Risk of Opioid Overdose High After Treatment Ends

People with an opioid addiction face a higher risk of overdose after ending their treatment, according to a new survey.

Researchers at Columbia University Vagelos College of Physicians and Surgeons. found that although an opioid addict’s treatment includes taking the medication buprenorphine and spending 18 months being treated, the patient remains to be at high risk-sometimes shortly after the treatment is over.

According to the study, 5% of those who were treated with buprenorphine continuously for six to 18 months needed medical treatment for an opioid overdose six months after ending their medication treatment. However, the true rate is likely higher as the study was unable to account for overdose events that did not present to healthcare settings.

"The rate at which individuals relapsed and overdosed after ending treatment was alarmingly high, suggesting that discontinuing buprenorphine is a life-threatening event," says Arthur Robin Williams, MD, MBE, assistant professor of clinical psychiatry at Columbia University Vagelos College of Physicians and Surgeons.

In addition, the study found the longer patients continued with treatment, the lower their risk of other outcomes.

The study suggests buprenorphine treatment may be most effective as a long-term therapy for those with opioid use disorder. FDA-approved buprenorphine is dispensed to almost 1 million individuals annually, the report says.

As the opioid epidemic continues, increasing attention has focused on difficulties faced by about 2.1 million patients with opioid use disorder in accessing evidence-based care.

However, an estimated 50% to 80% of patients discontinue the treatment within several weeks or months, and there is no consensus about how long patients should continue taking the medication although experts support indefinite use.

Related: Claims Data Study Reveals Risk Factors In Opioid Use

"Many clinicians think they should prescribe buprenorphine only for time-limited periods, due to stigma and outdated beliefs that patients using medications for opioid use disorder are not in 'true recovery,'" says Williams. "Our paper is one of the first to look at the effect of long-term durations of buprenorphine treatment on subsequent outcomes."

To understand whether the duration of buprenorphine treatment had an impact on outcomes after treatment ended, the researchers analyzed Medicaid claims data of nearly 9,000 adults aged 18 to 64 years who remained in continual treatment for at least six months and for as many as 18 months.

Researchers then found in the six months after treatment ended, approximately one in 20 individuals received treatment for an opioid overdose at least once.

Rates of new opioid prescriptions (~25%) and visits to the emergency room (~45%) remained high for all groups in the six months after ending buprenorphine treatment, especially among those with mental illness, the report says.

Rates were much higher for those who stopped treatment after six months versus the 15 to 18 months.

Previous studies have shown that the risk of dying from an opioid overdose drops by as much as 70% during buprenorphine treatment. However, most patients relapse after they discontinue the medication.

"Patients and families need guidance, social support, and better coordination of care to help facilitate long-term maintenance with buprenorphine for opioid use disorder," Williams says.