Insomnia symptoms are associated with return to use and non-fatal overdose following opioid use disorder treatment

Opioid use disorder (OUD) is a chronic, relapse-prone condition, often accompanied by sleep disturbances such as insomnia. While sleep disturbances have been implicated in negative treatment outcomes, no large-scale studies have examined the relationship between insomnia disorder and outcomes for persons completing an acute OUD treatment episode. This study assessed the association between insomnia symptoms at treatment intake, during treatment, and following acute treatment with post-treatment episode return to use and non-fatal overdose outcomes.

This study analyzed data from 1905 individuals with OUD who received one of three forms of acute OUD treatment: supervised withdrawal, intensive outpatient, or residential treatment at 70 programs in the United States in 2021. Insomnia was assessed using the Insomnia Severity Index (ISI). Logistic regression and mixed regression analyses were performed to evaluate the association between insomnia and return to substance use or non-fatal overdose following a treatment episode.

Higher ISI scores at intake were significantly associated with increased odds of return to use one-month post-treatment episode (p-value = .006). Reduction in ISI scores during treatment correlated with lower return-to-use rates (p-value = .015). Post-treatment episode, ISI scores indicative of insomnia were associated with return to use (p-values < .001) and non-fatal overdose (p-values < .004) at months one, three, and six.

These findings underscore the significant role of insomnia in return to opioid use following OUD treatment, highlighting the importance of addressing sleep disturbances early in OUD treatment. This study also suggests that maintaining sleep health during and after treatment could improve the long-term prognosis for OUD. Interventions targeting insomnia are a promising avenue to improve OUD treatment outcomes.