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Buprenorphine After Nonfatal Opioid Overdose: Reduced Mortality Risk in Medicare Disability Beneficiaries
Hillary Samples1, Molly A Nowels2, Arthur R Williams3
1Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey.
American Journal of Preventive Medicine
|March 11, 2023
Summary
Buprenorphine treatment following a nonfatal opioid overdose significantly reduced the risk of subsequent overdose death. However, less than 7% of individuals received this vital treatment, indicating a critical gap in care for opioid use disorder.
Area of Science:
- Public Health
- Addiction Medicine
- Epidemiology
Background:
- Opioid overdose mortality remains a significant public health crisis.
- Evidence linking post-overdose treatment for opioid use disorder (OUD) to reduced mortality is limited.
Purpose of the Study:
- To examine the association between OUD treatment (buprenorphine and psychosocial services) after a nonfatal overdose and subsequent overdose death.
- To identify treatment gaps for individuals with OUD following a nonfatal overdose.
Main Methods:
- Utilized national Medicare data (2008-2016) for adult disability beneficiaries with nonfatal opioid overdose.
- Defined OUD treatment by buprenorphine medication days and psychosocial service exposures.
- Employed Cox proportional hazards models to assess time-varying treatment effects on overdose mortality, using linked National Death Index data.
Main Results:
- The study included 81,616 individuals, with 6.5% receiving OUD treatment post-overdose.
- Buprenorphine treatment was associated with a 62% reduction in overdose death risk (aHR=0.38).
- Psychosocial treatment did not show a significant association with reduced overdose death risk (aHR=1.18).
Conclusions:
- Buprenorphine treatment after nonfatal opioid overdose significantly lowers the risk of fatal overdose.
- A substantial treatment gap exists, with fewer than 7% receiving buprenorphine post-overdose.
- Strengthening care connections after opioid-related events is crucial, especially for vulnerable populations.
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