February 27, 2020
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Opioid agonists reduce overdose death risk by 80%

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Noa Krawczyk

Individuals with opioid use disorder who were treated with opioid agonists had an 80% lower risk for opioid overdose death than those who did not receive medications during treatment, according to findings of a retrospective cohort study published in Addiction.

“Efforts to address the opioid crisis should ensure substance use treatment systems make opioid agonist medications highly accessible to all patients who present with opioid use disorder and focus efforts on promoting engagement and retention in these programs,” Noa Krawczyk, PhD, assistant professor in the department of population health at New York University Grossman School of Medicine, told Healio Psychiatry. “All opioid treatment programs should offer and encourage use of medications such as methadone and buprenorphine.”

Randomized controlled trials have established the efficacy of methadone and buprenorphine for reducing opioid use and improving treatment retention, according to Krawczyk and colleagues. However, data are sparse regarding the role of such opioid agonist treatments compared with nonmedication treatments in reducing overdose risk among U.S. patients who receive treatment in usual care settings. The current study is one of the first U.S. population-based research efforts to compare overdose risk for two patient populations across an entire state.

The researchers obtained statewide treatment data from death records and conducted a survival analysis of data in a time-to-event framework for services administered by 757 providers in publicly funded outpatient specialty treatment programs in Maryland. The analysis included 48,274 adults admitted to these programs between 2015 and 2016 for primary diagnosis of opioid use disorder. Time in medication treatment with methadone/buprenorphine, time following medication treatment, time exposed to nonmedication treatments and time following nonmedication treatment served as main exposures, with opioid overdose death during and after treatment as the main outcome. Researchers used Cox proportional hazard regression to calculate hazard ratios, and they adjusted propensity score weights for patient information on factors including primary opioid, mental health treatment, criminal justice referral, age, race and region of residence.

inforgraphic of study author Noa Krawczyk giving quote from article
Source: Krawczyk N, et al. Addiction. 2020;doi:10.1111/add.14991.

Results showed 371 opioid overdose deaths among the study population. Compared with periods in nonmedication treatment, periods in medication treatment were associated with substantially reduced hazard of opioid overdose death (adjusted HR [aHR] = 0.18, 95% CI, 0.08-0.4). Furthermore, the researchers reported similar and substantially elevated risk for periods after discharge from nonmedication treatment (aHR = 5.45, 95% CI, 2.8-9.53) and medication treatment (aHR = 5.85, 95% CI, 3.1-11.02) compared with periods during nonmedication treatment, which indicated an overall protective effect of being in treatment, regardless of type.

“These findings strengthen our confidence in the potential of expanding medication treatment to reduce overdoses at the population level,” Krawczyk said. “However, the large overdose risk that can occur at cessation of treatment emphasized the critical need to improve retention in medication treatment. Retention in treatment is fundamental for sustaining its protective effects, and we need to assure patients remain in medication treatment for as long as the treatment is helping and working for them.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.