Chance of fatal overdose triples when offenders don't take methadone, B.C. study says

Convicted offenders who stopped taking methadone to treat an opioid addiction were three times more likely to die from overdose, but their chances of continuing treatment with the drug could have increased dramatically with support for issues like mental illness, housing and employment, a researcher says.

Julian Somers, one of the authors of a new study of 14,530 people whose data was obtained through the ministries of health, justice and social development in British Columbia, said most of the substance users were serving community sentences while being prescribed methadone.

"We're not doing much else for them," said Somers, a professor at Simon Fraser University's faculty of health sciences, adding the substance users had prescriptions for methadone for an average of 7.9 years but took it for only about half that time between 1998 and 2015.

The study, published Tuesday in the journal PLOS Medicine, says a total of 1,275 participants died during that time.

Mental health concerns

Participants were 15 times more likely than the general population to also have schizophrenia and eight times more likely to be diagnosed with bipolar disorder, said Somers, who is also a clinical psychologist.

The methadone patients were in regular contact with government agencies that failed to adequately address their social and mental-heath needs, leaving them enduring homelessness, involvement with the criminal justice system and repeated hospitalizations, he said.

"So, they're well known to many, many service providers but they're not improving," Somers said. "Our resources are apparently not being applied to their best effect."

"It's not simply a matter of figuring out a way to strap an automatic methadone-administration backpack onto people so they're getting it all the time. We need to think more expansively about the supports and interventions that are necessary for people to recover from an addiction."

Need for 'more comprehensive' approach

Professionals, including doctors and lawyers battling addiction, often recover without any drug-substitution treatment, he said.

"The programs that support doctors overcoming opiate dependence and have over 80-per-cent, five-year recovery rates are able to capitalize on the fact that their clients have a number of substantial and important things going for them," Somers said, referring to so-called social capital.

Drug treatment courts work for many substance users because they offer housing and vocational and cultural support, and those supports would also help marginalized people taking methadone, including convicted offenders, many of whom are Indigenous, he said.

"This population, with the range of disadvantages that they face, requires a far more comprehensive approach to treatment, both in order to get the methadone adherence rate up but also to stand a more meaningful chance of helping people move forward with their lives in a state of recovery."

Housing helps

A study Somers led in Vancouver between 2009 and 2013 showed providing housing in the private rental market for mentally ill people and then giving them medical support resulted in use of fewer emergency services.

"In addition to being substance dependent and seriously mentally ill, they'd all been homeless for about 10 years," he said of the 200 participants who also experienced fewer interactions with the criminal justice system.

A pair of Australian researchers said in a perspective accompanying the study that expanding methadone-assisted treatment, as well as using suboxone as a substitution therapy, would help reduce the death toll from opioid overdose in North America.

Wayne Hall, a professor at the Centre for Youth Substance Abuse at the University of Queensland, and Michael Farrell, director of the National Drug and Alcohol Centre at the University of New South Wales, also called for funding of education programs to reduce the stigma of addiction that discourages people from seeking treatment.