Opioid agonist treatments and heroin overdose deaths in Baltimore, Maryland, 1995-2009

Am J Public Health. 2013 May;103(5):917-22. doi: 10.2105/AJPH.2012.301049. Epub 2013 Mar 14.


Objectives: We examined the association between the expansion of methadone and buprenorphine treatment and the prevalence of heroin overdose deaths in Baltimore, Maryland from 1995 to 2009.

Methods: We conducted a longitudinal time series analysis of archival data using linear regression with the Newey-West method to correct SEs for heteroscedasticity and autocorrelation, adjusting for average heroin purity.

Results: Overdose deaths attributed to heroin ranged from a high of 312 in 1999 to a low of 106 in 2008. While mean heroin purity rose sharply (1995-1999), the increasing number of patients treated with methadone was not associated with a change in the number of overdose deaths, but starting in 2000 expansion of opioid agonist treatment was associated with a decline in overdose deaths. Adjusting for heroin purity and the number of methadone patients, there was a statistically significant inverse relationship between heroin overdose deaths and patients treated with buprenorphine (P = .002).

Conclusions: Increased access to opioid agonist treatment was associated with a reduction in heroin overdose deaths. Implementing policies that support evidence-based medication treatment of opiate dependence may decrease heroin overdose deaths.

MeSH terms

  • Baltimore / epidemiology
  • Buprenorphine / adverse effects
  • Buprenorphine / therapeutic use*
  • Drug Overdose / mortality*
  • Heroin Dependence / drug therapy
  • Heroin Dependence / mortality*
  • Heroin Dependence / rehabilitation
  • Humans
  • Linear Models
  • Longitudinal Studies
  • Methadone / adverse effects
  • Methadone / therapeutic use*
  • Mortality / trends
  • Narcotic Antagonists / adverse effects
  • Narcotic Antagonists / therapeutic use
  • Opiate Substitution Treatment / trends*


  • Narcotic Antagonists
  • Buprenorphine
  • Methadone