Overdose following initiation of naltrexone and buprenorphine medication treatment for opioid use disorder in a United States commercially insured cohort.
Adult
Buprenorphine
/ administration & dosage
Cohort Studies
Delayed-Action Preparations
/ administration & dosage
Drug Overdose
/ diagnosis
Female
Follow-Up Studies
Humans
Insurance, Health
/ trends
Male
Middle Aged
Naltrexone
/ administration & dosage
Narcotic Antagonists
/ administration & dosage
Opiate Substitution Treatment
/ adverse effects
Opioid-Related Disorders
/ diagnosis
Retrospective Studies
United States
/ epidemiology
Young Adult
Buprenorphine
Injectable naltrexone
Opioid use disorder
Oral naltrexone
Overdose
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 07 2019
01 07 2019
Historique:
received:
15
10
2018
revised:
11
02
2019
accepted:
13
02
2019
pubmed:
15
5
2019
medline:
21
1
2020
entrez:
15
5
2019
Statut:
ppublish
Résumé
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. Retrospective cohort study SETTING: United States. 46,846 commercially insured individuals diagnosed with opioid use disorder and initiating medication treatment between 2010 and 2016. Opioid-related overdose identified by International Classification of Diseases, Ninth and Tenth Revisions. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 31082666
pii: S0376-8716(19)30131-0
doi: 10.1016/j.drugalcdep.2019.02.031
pmc: PMC6613830
mid: NIHMS1530317
pii:
doi:
Substances chimiques
Delayed-Action Preparations
0
Narcotic Antagonists
0
Buprenorphine
40D3SCR4GZ
Naltrexone
5S6W795CQM
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
34-39Subventions
Organisme : NIAID NIH HHS
ID : P30 AI042853
Pays : United States
Organisme : NIDA NIH HHS
ID : P30 DA040500
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA046527
Pays : United States
Informations de copyright
Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.
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