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Buprenorphine, methadone significantly reduce mortality after opioid overdose

Individuals treated with buprenorphine and methadone after a nonfatal opioid overdose had a 40% to 60% reduction in all-cause and opioid-related mortality; however, use of such medications were low, according to findings published in Annals of Internal Medicine.

“Opioid overdose survivors have an increased risk for death. Whether use of medications for opioid use disorder after overdose is associated with mortality is not known,” Marc R. Larochelle, MD, MPH, from Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center, and colleagues wrote.

Larochelle and colleagues conducted a cohort study to determine whether medications for opioid use disorder, such as methadone maintenance treatment, buprenorphine and naltrexone, reduced all-cause and opioid-related mortality after an overdose. The researchers analyzed data of 17,568 adults without cancer who survived an opioid overdose between 2012 and 2014.

A total of 2,040 participants received methadone maintenance treatment (median duration, 5 months), 3,022 received buprenorphine (median duration, 4 months) and 1,099 received naltrexone (median duration, 1 month) within year after a nonfatal opioid overdose.

Individuals treated with buprenorphine and methadone after a nonfatal opioid overdose had a 40% to 60% reduction in all-cause and opioid-related mortality; however, use of such medications were low.

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Overall, 4.7 deaths per 100 person-years for any cause occurred, as did 2.1 opioid-related deaths per 100 person-years.

Participants receiving methadone maintenance treatment had lower all-cause mortality (adjusted HR = 0.47; 95% CI, 0.32-0.71) and opioid-related mortality (aHR = 0.41; 95% CI, 0.24-0.70) compared with no treatment. Similarly, participants receiving buprenorphine had reduced all-cause mortality (aHR = 0.63; 95% CI, 0.46-0.87) and opioid-related mortality (aHR = 0.62; 95% CI, 0.41-0.92). However, there were no associations observed between naltrexone and all-cause mortality (aHR = 1.44; 95% CI, 0.84-2.46]) or opioid-related mortality (aHR = 1.42; 95% CI, 0.73-2.79).

“These findings suggest meaningful opportunities to improve engagement and retention in treatment of opioid use disorders after a nonfatal overdose,” Larochelle and colleagues concluded.

In an accompanying editorial, Nora D. Volkow, MD, and Eric M. Wargo, PhD, both from the

National Institute on Drug Abuse wrote that the findings by Larochelle and colleagues highlight the challenges in treating opioid use disorder.

“Ending the crisis will require changing policies to make these medications more accessible and educating primary care and emergency providers, among others, that opioid addiction is a medical illness that must be treated aggressively with the effective tools that are available,” Volkow and Wargo wrote. “To do this, we must remove the stigma from the disease of addiction and from the medications that can be used to treat it.” – by Alaina Tedesco

Disclosure: Larochelle reports receiving grants from Boston University School of Medicine Department of Medicine, National Center for Advancing Translational Sciences and National Institute on Drug Abuse. Please see study for all other authors’ relevant financial disclosures. Volkow and Wargo report no relevant financial disclosures.