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Cited by 1,076Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesHIV, Drug Use, Sexual Risk

Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study

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Larochelle, Marc R., Bernson, Dana, Land, Thomas, Stopka, Thomas J., Wang, Na, Xuan, Ziming, Bagley, Sarah M., Liebschutz, Jane M. +1 more·2018·Annals of Internal Medicine
DOI 10.7326/m17-3107PMC PMC6387681
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Abstract

Background: Opioid overdose survivors have an increased risk for death. Whether use of medications for opioid use disorder (MOUD) after overdose is associated with mortality is not known. Objective: To identify MOUD use after opioid overdose and its association with all-cause and opioid-related mortality. Design: Retrospective cohort study. Setting: 7 individually linked data sets from Massachusetts government agencies. Participants: 17 568 Massachusetts adults without cancer who survived an opioid overdose between 2012 and 2014. Measurements: Three types of MOUD were examined: methadone maintenance treatment (MMT), buprenorphine, and naltrexone. Exposure to MOUD was identified at monthly intervals, and persons were considered exposed through the month after last receipt. A multivariable Cox proportional hazards model was used to examine MOUD as a monthly time-varying exposure variable to predict time to all-cause and opioid-related mortality. Results: In the 12 months after a nonfatal overdose, 2040 persons (11%) enrolled in MMT for a median of 5 months (interquartile range, 2 to 9 months), 3022 persons (17%) received buprenorphine for a median of 4 months (interquartile range, 2 to 8 months), and 1099 persons (6%) received naltrexone for a median of 1 month (interquartile range, 1 to 2 months). Among the entire cohort, all-cause mortality was 4.7 deaths (95% CI, 4.4 to 5.0 deaths) per 100 person-years and opioid-related mortality was 2.1 deaths (CI, 1.9 to 2.4 deaths) per 100 person-years. Compared with no MOUD, MMT was associated with decreased all-cause mortality (adjusted hazard ratio [AHR], 0.47 [CI, 0.32 to 0.71]) and opioid-related mortality (AHR, 0.41 [CI, 0.24 to 0.70]). Buprenorphine was associated with decreased all-cause mortality (AHR, 0.63 [CI, 0.46 to 0.87]) and opioid-related mortality (AHR, 0.62 [CI, 0.41 to 0.92]). No associations between naltrexone and all-cause mortality (AHR, 1.44 [CI, 0.84 to 2.46]) or opioid-related mortality (AHR, 1.42 [CI, 0.73 to 2.79]) were identified. Limitation: Few events among naltrexone recipients preclude confident conclusions. Conclusion: A minority of opioid overdose survivors received MOUD. Buprenorphine and MMT were associated with reduced all-cause and opioid-related mortality. Primary Funding Source: National Center for Advancing Translational Sciences of the National Institutes of Health.

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  • Massachusetts data were used because this state has some of the best data on OUD and its complications.

    “We used Massachusetts data because this state has some of the best data on OUD and its complications.46”

    From Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder (2023) · cites this paper as [46]

    The Methods (Study Design and Data Source) describe linked Massachusetts databases covering more than 98% of state residents, and the introductory passage describes authorization to link data from 16 state agencies. These passages support the availability of extensive opioid-related data, but do not establish that Massachusetts has some of the best such data relative to other states. (LLM, conf=0.82)

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  • Buprenorphine use is linked to lower opioid-related death rates.

    “A partial mu-opioid receptor agonist, buprenorphine effectively treats opioid withdrawal symptoms and is associated with reduced opioid-related mortality.4,5”

    From Oral Health Risks of Transmucosal Buprenorphine: Commentary on Tuan et al. and Zheng et al. (2025) · cites this paper as [5]

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Authors
Larochelle, M. R., Bernson, D., Land, T., Stopka, T. J., Wang, N., Xuan, Z., Bagley, S. M., Liebschutz, J. M., & Walley, A. Y.
Affiliations
  • Boston University (US)
  • Massachusetts Department of Public Health (US)
  • Tufts University (US)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2018-08-07
Volume
169
Issue
3
Pages
137-145
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/m17-3107
PMC
PMC6387681
OpenAlex
W2808907017
Cited by
1,076
References
38
Citations by year
2026: 99 · 2025: 140 · 2024: 161 · 2023: 133 · 2022: 134 · 2021: 157 · 2020: 117 · 2019: 113 · 2018: 21
FWCI
97.09
Type
journal article
Language
en
Open access
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR001430)
  • National Institute on Drug Abuse (K23DA042168)
  • 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 › Epidemiology › HIV, Drug Use, Sexual Risk
Keywords
opioid use disorder, medication-assisted treatment, methadone maintenance treatment, buprenorphine, naltrexone, opioid-related deaths, all-cause mortality, opioid overdose prevention
MeSH terms
Adolescent, Adult, Analgesics, Opioid, Buprenorphine, Female, Humans, Male, Massachusetts, Methadone, Middle Aged, Mortality, Naltrexone, Opioid-Related Disorders, Retrospective Studies, Proportional Hazards Models, Young Adult, Opiate Substitution Treatment, Drug Overdose

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