Buprenorphine, Methadone Use After Overdose Reduces Death

Treating patients who survive an opioid overdose with either methadone or buprenorphine appears to significantly reduce their risk of death for at least 12 months, but only a third of opioid overdose survivors may be receiving these medications, according to a report published June 19 in the Annals of Internal Medicine.

“These findings suggest meaningful opportunities to improve engagement and retention in treatment of opioid use disorders after a nonfatal overdose,” wrote Marc Larochelle, M.D., M.P.H., of Boston Medical Center and colleagues.

Using the Massachusetts All-Payer Claims Database and several other linked Massachusetts state databanks, Larochelle and colleagues identified adults aged 18 and older who survived an opioid overdose between January 2012 and December 2014. The researchers also identified those who received medication for opioid use disorder, including methadone maintenance treatment, buprenorphine, or naltrexone.

In the 12 months after a nonfatal overdose, 2,040 people (11 percent) enrolled in methadone maintenance treatment for a median of five months, 3,022 people (17 percent) received buprenorphine for a median of four months, and 1,099 persons (6 percent) received naltrexone for a median of one month.

Over 12 months of follow-up, 807 participants died of any cause and 368 died of an opioid-related overdose. Compared with individuals who received no treatment for opioid use disorder, those who received methadone maintenance treatment or buprenorphine were less likely to die of any cause or of an opioid-related cause. No such association was found for naltrexone and all-cause and opioid-related death, although Larochelle and colleagues noted this may have been due to the small number of patients who received naltrexone.

“Our data confirm that nonfatal opioid overdose is an opportunity to identify persons at high risk for death and engage them in treatment,” Larochelle and colleagues wrote.

They noted that rates of treatment initiation are inversely proportional to the lag in time between being offered treatment and being able to start the treatment. “New models that offer treatment initiation and linkage to care from emergency department and inpatient settings have demonstrated increased treatment engagement. Our findings also show that treatment initiation without retention undermines benefits. We need to improve delivery systems that improve treatment retention, especially with naltrexone.”

David Hathcox

In an accompanying editorial, Nora Volkow, M.D., and Eric Wargo, Ph.D., of the National Institute on Drug Abuse offered several strategies to increase medication-assisted treatment delivery to people at risk for opioid overdose. They recommended initiating buprenorphine therapy in the emergency room for overdose survivors and connecting these patients with primary care physicians who have the proper waivers to continue prescribing the medication. They also recommended prescribing medication-assisted treatment to people who are incarcerated or shortly before their release.

“A great part of the tragedy of this opioid crisis is that, unlike in previous such crises America has seen, we now possess effective treatment strategies that could address it and save many lives, yet tens of thousands of people die each year because they have not received these treatments,” they wrote. “Ending the crisis will require changing policies to make these medications more accessible and educating primary care and emergency providers, among others, that opioid addiction is a medical illness that must be treated aggressively with the effective tools that are available. To do this, we must remove the stigma from the disease of addiction and from the medications that can be used to treat it.”

This study was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health. ■