Were the changes to Sweden’s maintenance treatment policy 2000–06 related to changes in opiate-related mortality and morbidity?

Restrictions in Sweden on maintenance prescribing of heroin substitutes such as methadone have provided an opportunity to reliably assess the treatment’s lifesaving potential. This study took advantage of a major expansion in provision and easing of restrictions between 2000 and 2006 to assess whether these reduced illnesses and deaths were due to heroin misuse.

The authors concluded that these developments were associated with and may have contributed to declines in opiate-related deaths and hospitalisations. Overall deaths declined despite a large proportional increase in deaths where methadone and buprenorphine were found in the body.

Since the end of the study’s period deaths have risen, possible due to more patients being discharged for continuing to use illegal drugs. Experience in Scandinavia and elsewhere shows that the degree to which substitute prescribing programmes save lives overall depends on striking the right balance between access and control, flexibility and regulation.

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