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. 2013 May;103(5):917-22.
doi: 10.2105/AJPH.2012.301049. Epub 2013 Mar 14.

Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009

Robert P Schwartz  1 , Jan Gryczynski, Kevin E O'Grady, Joshua M Sharfstein, Gregory Warren, Yngvild Olsen, Shannon G Mitchell, Jerome H Jaffe
Affiliations

Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009

Robert P Schwartz et al. Am J Public Health. 2013 May.

Abstract

Objectives: We examined the association between the expansion of methadone and buprenorphine treatment and the prevalence of heroin overdose deaths in Baltimore, Maryland from 1995 to 2009.

Methods: We conducted a longitudinal time series analysis of archival data using linear regression with the Newey-West method to correct SEs for heteroscedasticity and autocorrelation, adjusting for average heroin purity.

Results: Overdose deaths attributed to heroin ranged from a high of 312 in 1999 to a low of 106 in 2008. While mean heroin purity rose sharply (1995-1999), the increasing number of patients treated with methadone was not associated with a change in the number of overdose deaths, but starting in 2000 expansion of opioid agonist treatment was associated with a decline in overdose deaths. Adjusting for heroin purity and the number of methadone patients, there was a statistically significant inverse relationship between heroin overdose deaths and patients treated with buprenorphine (P = .002).

Conclusions: Increased access to opioid agonist treatment was associated with a reduction in heroin overdose deaths. Implementing policies that support evidence-based medication treatment of opiate dependence may decrease heroin overdose deaths.

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Figures

FIGURE 1—
FIGURE 1—
Heroin overdose deaths and opioid agonist treatment: Baltimore, MD, 1995–2009.
See this image and copyright information in PMC

Comment in

  • Schwartz et al. respond.
    Schwartz RP, Gryczynski J, O'Grady KE, Sharfstein JM, Warren G, Olsen YK, Mitchell SG, Jaffe JH. Schwartz RP, et al. Am J Public Health. 2013 Aug;103(8):e2-3. doi: 10.2105/AJPH.2013.301428. Epub 2013 Jun 13. Am J Public Health. 2013. PMID: 23763406 Free PMC article. No abstract available.
  • Efforts to reduce overdose deaths.
    Sherman SG, Han J, Welsh C, Chaulk P, Serio-Chapman C. Sherman SG, et al. Am J Public Health. 2013 Aug;103(8):e1-2. doi: 10.2105/AJPH.2013.301410. Epub 2013 Jun 13. Am J Public Health. 2013. PMID: 23763429 Free PMC article. No abstract available.

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