Buprenorphine prevents deaths from opioid use disorder
Buprenorphine appears to be a strong protective factor against mortality in patients with opioid use disorder, according to research recently published in Annals of Family Medicine.
The research underscores the value of buprenorphine in treating patients with opioid use disorder as the nation struggles with an opioid epidemic.
The CDC reported just last week that although opioid prescriptions declined from 2010 to 2015, the opioid prescription rate in 2015 was three times higher than the rate reported in 1999. That agency also has previously reported that 91 Americans die every day from opioid overdose.
“There is a lack of data regarding the association of buprenorphine as sole [opioid maintenance therapy] with mortality in office-based general medical practice,” Julie Dupouy, MD, PhD, Département de Médecine Générale Faculté de Médecine, Université Toulouse III Paul Sabatier, Toulouse, France and colleagues wrote. “We therefore investigated mortality among outpatients starting [opioid maintenance therapy] with buprenorphine or buprenorphine-naloxone in France, comparing deaths during periods in and out of buprenorphine treatment.
Researchers used a cohort of 713 patients from the French Health Insurance System database aged 16 to 60 years that newly started buprenorphine or buprenorphine-naloxone therapy between January 2007 and December 2011. All patients had at least 2 years of follow-up until December 2013, and patients who subsequently switched to methadone were excluded. The mean follow-up with the patients was 4.5 years, and for 588 patients, the first buprenorphine prescriber was a general practitioner in private practice. Patients were treated for a median duration of 680 days (interquartile range, 116-1,292 days), corresponding to three treatment periods (interquartile range, 1-6).
Dupouy and colleagues found that 25 patients were hospitalized for a psychiatric disorder and 106 were hospitalized for another disease; the mean time spent in the hospital was 7 days. In addition, 29 patients died during follow-up, but none of these deaths occurred during hospitalization. The mortality rate among the study cohort was 0.63 per 100 person-years (95% CI, 0.4-0.85), compared with 0.24 per 100 person-years (95% CI, 0.24-0.25) for other individuals aged 16 to 60 years from the same database during the same period. Multivariate analysis showed patients had an elevated risk for death if they were older than 40 years compared with younger than 30 years (HR = 3.94; 95% CI, 1.45-10.69) and particularly if they were out of buprenorphine treatment as compared with in treatment (HR = 29.04; 95% CI, 10.04-83.99). Opioid analgesic use was associated with a lower risk for death (HR = 0.37; 95% CI, 0.18-0.79).
“To the best of our knowledge, this study is the first to describe the association of exclusive buprenorphine maintenance with mortality among patients in ambulatory practice,” Dupouy and colleagues wrote. “In this French-specific context, being in treatment vs. out of treatment was associated with a reduction of at least 10-fold in the risk of death. These findings should encourage physicians to avoid interrupting buprenorphine treatment and encourage patients to continue treatment as long as it is needed.”
The CDC has previously published guidelines for opioid use, which include that treatment of acute pain with opioids should be for the shortest duration possible, and that primary care providers should use caution when prescribing opioids and closely monitor all patients receiving them.
In addition, information presented at this year’s AANP conference suggested that successfully treating patients with chronic pain and opioid use disorder must involve the patient being actively engaged in self-management of their condition, while other research recently identified six potential ‘building blocks’ that could lead to better outcomes in chronic opioid management, including calculating progress toward achieving clinic objectives and pinpointing resources for complex patients.– by Janel Miller
Disclosure: The researchers report no relevant financial disclosures.