Drug treatment associated with a significant reduction in death risk following opioid overdose

1. Buprenorphine and methadone maintenance treatment (MMT) was associated with reduced death in opioid users.

2. No significant associations were found between naltrexone and all-cause mortality or opioid-related mortality.

Evidence Rating Level: 2 (Good)

Study Rundown: Opioid overdose has become a rising problem in North America. There are several medications currently available to help reduce death from opioid overdose, including buprenorphine, MMT and naltrexone. The authors of this study aimed to evaluate the relationship between all-cause and opioid-related mortality with the use of medications for opioid use disorder (MOUD) administered after overdose. In general, it was observed that buprenorphine and MMT were associated with a reduction in both all-cause and opioid-related mortality, while no associations were observed with naltrexone. This study had several limitations. First, the findings from this study may not be generalizable to all populations, as it was only conducted in Massachusetts. Further, the data was subject to selection bias.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Treatment of opioid dependence with buprenorphine: current update

In-Depth [retrospective cohort]: The authors conducted a retrospective cohort study in order to assess MOUD following opioid overdose. A total of 17 568 patients with opioid overdose from Massachusetts were included in this study. The three types of MOUD that were evaluated were MMT, buprenorphine, and naltrexone. Data was analyzed using a multivariable Cox proportional hazards model. In general, 30% of patients received any form of MOUD during the 12 months of the study, with 13% receiving buprenorphine (n = 2228) and 8% receiving MMT (1416). Out of the patient cohort, the all-cause mortality was 4.7 deaths (95% CI, 4.4 to 5.0 deaths) per 100 person years. Opioid-related mortality was 2.1 deaths (CI, 1.9 to 2.4 deaths) per 100 person-years. There was a reduction in both all-cause and opioid-related mortality for buprenorphine (AHR, 0.63 [CI, 0.46 to 0.87] and AHR, 0.62 [CI, 0.41 to 0.92]) as well as MMT (AHR 0.47 [CI, 0.32 to 0.71] and AHR, 0.41 [CI, 0.24 to 0.70]).

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