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Ann Intern Med. 2018 Aug 7;169(3):137-145. doi: 10.7326/M17-3107. Epub 2018 Jun 19.

Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study.

Author information

1
Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts (M.R.L., S.M.B.).
2
Office of Special Analytic Projects, Office of Population Health, Massachusetts Department of Public Health, Boston, Massachusetts (D.B., T.L.).
3
Tufts University School of Medicine, Boston, Massachusetts (T.J.S.).
4
Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts (N.W.).
5
Boston University School of Public Health, Boston, Massachusetts (Z.X.).
6
Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, and Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (J.M.L.).
7
Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center and Bureau of Substance Addiction Services, Massachusetts Department of Public Health, Boston, Massachusetts (A.Y.W.).

Abstract

Background:

Opioid overdose survivors have an increased risk for death. Whether use of medications for opioid use disorder (MOUD) after overdose is associated with mortality is not known.

Objective:

To identify MOUD use after opioid overdose and its association with all-cause and opioid-related mortality.

Design:

Retrospective cohort study.

Setting:

7 individually linked data sets from Massachusetts government agencies.

Participants:

17 568 Massachusetts adults without cancer who survived an opioid overdose between 2012 and 2014.

Measurements:

Three types of MOUD were examined: methadone maintenance treatment (MMT), buprenorphine, and naltrexone. Exposure to MOUD was identified at monthly intervals, and persons were considered exposed through the month after last receipt. A multivariable Cox proportional hazards model was used to examine MOUD as a monthly time-varying exposure variable to predict time to all-cause and opioid-related mortality.

Results:

In the 12 months after a nonfatal overdose, 2040 persons (11%) enrolled in MMT for a median of 5 months (interquartile range, 2 to 9 months), 3022 persons (17%) received buprenorphine for a median of 4 months (interquartile range, 2 to 8 months), and 1099 persons (6%) received naltrexone for a median of 1 month (interquartile range, 1 to 2 months). Among the entire cohort, all-cause mortality was 4.7 deaths (95% CI, 4.4 to 5.0 deaths) per 100 person-years and opioid-related mortality was 2.1 deaths (CI, 1.9 to 2.4 deaths) per 100 person-years. Compared with no MOUD, MMT was associated with decreased all-cause mortality (adjusted hazard ratio [AHR], 0.47 [CI, 0.32 to 0.71]) and opioid-related mortality (AHR, 0.41 [CI, 0.24 to 0.70]). Buprenorphine was associated with decreased all-cause mortality (AHR, 0.63 [CI, 0.46 to 0.87]) and opioid-related mortality (AHR, 0.62 [CI, 0.41 to 0.92]). No associations between naltrexone and all-cause mortality (AHR, 1.44 [CI, 0.84 to 2.46]) or opioid-related mortality (AHR, 1.42 [CI, 0.73 to 2.79]) were identified.

Limitation:

Few events among naltrexone recipients preclude confident conclusions.

Conclusion:

A minority of opioid overdose survivors received MOUD. Buprenorphine and MMT were associated with reduced all-cause and opioid-related mortality.

Primary Funding Source:

National Center for Advancing Translational Sciences of the National Institutes of Health.

PMID:
29913516
DOI:
10.7326/M17-3107

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