Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality

Details

• Alternative Title:
  Ann Intern Med
• Personal Author:
  Larochelle, Marc R. ; Bernson, Dana ; Land, Thomas ; Stopka, Thomas J. ; Wang, Na ; Xuan, Ziming ; Bagley, Sarah M. ; Liebschutz, Jane M. ; Walley, Alexander Y.
• Description:
  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.
  
  
• Subjects:
  Adolescent Adult Analgesics, Opioid Article Buprenorphine Drug Overdose Female Humans Male Massachusetts Methadone Middle Aged Mortality Naltrexone Opiate Substitution Treatment Opioid-Related Disorders Proportional Hazards Models Retrospective Studies Young Adult

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• Source:
  Ann Intern Med. 169(3):137-145
• Pubmed ID:
  29913516
• Pubmed Central ID:
  PMC6387681
• Document Type:
  Journal Article
• Funding:
  K23 DA042168/DA/NIDA NIH HHS/United States ; U01 CE002780/CE/NCIPC CDC HHS/United States ; UL1 TR001430/TR/NCATS NIH HHS/United States
• Volume:
  169
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:27202ece746515d708fd6d288f7a218bd10cea7d76f94cf8a560f4cd13ec207f
• Download URL:
  https://stacks.cdc.gov/view/cdc/101059/cdc_101059_DS1.pdf
• File Type:
  [PDF - 928.39 KB ]