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Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study
Open accessAbstract
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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“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]
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“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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Metadata
- 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
- 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
- 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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