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Opioid Agonist Treatment and Fatal Overdose Risk in a State-wide US Population Receiving Opioid Use Disorder Services

NCJ Number
Addiction Volume: 115 Issue: 9 Dated: 2020
Noa Krawczyk; Ramin Mojtabal; Elizabeth A. Stuart; Michael Fingerhood; Deborah Agus; B. Casey Lyons; Jonathan P Weiner; Brendan Saloner
Date Published
9 pages
This study compared overdose mortality among those in medication treatment for substance-use disorders compared with those in non-medication treatments in specialty care settings.
Evidence from randomized controlled trials has established that medication treatment with methadone and buprenorphine reduces opioid use and improves treatment retention; however, little is known about the role of such medications compared with non-medication treatments in mitigating overdose risk among U.S. patient populations receiving treatment in usual care settings. The current study was a retrospective cohort study that used state-wide treatment data linked to death records. Survival analysis was used to analyze data in a time-to-event framework. Services were delivered by 757 providers in publicly funded out-patient specialty treatment programs in Maryland between January 1, 2015 and December 31, 2016. Study participants were 48,274 adults admitted to out-patient specialty treatment programs in 2015-16 with a primary diagnosis of opioid-use disorder. Main exposure was time in medication treatment (methadone/buprenorphine), time following medication treatment, time exposed to non-medication treatments, and time following non-medication treatment. The main outcome measure was opioid overdose death during or after treatment. Hazard ratios were calculated using Cox proportional hazard regression. Propensity score weights were adjusted for patient information on sex, age, race, region of residence, marital and veteran status, employment, homelessness, primary opioid, mental health treatment, arrests, and criminal justice referral. The study population experienced 371 opioid overdose deaths. Periods in medication treatment were associated with a substantially reduced hazard of opioid overdose death compared with periods in non-medication treatment [adjusted hazard ratio (aHR) = 0.18, 95 percent confidence interval (CI) = 0.08-0.40]. Periods after discharge from non-medication treatment (aHR = 5.45, 95 percent CI = 2.80-9.53) and medication treatment (aHR = 5.85, 95-percent CI = 3.10-11.02) had similar and substantially elevated risks compared with periods in non-medication treatments. The Overall conclusion is that among Maryland patients in specialty opioid treatment, periods in treatment were protective against overdose compared with periods out of care. Those treated with methadone and buprenorphine had significantly lower overdose deaths during treatment compared with non-medication treatments, but not after treatment was discontinued. (publisher abstract modified)