Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan.

This study compared the cause-specific standardized mortality ratios (SMRs) and expected years of life lost (EYLL) among opioid-dependent individuals in the United States and Taiwan. Survival data came from two cohorts followed until 2014: The U.S. data were based on a randomized trial of 1267 opioid-dependent participants enrolled between 2006 and 2009, the CTN START study (CTN-0027); the Taiwan data were from a study of 983 individuals that began in 2006, when opioid agonist treatment (OAT) was implemented in Taiwan. SMRs were calculated for each national cohort and compared. Kaplan-Meier estimation was performed on the survival data, then lifespans were extrapolated to 70 years (840 months) to estimate life expectancy using a semi-parametric method. EYLLs for both cohorts were estimated by subtracting their life expectancies from the age- and gender-matched referents within the general population of their respective country.

Compared with age- and gender-matched references, the SMRs were 3.2 for the U.S. sample and 7.8 for the Taiwan sample; the EYLLs were 7.7 and 16.4 years, respectively. Half of decedents died of unnatural causes in both cohorts; overdose deaths predominated in the U.S. and suicide in Taiwan (with suicide mortality among the Taiwan OAT group 20 times greater than that of the U.S. START group).

Conclusions: Despite different contexts in two vastly different countries, the current estimates of EYLL highlight that opioid dependence and its associated comorbidities and risk factors still contribute severe health burdens across regions. This comparison of cause-specific SMRs could inform stakeholders as they make health policy modifications relevant to their region. Given the prominent role of overdose in the U.S. START cohort, improving access to medication-assisted treatment to prevent overdoses or naloxone to treat them will help address the problem. Suicide is preventable; intervention strategies, including regular screening of ideation and depressive symptoms and providing treatment and support among opioid users in OAT treatment, are urgently needed in Taiwan.

Related protocols: CTN-0027