Medication for Opioid Use Disorder Reduces the Risk of Overdose More Than Treatment Without Medication

Opioid overdose is a leading cause of morbidity and mortality in the US and effective measures to mitigate this problem are urgently needed. Medications for opioid use disorder (MOUD), particularly methadone and buprenorphine, have been shown to reduce the risk of overdose. The impact of treatment without medication is less clear. Researchers used data from Maryland statewide claims and death records to compare opioid overdose death rates during treatment episodes that included MOUD (in this case, methadone or buprenorphine) in specialty care settings with treatment episodes that did not include MOUD.

• A total of 48,274 adults received outpatient treatment for OUD in 2015/2016; 50% had treatment episodes with MOUD, 28% had treatment episodes without medication, and 22% had both treatment episodes that did include MOUD and treatment episodes that did not include MOUD.
• Those who received MOUD were more likely to be female, older than 35, married, employed, not homeless, to not have reported an arrest in the past year, and to have been referred by a non-criminal justice source. There were no significant differences by race.
• Overdose death rates were lowest during receipt of MOUD (0.5/1000 person-years), followed by treatment without medication (4.1), after treatment without medication (13.2), and after MOUD (17.2).
• Weighted hazard ratio (HR) for overdose was significantly lower during receipt of MOUD versus treatment without medication (HR, 0.18). Periods after receipt of MOUD and non-medication treatment both had elevated risk, but were not significantly different from each other (HR, 5.45 and 5.85, respectively).

Comments: This study adds to the overwhelming evidence that methadone and buprenorphine reduce the risk of overdose among people with OUD. Other treatments reduce the risk, but less so. This reinforces the importance of including these medications as an option in all treatment settings, and doing a better job to recruit and retain people with OUD into evidence-based treatment.

Darius A. Rastegar, MD

Reference: Krawczyk N, Mojtabai R, Stuart EA, et al. Opioid agonist treatment and fatal overdose risk in a state-wide US population receiving opioid use disorder services. Addiction. 2020;115:1683–1694.