buprenorphine or methadone associated with reductions in overdose *

~ Jason Schwartz

Here’s the conclusion of an interesting new paper:

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.

Seems pretty straightforward, right? Buprenorphine and methadone protect patients from OD.

But, I added an asterisk. Why?

Treatment duration for MOUD was relatively short. During 12 months, the mean (SD) treatment duration for naltrexone was 74.41 (70.15) days and 149.65 (119.37) days for buprenorphine or methadone. Individuals who received longer-duration MOUD treatment with buprenorphine or methadone had lower rates of overdose (Figure 2A) or serious opioid-related acute care use (Figure 2B).

At the end of 12 months, 1198 (3.6%) of those who received no MOUD had an overdose, and 1204 (3.6%) had serious opioid-related acute care use; 105 (6.4%) of those who received MOUD treatment with buprenorphine or methadone for 1 to 30 days had an overdose, and 133 (8.2%) had serious opioid-related acute care use; 101 (3.4%) of those who received MOUD treatment with buprenorphine or methadone for 31 to 180 days had an overdose, and 148 (5.0%) had serious opioid related acute care use; and 28 (1.1%) of those who received MOUD treatment with buprenorphine or methadone for more than 180 days had an overdose, and 69 (2.6%) had serious opioid-related acute care use.

I spend some time trying to make sure I was understanding these findings.

This appears to say that most people receiving buprenorphine or methadone are retained on medication for less than 6 months AND the OD rate is higher or equal than no medication until you get to more than 180 days of medication compliance.

I was sure I was reading it wrong, until I got to this.

Individuals who received methadone or buprenorphine for longer than 6 months experienced fewer overdose events and serious opioid-related acute care use compared with those who received shorter durations of treatment or no treatment.

The reported conclusions and this asterisk are important.

For years, residential and inpatient treatment providers touted implausible success rates.

These providers were (correctly) criticized for basing their conclusions on treatment completers, which were a fraction of their patients.

These conclusions appear to do the same thing–basing their conclusions on the minority of patients who were retained on MOUD for more than 6 months.

This observation doesn’t mean we should disregard their findings, but if we’re going to draw conclusions about MOUD on the basis of patients retained for 6 months, why not do the same for residential and behavioral treatments?

Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I no longer work at Dawn Farm and am now the Director of Behavioral Medicine at a community hospital, and a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.