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Aims: To quantify the association between opioid agonist treatment (OAT) and overdose death by age group; test the hypothesis that across different age groups, opioid overdose mortality is lowest during OAT with buprenorphine compared with time out of treatment or OAT with methadone; and test associations between OAT and opioid overdose mortality in the presence of chronic circulatory, respiratory, liver, and kidney diseases. Design: Retrospective observational cohort study using linked administrative data. Setting: New South Wales, Australia. Participants: 37,764 people prescribed OAT, 1 August 2002 and 31 December 2017. Measurements: OAT exposure, opioid overdose mortality, and key confounders were measured using linked population datasets on OAT entry and exit, hospitalisation, mental health care, incarceration, and mortality. ICD-10 codes were used to define opioid overdose mortality and chronic disease groups of interest. Findings: Relative to time out of treatment, time in OAT was associated with lower risk of opioid overdose death across all age groups and chronic diseases. Among people aged 50 years and older, there was weak evidence that buprenorphine may be associated with greater protection against opioid overdose death than methadone (generalised estimating equation [GEE] adjusted incident rate ratio (aIRR) 0.47; 95% confidence interval (CI) 0.21, 1.02; marginal structural models [MSM] aIRR 0.49; 95%CI 0.17, 1.41). Buprenorphine was associated with greater protection against overdose death than methadone for clients with circulatory (MSM aIRR 0.27; 95% CI 0.11, 0.67) or respiratory (MSM aIRR 0.26; 95% CI 0.07, 0.94) diseases, but not liver (MSM aIRR 0.59; 95% CI 0.14, 2.43) or kidney (MSM aIRR 1.16; 95% CI 0.31, 4.36) diseases. Conclusions: Opioid agonist treatment (OAT) appears to reduce mortality risk in people with opioid use disorder who are older or who have physical comorbidities. Opioid overdose mortality during OAT with buprenorphine appears to be lower and reduced in clients with circulatory and respiratory diseases compared with OAT with methadone.

This research is set within the framework of a recent decline in desired and actual fertility in France. This decline corresponds to an increasing delay in marriage, and a reorganisation of male and female roles within and outside the family. The thesis first describes the major demographic changes in fertility and nuptiality in the post war period and examines the arguments and evidence for a relationship between the development of an approved social status for women, other than that of wife and mother, and a planning and limitation of family size. It is suggested that women's improved access to education, employment and an independent income provides resources which influence fertility by encouraging a discussion and redefinition of the couple's priorities and goals, and a breakdown in the sexual segregation of family tasks and decisions that identify women with the maternal and domestic role. The thesis examines this proposition with reference to a sample of women attending two family planning clinics in Marseille. The sample is composed of two groups, Maghrebine immigrant women who combine a traditional, highly segregated family model with a low level of personal resources, and French women, who benefit from a greater social autonomy and have a wider range of external resources. The status, fertility expectations and behaviour of these women are examined and compared, as well as a series of intermediate variables which include knowledge, attitudes, and practice of birth control, attitudes towards work and family roles, and the actual allocation of tasks and decision making within the French and Maghrebine couple. Evidence is found for the proposition that the access of women to an alternative social status acts to redefine the priorities, goals, and organisation of the couple, reducing the woman's identification with the maternal role, and leading to a planning and limitation of desired and actual fertility.