Overdose following initiation of naltrexone and buprenorphine medication treatment for opioid use disorder in a United States commercially insured cohort
Open accessAbstract
BACKGROUND AND AIMS: Despite the growing opioid overdose crisis, medication treatment for opioid use disorder remains uncommon. The comparative effectiveness of buprenorphine and naltrexone treatment in reducing overdose and the comparative risks of discontinuing treatment in the real world, remain uncertain. Our aim was to examine the effectiveness of medications for opioid use disorder in preventing opioid-related overdose. DESIGN: Retrospective cohort study SETTING: United States. PATIENTS: 46,846 commercially insured individuals diagnosed with opioid use disorder and initiating medication treatment between 2010 and 2016. MEASUREMENTS: Opioid-related overdose identified by International Classification of Diseases, Ninth and Tenth Revisions. FINDINGS: In our sample, 1386 individuals were prescribed extended-release injectable naltrexone (median filled prescriptions = 9 months), 7782 were prescribed oral naltrexone (5 months), and 40,441 were prescribed buprenorphine (19 months) at least once during follow-up. Individuals receiving buprenorphine therapy were at significantly reduced risk of opioid-related overdose compared to no treatment (adjusted hazard ratio (HR) = 0.40, 95% CI 0.35-0.46), while a significant association was not observed in extended-release injectable (HR = 0.74, 95% CI 0.42-1.31) or oral (HR = 0.93, 95% CI 0.71-1.22) naltrexone. We found no association with opioid overdose within four weeks of discontinuation of any medication. CONCLUSION: Among commercially-insured patients who initiate medications for opioid use disorder, buprenorphine, but not naltrexone, was associated with lower risk of overdose during active treatment compared to post-discontinuation. More research is needed to understand the benefits and risks unique to each treatment option to better tailor therapies to patients with opioid use disorder.
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The monthly rate of overdose among individuals treated with transmucosal buprenorphine or extended-release buprenorphine is 2.72 per 1000 people.
“The monthly rate of overdose among individuals treated with transmucosal buprenorphine or extended-release buprenorphine is 2.72 per 1000 people.4,32”
From Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder (2023) · cites this paper as [32]
The Results section (Overall Overdose Rates; page not provided) reports 2.08 overdoses per 100 person-years among people taking buprenorphine products, equivalent to about 1.73 per 1,000 person-months—not 2.72. It does not report separate rates for transmucosal and extended-release buprenorphine. (LLM, conf=0.88)
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Comparative effectiveness of different treatment pathways for opioid use disorder.
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Self-citation
- Authors
- Morgan, J. R., Schackman, B. R., Weinstein, Z. M., Walley, A. Y., & Linas, B. P.
- Affiliations
- Boston Medical Center (US)
- Weill Cornell Medicine (US)
- Boston University (US)
- Corresponding author
- Morgan, Jake R.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 200
- Pages
- 34-39
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC6613830
- OpenAlex
- W2943532942
- Cited by
- 159
- References
- 6
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 19 · 2023: 16 · 2022: 27 · 2021: 41 · 2020: 27 · 2019: 4
- FWCI
- 22.79
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Drug and Alcohol Dependence (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse
- 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 › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- opioid use disorder, opioid overdose, buprenorphine, naltrexone, medication-assisted treatment, overdose prevention, treatment discontinuation, commercially insured patients, comparative effectiveness
- MeSH terms
- Adult, Buprenorphine, Delayed-Action Preparations, Female, Follow-Up Studies, Humans, Insurance, Health, Male, Middle Aged, Naltrexone, Narcotic Antagonists, Opioid-Related Disorders, Retrospective Studies, United States, Cohort Studies, Young Adult, Opiate Substitution Treatment, Drug Overdose
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