Observational studyAddiction (Abingdon, England)2023
Does opioid agonist treatment reduce overdose mortality risk in people who are older or have physical comorbidities? Cohort study using linked administrative health data in New South Wales, Australia, 2002-17.
Observational study in Addiction (Abingdon, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 4 of them syntheses that pooled it.
What it found
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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
11 citing papers in PubMed, 4 syntheses or guidelines pooled it, 15 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
- Guideline
- Management of opioid use disorder: 2024 update to the national clinical practice guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024Guideline
- Case Report: Reintroduction of winged infusion sets to needle syringe programs - advancing equity in harm reduction.Frontiers in psychiatry · 2026Article
- Individuals 45 Years and Older in Opioid Agonist Treatment: A Scoping Review.International journal of environmental research and public health · 2025Article
- Data Resource Profile Update: The Opioid Agonist Treatment and Safety II (OATS II) Study, 2001-22, New South Wales, Australia.International journal of epidemiology · 2025Article
- Medications for opioid use disorder in traditional medicare beneficiaries: associations with age.Health affairs scholar · 2025Article
- Opioid Use Disorder in Older Adults: a Narrative Review.Current geriatrics reports · 2025Article
- Differences in heroin overdose deaths in Australia by age, 2020-2022: Disease and estimated survival times.Drug and alcohol dependence reports · 2024Article
- Estimating effects of time-varying exposures on mortality risk.Journal of applied statistics · 2024Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
Abstract
aimsTo quantify the association between opioid agonist treatment (OAT) and overdose death by age group; test the hypothesis that across different age groups, opioid overdose mortality is lowest during OAT with buprenorphine compared with time out of treatment or OAT with methadone; and test associations between OAT and opioid overdose mortality in the presence of chronic circulatory, respiratory, liver and kidney diseases.
designRetrospective observational cohort study using linked administrative data.
settingNew South Wales, Australia.
participantsA total of 37 764 people prescribed OAT, 1 August 2002 and 31 December 2017. MEASUREMENTS: OAT exposure, opioid overdose mortality and key confounders were measured using linked population data sets on OAT entry and exit, hospitalization, mental health care, incarceration and mortality. ICD-10 codes were used to define opioid overdose mortality and chronic disease groups of interest.
findingsRelative to time out of treatment, time in OAT was associated with a lower risk of opioid overdose death across all age groups and chronic diseases. Among people aged 50 years and older, there was weak evidence that buprenorphine may be associated with greater protection against opioid overdose death than methadone [generalized estimating equation (GEE) adjusted incident rate ratio (aIRR) = 0.47; 95% confidence interval (CI) = 0.21, 1.02; marginal structural models (MSM) aIRR = 0.49; 95% CI = 0.17, 1.41]. Buprenorphine was associated with greater protection against overdose death than methadone for clients with circulatory (MSM aIRR = 0.27; 95% CI = 0.11, 0.67) or respiratory (MSM aIRR = 0.26; 95% CI = 0.07, 0.94) diseases, but not liver (MSM aIRR = 0.59; 95% CI = 0.14, 2.43) or kidney (MSM aIRR = 1.16; 95% CI = 0.31, 4.36) diseases.
conclusionsOpioid agonist treatment (OAT) appears to reduce mortality risk in people with opioid use disorder who are older or who have physical comorbidities. Opioid overdose mortality during OAT with buprenorphine appears to be lower and reduced in clients with circulatory and respiratory diseases compared with OAT with methadone.
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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.