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Comparative effectiveness of different treatment pathways for opioid use disorder.
Open accessAbstract
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.
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“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]
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The triple wave epidemic: Supply and demand drivers of the US opioid overdose crisis
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Metadata
- 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.
- ORCID
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2020-02-05
- Volume
- 3
- Issue
- 2
- Pages
- e1920622
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC11143463
- 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
- gold
- doi.org
- 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
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