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ACM was available for all patients; information on cause of death and DRP was available for 5935 patients (54%) followed\u2010up for 16\u2009363 person\u2010years. Poisson regression modelled mortality by treatment period with an interaction between OST type and treatment period (first 4\u00a0weeks on OST, rest of time off OST, first 4\u00a0weeks off OST, rest of time out of OST censored at 12\u00a0months) to test whether ACM or DRP differed between methadone and buprenorphine. Inverse probability weights were included to adjust for confounding and balance characteristics of patients prescribed methadone or buprenorphine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>ACM and DRP rates were 1.93 and 0.53 per 100 person\u2010years, respectively. DRP was elevated during the first 4\u00a0weeks of OST [incidence rate ratio (IRR)\u00a0=\u00a01.93 95% confidence interval (CI)\u00a0=\u00a00.97\u20133.82], the first 4\u00a0weeks off OST (IRR\u00a0=\u00a08.15, 95% CI\u00a0=\u00a05.45\u201312.19) and the rest of time out of OST (IRR\u00a0=\u00a02.13, 95% CI\u00a0=\u00a01.47\u20133.09) compared with mortality risk from 4\u00a0weeks to end of treatment. Patients on buprenorphine compared with methadone had lower ACM rates in each treatment period. After adjustment, there was evidence of a lower DRP risk for patients on buprenorphine compared with methadone at treatment initiation (IRR\u00a0=\u00a00.08, 95% CI\u00a0=\u00a00.01\u20130.48) and rest of time on treatment (IRR\u00a0=\u00a00.37, 95% CI\u00a0=\u00a00.17\u20130.79). Treatment duration (mean and median) was shorter on buprenorphine than methadone (173 and 40 versus 363 and 111, respectively). Model estimates suggest that there was a low probability that methadone or buprenorphine reduced the number of DRP in the population: 28 and 21%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In UK general medical practice, opioid substitution treatment with buprenorphine is associated with a lower risk of all\u2010cause and drug\u2010related poisoning mortality than methadone. In the population, buprenorphine is unlikely to give greater overall protection because of the relatively shorter duration of treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.14188","type":"journal-article","created":{"date-parts":[[2018,4,19]],"date-time":"2018-04-19T19:04:05Z","timestamp":1524164645000},"page":"1461-1476","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":112,"title":["The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom"],"prefix":"10.1111","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9864-459X","authenticated-orcid":false,"given":"Matthew","family":"Hickman","sequence":"first","affiliation":[{"name":"Population Health Sciences, Bristol Medical School University of Bristol  Bristol 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