{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T22:13:43Z","timestamp":1793744023543,"version":"4.6.1"},"reference-count":76,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,9,18]],"date-time":"2019-09-18T00:00:00Z","timestamp":1568764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Opioid agonist therapies are effective medications that can greatly improve the quality of life of individuals with opioid use disorder. However, there is significant uncertainty about the risks of cause\u2010specific mortality in and out of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review and meta\u2010analysis explored the association between methadone and buprenorphine with cause\u2010specific mortality among opioid\u2010dependent persons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched six online databases to identify relevant cohort studies, calculating all\u2010cause and overdose\u2010specific mortality rates during periods in and out of treatment. We pooled mortality estimates using multivariate random effects meta\u2010analysis of the crude mortality rate per 1000 person\u2010years of follow\u2010up as well as relative risks comparing mortality in vs. out of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 32 cohort studies (representing 150\u00a0235 participants, 805\u00a0423.6 person\u2010years, and 9112 deaths) met eligibility criteria. Crude mortality rates were substantially higher among methadone cohorts than buprenorphine cohorts. Relative risk reduction was substantially higher with methadone relative to buprenorphine when time in\u2010treatment was compared to time out\u2010of\u2010treatment. Furthermore, the greatest mortality reduction was conferred during the first 4\u00a0weeks of treatment. Mortality estimates were substantially heterogeneous and varied significantly by country, region, and by the nature of the treatment provider.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Precautions are necessary for the safer implementation of opioid agonist therapy, including baseline assessments of opioid tolerance, ongoing monitoring during the induction period, education of patients about the risk of overdose, and coordination within healthcare services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.13088","type":"journal-article","created":{"date-parts":[[2019,8,16]],"date-time":"2019-08-16T16:13:33Z","timestamp":1565972013000},"page":"313-339","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Reduction in mortality risk with opioid agonist therapy: a systematic review and 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