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

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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., Walley, Alexander Y.·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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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: Larochelle, Marc R.
Bernson, Dana
Stopka, Thomas J.
Wang, Na
Xuan, Ziming
Bagley, Sarah M.
Liebschutz, Jane M.
Walley, Alexander Y.
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: green
europepmc.org
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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Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study

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