Pw. Appel et al., Causes and rates of death among methadone maintenance patients before and after the onset of the HIV/AIDS epidemic, MT SINAI J, 67(5-6), 2000, pp. 444-451
Causes of death and the mortality rates of active methadone patients and th
ose who had left treatment were compared. Prior to the HIV epidemic, death
rates among discharged methadone patients were more than twice that of pati
ents who continued with their methadone treatment. However, the death rate
from heroin-related causes in the post-treatment period was 51 times the ra
te among active patients. Alcohol-related conditions were the leading cause
s of death in patients more than 30 years old on methadone. During the post
-treatment period, alcohol-related deaths were second to those of heroin-re
lated causes. Alcohol-related deaths were particularly pronounced among bla
ck patients. Death rates among active male and female patients were identic
al, but the death rate for discharged female patients was greater than for
discharged males
With the onset of the HIV epidemic in the 1980s, AIDS-related causes became
the major cause of death in treatment. However, other causes of death, suc
h as alcohol and other medical conditions, identified prior to the AIDS epi
demic, persisted. AIDS-related deaths peaked in the mid-1990s and have rece
ntly subsided. However, within the past two years, deaths related to HCV ha
ve increased to 9% of all patient deaths in a major methadone program. With
the emergence of HCV, deaths from this cause are expected to eclipse AIDS-
related deaths within the next decade.