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Trends in drug overdose deaths in England and Wales 1993–98: methadone does not kill more people than heroin

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Abstract Aims 

To test the hypothesis that methadone is responsible for a greater increase in overdose deaths than heroin, and causes proportionally more overdose deaths than heroin at weekends. Design and setting 

Multivariate analysis of 3961 death certificates mentioning heroin, morphine and/or methadone held on the Office for National Statistics drug-related poisoning mortality database from 1993 to 1998 in England and Wales. Measurements 

Percentage increase in deaths by year by drug, odds ratio (OR) of dying at the weekend from methadone-related overdose compared to dying from heroin/morphine overdose. Findings 

From 1993 to 1998, annual opiate overdose deaths increased from 378 to 909. There was a 24.7% (95% confidence interval (CI) 22–28%) yearly increase in heroin deaths compared to 9.4% (95% CI 6–13%) for methadone only. This difference was significant (P < 0.001 by test of interaction) after adjustment for sex, age group, polydrug use, area of residence and underlying cause of death. The largest number of deaths occurred on Saturday (673). The OR of death from methadone overdose on Saturday and Sunday was 1.48 (95% CI 1.29–1.71) for methadone-only deaths compared to dying from heroin/morphine at the weekend after adjustment for other covariates, but the OR was not significant (1.09, 95% CI 0.95–1.25) if the weekend was defined as Friday and Saturday. Conclusions 

There was no evidence that the threefold increase in deaths over time was due to methadone. There was equivocal support only for the hypothesis that there was an excess of deaths from methadone at weekends. Increased interventions to prevent overdose among injectors in England and Wales are long overdue.
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Keywords: Heroin; methadone; mortality; overdose

Document Type: Research Article

Affiliations: 1: Centre for Research on Drugs and Health Behaviour, Social Science and Medicine, Imperial College, London, UK 2: , Division of Surgery, Imperial College, London, UK 3: , Office for National Statistics (ONS), London, UK 4: , London School of Hygiene and Tropical Medicine, London, UK 5: , Department of Biostatistics, University of Washington, Seattle, WA, USA and 6: Centre for Epidemiology and Biostatistics, Primary Care and Population Health Sciences, Imperial College, London, UK

Publication date: 01 April 2003

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