Abstract
In this report we review both published and unpublished studies of mortality among opioid drug users in order to summarize current knowledge about the impact of methadone maintenance on death rates. Only a handful of studies spanning three decades of research employed designs judged adequate to answer this question reliably. These seven studies, which directly compared death rates of op-ioid users during measured periods on and off methadone, produced clear results. The risk of death while on methadone maintenance relative to that while off methadone varied form 0.24 to 0.43; the median value was 0.30. Reductions in death were attributable in large part to protection from opioid drug overdose.