Medication treatment for opioid use disorder linked with lowered mortality in veterans

Treatment with medications for opioid use disorder is associated with significant reductions in multiple modes of mortality for American veterans, according to a study published in the American Journal of Psychiatry.

“Suicide is a leading cause of mortality in the United States, with more than 45,000 deaths each year. Over the past decade, the rate of suicide in the U.S. population has risen by more than 20%. Moreover, opioid use disorder is an independent risk factor for suicide,” Bradley V. Watts, MD, MPH, of the Geisel School of Medicine at Dartmouth College, and colleagues wrote. “Use of medications for opioid use disorder (MOUD) has been shown to increase quality of life, improve health outcomes and decrease illicit drug use.”

Watts and colleagues sought to determine how the effectiveness of medication treatment for opioid use disorder to decrease suicide mortality risk in the veteran population could inform future clinical and policy decisions, while also attempting to describe effects of medications for opioid use disorder on risk of suicide mortality.

The retrospective cohort study included more than 60,000 patients (92.8% male; mean age 46.5 years) from the Department of Veterans Affairs between 2003 and 2017. The researchers linked three data sources — the VA Corporate Data Warehouse, CMS Claims Data, and the VA–Department of Defense Mortality Data Repository.

The exposure of interest was MOUD, including starting periods (first 14 days on treatment), stopping periods (first 14 days off treatment), stable time on treatment, and stable time off treatment (reference category). The main outcome measures included suicide mortality, external-cause mortality, and all-cause mortality in the 5 years following initiation of MOUD.

After adjusting for demographic characteristics, mental health and physical health conditions, and health care utilization, results showed the adjusted HR during stable MOUD was 0.45 (95% CI, 0.32-0.63) for suicide mortality, 0.35 (95% CI, 0.31-0.40) for external-cause mortality, and 0.34 (95% CI, 0.31-0.37) for all-cause mortality. MOUD starting periods were associated with an aHR for suicide mortality of 0.55 (95% CI, 0.25-1.21), and MOUD stopping periods were associated with an aHR for suicide mortality of 1.38 (95% CI, 0.82-2.34).

“These results again highlight the importance of providing medication treatment to as many people with opioid use disorder as possible,” Watts and colleagues wrote. “Doing so may have broad impacts on health outcomes, including suicide mortality.”