardised mortality ratio was substantially lower on OAT (4.6, 95% confidence interval 4.4 to 4.8) than off OAT (9.7, 9.5 to 10.0). In a period of increasing prevalence of fentanyl, the relative risk of mortality off OAT was 2.1 (95% confidence interval 1.8 to 2.4) times higher than on OAT before the introduction of fentanyl, increasing to 3.4 (2.8 to 4.3) at the end of the study period (65% increase in relative risk).
conclusionsRetention on OAT is associated with substantial reductions in the risk of mortality for people with opioid use disorder. The protective effect of OAT on mortality increased as fentanyl and other synthetic opioids became common in the illicit drug supply, whereas the risk of mortality remained high off OAT. As fentanyl becomes more widespread globally, these findings highlight the importance of interventions that improve retention on opioid agonist treatment and prevent recipients from stopping treatment.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.