Thursday, February 27, 2020

Medication Treatment for OUD Linked With 80% Lower Risk of Fatal Overdose

Patients with opioid use disorder (OUD) who receive treatment with methadone or buprenorphine have a significantly lower risk of dying from an opioid overdose compared with patients receiving nonmedication treatment, according to a study in Addiction.

“Compared with patients in nonmedication treatment, those in medication treatment had an 80% lower hazard of overdose death during care,” wrote Noa Krawczyk, Ph.D., of the NYU School of Medicine, and colleagues. The risk of fatal overdose significantly increased, however, in the first few weeks following discharge, regardless of the treatment type.

The researchers used outpatient substance use specialty treatment records from 48,274 patients in Maryland from 2015 to 2016 and cross-referenced the data with opioid overdose death records. Treatment records were divided into two categories: those of patients who had received methadone or buprenorphine and those of patients who had received nonmedication treatment, such as psychotherapy, group and individual counseling, and educational programming. A treatment period could not be interrupted by more than two weeks.

There were 371 deaths from opioid overdose during the study period. The opioid overdose rate was lowest when patients were receiving medication treatment, with a rate of .48 deaths per 1,000 person-years. In contrast, the rate for patients who received nonmedication treatment was 4.13 deaths per 1,000 person-years. Also, patients who had received medication treatment stayed, on average, in treatment longer—248 days versus 22 days.

After medication treatment, the rate of overdose deaths increased to 17.21 deaths per 1,000 person-years, “indicating an overall protective effect of being in treatment, regardless of type,” the authors wrote. The risk of overdose immediately after treatment highlights the need to combine care with overdose education and harm-reduction modalities, such as naloxone training and distribution.

In addition, the findings “support efforts to increase expansion of and access to medications in community settings as a means of reducing overdose risk,” the authors continued. “Policymakers should ensure substance use treatment systems make opioid agonist medications (buprenorphine and methadone) highly accessible to all patients who present with OUD and focus efforts on promoting engagement and retention in these programs.”

For related information, see the Psychiatric Research and Clinical Practice article “Pharmacological and Behavioral Treatment of Opioid Use Disorder.”

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