Association Between Buprenorphine for Opioid Use Disorder and Mortality Risk

Area of Science:

• Public Health
• Pharmacology
• Veterans Health

Background:

• Veterans with opioid use disorder (OUD) face higher suicide and overdose risks.
• Buprenorphine is an FDA-approved medication for OUD, showing promise in reducing illicit drug use and overdose.
• Assessing long-term mortality outcomes associated with buprenorphine treatment in Veterans is crucial.

Purpose of the Study:

• To evaluate the mortality outcomes, specifically suicide and overdose deaths, among Veterans receiving buprenorphine pharmacotherapy.
• To analyze the risk of death up to 5 years post-treatment initiation.
• To investigate the impact of treatment discontinuation on mortality risk.

Main Methods:

• Retrospective cohort study of Veterans receiving buprenorphine from 2008-2017.
• Buprenorphine pharmacotherapy was analyzed as a time-varying covariate.
• Primary outcome: death by suicide/overdose within 5 years; secondary outcomes included all-cause death and opioid-specific mortality.

Main Results:

• Veterans not on buprenorphine were 4.33 times more likely to die by suicide/overdose.
• Buprenorphine treatment demonstrated protective associations across all assessed mortality outcomes.
• The highest risk of suicide/overdose occurred 8-14 days after treatment discontinuation.

Conclusions:

• Mortality risk, particularly from suicide and overdose, is significantly lower for Veterans receiving buprenorphine pharmacotherapy.
• Continuous or intermittent buprenorphine treatment may offer substantial health benefits and prevent mortality in Veterans with OUD.
• Healthcare providers should consider ongoing buprenorphine pharmacotherapy for patients with OUD.