Cited by 995Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPain Management and Opioid Use

Comparative effectiveness of different treatment pathways for opioid use disorder.

Open access
Wakeman, Sarah E., Larochelle, Marc R., Ameli, Omid, Chaisson, Christine E., McPheeters, Jeffrey Thomas, Crown, William H., Azocar, Francisca, Sanghavi, Darshak M.·2020·JAMA Network Open

Abstract

Importance: Although clinical trials demonstrate the superior effectiveness of medication for opioid use disorder (MOUD) compared with nonpharmacologic treatment, national data on the comparative effectiveness of real-world treatment pathways are lacking. Objective: To examine associations between opioid use disorder (OUD) treatment pathways and overdose and opioid-related acute care use as proxies for OUD recurrence. Design, Setting, and Participants: This retrospective comparative effectiveness research study assessed deidentified claims from the OptumLabs Data Warehouse from individuals aged 16 years or older with OUD and commercial or Medicare Advantage coverage. Opioid use disorder was identified based on 1 or more inpatient or 2 or more outpatient claims for OUD diagnosis codes within 3 months of each other; 1 or more claims for OUD plus diagnosis codes for opioid-related overdose, injection-related infection, or inpatient detoxification or residential services; or MOUD claims between January 1, 2015, and September 30, 2017. Data analysis was performed from April 1, 2018, to June 30, 2019. Exposures: One of 6 mutually exclusive treatment pathways, including (1) no treatment, (2) inpatient detoxification or residential services, (3) intensive behavioral health, (4) buprenorphine or methadone, (5) naltrexone, and (6) nonintensive behavioral health. Main Outcomes and Measures: Opioid-related overdose or serious acute care use during 3 and 12 months after initial treatment. Results: A total of 40 885 individuals with OUD (mean [SD] age, 47.73 [17.25] years; 22 172 [54.2%] male; 30 332 [74.2%] white) were identified. For OUD treatment, 24 258 (59.3%) received nonintensive behavioral health, 6455 (15.8%) received inpatient detoxification or residential services, 5123 (12.5%) received MOUD treatment with buprenorphine or methadone, 1970 (4.8%) received intensive behavioral health, and 963 (2.4%) received MOUD treatment with naltrexone. During 3-month follow-up, 707 participants (1.7%) experienced an overdose, and 773 (1.9%) had serious opioid-related acute care use. Only treatment with buprenorphine or methadone was associated with a reduced risk of overdose during 3-month (adjusted hazard ratio [AHR], 0.24; 95% CI, 0.14-0.41) and 12-month (AHR, 0.41; 95% CI, 0.31-0.55) follow-up. Treatment with buprenorphine or methadone was also associated with reduction in serious opioid-related acute care use during 3-month (AHR, 0.68; 95% CI, 0.47-0.99) and 12-month (AHR, 0.74; 95% CI, 0.58-0.95) follow-up. Conclusions and Relevance: Treatment with buprenorphine or methadone was associated with reductions in overdose and serious opioid-related acute care use compared with other treatments. Strategies to address the underuse of MOUD are needed.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamanetworkopen.2019.20622

Cites

36 of 36 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Data show that detoxification fails to reduce risk of relapse and overdose.

    “Although data show that detoxification fails to reduce risk of relapse and overdose, we included it to reflect its real-world use.20”

    From Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder (2023) · cites this paper as [20]

    The Discussion reports that detoxification was not associated with reduced overdose at 3 or 12 months. The Methods (Outcomes) and Results (Recurrence Outcomes) report subsequent detoxification admissions, not relapse itself, so the relapse part is not directly supported. The study also reports associations rather than establishing that detoxification fails causally. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

3 of the 39 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [24]OptumLabs. OptumLabs and OptumLabs Data Warehouse (OLDW) Descriptions and Citation. Cambridge, MA: OptumLabs; May 2019.

Cited by

Sorted by citations

Authors
Wakeman, S. E., Larochelle, M. R., Ameli, O., Chaisson, C. E., McPheeters, J. T., Crown, W. H., Azocar, F., & Sanghavi, D. M.
Affiliations
  • Harvard University (US)
  • Boston University (US)
  • Integrated Programs, OptumLabs Inc, Cambridge, Massachusetts
  • Optum (United States) (US)
  • Department of Research, OptumLabs, Cambridge, Massachusetts
  • Department of Research, Optum Behavioral Health, Cambridge, Massachusetts
  • UnitedHealth Group (United States) (US)
Corresponding author
Wakeman, Sarah E.
Venue
JAMA Network Open
Published
2020-02-05
Volume
3
Issue
2
Pages
e1920622
ISSN
2574-3805 (ISSN-L)
OpenAlex
W3005454586
Cited by
995
References
39
Citations by year
2026: 137 · 2025: 170 · 2024: 192 · 2023: 161 · 2022: 158 · 2021: 128 · 2020: 49
FWCI
92.82
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • JAMA Network Open (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Massachusetts General Hospital
  • School of Medicine, Boston University (1UL1TR001430)
  • Laura and John Arnold Foundation
  • Office of National Drug Control Policy (G1799ONDCP06B)
  • Hamilton Health Sciences Foundation
  • National Institutes of Health (UL1TR001430)
  • Centers for Disease Control and Prevention (U01CE002780)
  • U.S. Food and Drug Administration (HHSF223200910006I)
  • Substance Abuse and Mental Health Services Administration (1H79TI081442-01)
  • National Institute on Drug Abuse (K23DA042168, R01DA044526, UG1DA015831, G1799ONDCP06B)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
opioid use disorder, medication-assisted treatment, buprenorphine, methadone, naltrexone, inpatient detoxification, residential treatment, opioid overdose, acute care utilization, treatment pathways, comparative effectiveness, real-world evidence, injection-related infections
MeSH terms
Adolescent, Adult, Analgesics, Opioid, Behavior Therapy, Buprenorphine, Female, Humans, Male, Methadone, Middle Aged, Opioid-Related Disorders, Retrospective Studies, United States, Proportional Hazards Models, Substance Abuse Treatment Centers, Treatment Outcome, Critical Pathways, Young Adult, Comparative Effectiveness Research, Opiate Substitution Treatment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review