Methadone, Buprenorphine May Lower Opioid Overdose Risk

TOPLINE:

Use of medications for newly-diagnosed opioid use disorder (OUD) increased from 2016 to 2019 but remained low, a new cohort study showed. Additionally, methadone and buprenorphine were potentially protective and linked to risk reductions of 86% and 77% for opioid overdose, respectively.

METHODOLOGY:

• The cohort analysis included data from more than 1.1 million Medicaid beneficiaries aged 18-64 years (52% women; 56% White, 14% Black, and 8.5% Hispanic individuals) from 44 US states. All were newly diagnosed with OUD between 2016 and 2019.
• Outcomes included time to receipt of medications for OUD and medically treated nonfatal opioid overdose.
• OUD medications included buprenorphine, methadone dispensed in opioid treatment programs, and extended-release naltrexone.

TAKEAWAY:

• Within 180 days, 31% of participants received OUD medications, 3% experienced a heroin or synthetic opioid overdose, and 2% experienced an overdose.
• Receipt of OUD drugs increased annually between 2016 and 2019 (hazard ratio [HR], 1.21). Black (HR, 0.68) and Hispanic (HR, 0.91) patients had a lower likelihood of receiving these treatments than White patients; those aged 18-29 years (HR, 1.06) and 30-44 years (HR, 1.24) were more likely to receive them than older adults; and those with a history of medically treated heroin or synthetic opioid overdose (HR, 1.06) also had an increased likelihood of receipt.
• The risk for opioid overdose decreased between 2016 and 2019 (HR, 0.71; 95% CI, 0.68-0.73) and was lower for Black patients (HR, 0.68), Hispanic patients (HR, 0.89), and those of other races (HR, 0.94) than for White patients. Risk factors for overdose included a history of medically treated heroin or synthetic opioid overdose (HR, 4.85), a diagnosis of anxiety (HR, 1.05), and benzodiazepine prescriptions at baseline (HR, 1.32).
• Methadone and buprenorphine were associated with a lower risk for opioid overdose (HRs, 0.14 and 0.23; respectively) than naltrexone (HR, 0.70).

IN PRACTICE:

“Results highlight the critical need for policies to ensure everyone can access treatment — regardless of where they live, their ability to pay, or other personal characteristics. Interventions should increase the use of medications for opioid use disorder and provide supports that reduce treatment dropout,” lead investigator Peter Treitler, Boston University School of Social Work, Boston, said in a press release.