Longterm Outcomes

In follow-up studies extending from five to more than twenty years after admission to treatment, the percentages of users reported abstinent from opioid drugs have varied from 9 percent to 21 percent (Maddux & Desmond, 1992). Some of this variation was due to different ways of counting abstinence. In some studies the users were counted as abstinent only if they remained so during the entire period from treatment to follow-up, whereas in others the users were counted as abstinent if they were found so at the time of follow-up. Despite these differences, the studies collectively indicate that only a minority of opioid users are found to be abstinent on long-term follow-up.

Although only small to medium percentages were found to be abstinent, it should not be assumed that the remainder of people were using opioid drugs. Some were dead, some were in prison, and some were in treatment. The death rate of opioid users is about three times the expected rate. Overdose, homicide, suicide, accidents, and liver disease account for many of the deaths. In the 1980s the acquired immunodeficiency syndrome appeared as an additional hazard for drug injectors. A follow-up of opioid users in San Antonio revealed the following different statuses twenty years after first use: 16 percent were abstinent, 29 percent were using heroin, 30 percent were in prison or other institutions, 8 percent were maintained on methadone, and the remaining 17 percent were dead or their status was unknown (Maddux & Desmond, 1981).

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