How Opioid Use Disorder Meds Affect Opioid Death Rates

Larochelle

Two FDA-approved medications to treat opioid use disorder (OUD) save lives, but only three out of 10 overdose survivors receive them, according to a new study from Boston Medical Center’s (BMC) Grayken Center for Addiction.

The first-of-its-kind study, published in the Annals of Internal Medicine, examined the association between using medication to treat OUD and mortality in patients who had previously had a nonfatal opioid overdose.

In total, regardless of whether patients were taking an FDA approved OUD medication or not), 5% of patients who initially survived an overdose died within one year. Methadone, buprenorphine, and naltrexone are FDA-approved medications to treat OUD.

“We conducted this study in order to determine what happens when people survive an opioid overdose and more specifically, if the FDA-approved medications have an impact on their mortality,” says lead study author Marc Larochelle, MD, general internist and researcher at BMC’s Grayken Center.

Using a novel public health dataset from the Massachusetts Department of Public Health, Larochelle and BMC researchers analyzed data from cases where a person survived an overdose and whether the three medications used to treat OUD were associated with mortality. Researchers identified 17,568 cases where an adult in Massachusetts survived an overdose between 2012 and 2014.

After surviving the overdose, there was a 59% reduction in mortality for individuals who were taking methadone compared to those who were not taking medication. For individuals who were receiving buprenorphine, there was a 38% reduction in mortality. The data indicated no association with a change in mortality for patients receiving naltrexone compared to patients not receiving medication.

In the 12 months following the overdose, 30% of the individuals received a medication: 8% of the individuals received methadone maintenance treatment; 13% received buprenorphine; 4% received naltrexone; and 5% received more than one medication. 

In addition, the results highlight the missed opportunities to pinpoint individuals with OUD and engage them in treatment when and where they enter the healthcare system with opioid-related issues.

“Healthcare executives should take note because this study found that methadone and buprenorphine substantially reduced mortality but only a minority received them,” says Larochelle. “We need to reform our healthcare delivery systems to improve access to these life-saving treatments in ways that patients are willing to engage. This includes offering support and treatment-not only in traditional settings where patients are referred for specialty addiction treatment-but wherever patients are accessing the healthcare system including emergency departments, inpatient settings, primary care, and elsewhere.”