Thursday, March 16, 2023

Certain Patients With OUD Remain at Risk of Overdose After Entering Treatment

Patients who enrolled in a trial of medication treatment for opioid use disorder (OUD) who did not start or complete their assigned medication were at greater risk of experiencing an overdose than those who took their medication, according to a study published in The American Journal of Psychiatry.

“A substantial body of evidence has shown that treatment with medication for opioid use disorder (MOUD) can decrease both overdose risk and all-cause mortality among people with opioid use disorder,” wrote Laura Brandt, Ph.D., of City College of New York and colleagues. “The aim of this study was to estimate the risk of overdose events once a patient is diagnosed with OUD and engaged in MOUD treatment and to test whether the assignment to a medication (methadone, buprenorphine, extended-release naltrexone) influences this risk.”

Brandt and colleagues used data from three large MOUD clinical trials that included 2,199 adult participants with OUD:

  • In the first study, participants received outpatient methadone or buprenorphine treatment for 24 weeks. Adverse events such as overdoses were reported weekly.
  • For the second study, participants received counseling and buprenorphine for three to four weeks and were followed for an additional four to eight weeks. Those who did not maintain abstinence received buprenorphine treatment for 12 weeks followed by a four-week taper period. Adverse events were reported biweekly.
  • Participants in the third study received outpatient buprenorphine or extended-release naltrexone over 24 weeks. Adverse events were reported weekly.

Fifty-seven overdose events occurred in the three studies, experienced by 51 participants. Fifteen overdoses occurred among 283 participants assigned to naltrexone (5.3%), eight among 529 participants assigned to methadone (1.51%), and 16 among 1,387 patients assigned to buprenorphine (1.15%). Nearly 28% of the participants assigned to naltrexone never started the medication, compared with only 2.2% of those assigned to buprenorphine and 1.7% of those assigned to methadone. Those who did not start naltrexone had an overdose rate of 8.9% compared with 3.9% among those who did start the medication.

Overall, the risk of experiencing an overdose was significantly higher among those who never started their assigned medication or who stopped their medication. Further, taking benzodiazepines at baseline was associated with an increased risk of an overdose among participants in all three medication groups.

“Patients should be educated about overdose risk, the protective effect of MOUD, and the danger of discontinuing medication,” the authors concluded. “Benzodiazepine use is also a signal of risk, and patients taking benzodiazepines should be evaluated and treated for mental health problems as part of an effort to wean them off benzodiazepines.”

For related information, see the Psychiatric Services article “Factors Associated With Initial Treatment Choice, Engagement, and Discontinuation for Patients With Opioid Use Disorder.”

(Image: iStock/SDI Productions)

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