The use of prescription opioids has increased in recent years, leading to an increased risk of addiction, overdose, and death. Medication for opioid use disorder (MOUD) has emerged as an effective treatment option for individuals with opioid use disorder. MOUD involves the use of medications such as methadone, buprenorphine, and naltrexone, which work to reduce opioid cravings, prevent withdrawal symptoms, and block the effects of opioids.
Despite the effectiveness of MOUD in treating opioid addiction, there is still limited research on the risks associated with MOUD treatment, including the risk of overdose. To address this gap, a new study has investigated the risk of overdose during a course of MOUD treatment.
New research published in The American Journal of Psychiatry has revealed that the risk of an overdose during treatment with medication for opioid use disorder (MOUD) is higher for those who fail to initiate or discontinue medication and those who report benzodiazepine use at the start of their treatment.
The study’s authors aimed to address a gap in understanding the risk of overdose during treatment with MOUD, which has not been clearly delineated until now. They analyzed a new data set from three large pragmatic clinical trials of MOUD, including adverse event logs that recorded overdose events.
The trials included a total of 2,199 participants, who were assigned to one of five study arms, including methadone, naltrexone, and buprenorphine groups. The researchers used survival analysis with time-dependent Cox proportional hazard models to compare the risk of overdose events 24 weeks after randomization for each study arm.
By week 24, 39 participants had experienced at least one overdose event. The observed frequency of overdose events was highest among those assigned to naltrexone, at 5.3% among 283 patients, compared to 1.5% among 529 patients assigned to methadone and 1.15% among 1,387 patients assigned to buprenorphine. The researchers also found that 27.9% of patients assigned to extended-release naltrexone never initiated the medication, and their overdose rate was 8.9%, compared to 3.9% among those who initiated naltrexone.
After controlling for sociodemographic and time-varying medication adherence variables and baseline substance use, the researchers found no significant effect of naltrexone assignment on the risk of overdose events. However, they did find significantly higher probabilities of experiencing an overdose event among patients with baseline benzodiazepine use and those who either never initiated or stopped their medication after the initial induction.
The study’s authors conclude that among patients with opioid use disorder seeking medication treatment, the risk of overdose events over the next 24 weeks is elevated among those who fail to initiate or discontinue medication and those who report benzodiazepine use at baseline. These findings highlight the importance of ensuring patients are adherent to their medication and avoiding benzodiazepine use during treatment.
The study’s lead author, Dr. Katherine E. Watkins, a senior natural scientist at RAND Corporation, stated, “our findings underscore the importance of helping patients stay engaged in treatment and minimizing benzodiazepines and other substances that can increase the risk of overdose.” She added, “MOUD is a critical part of the response to the opioid epidemic, and we need to ensure that we are using these treatments in the safest and most effective way possible.”
Overall, the study provides important insights into the risk of overdose during treatment with MOUD and highlights the need for clinicians to carefully monitor patients for medication adherence and substance use during treatment. By doing so, clinicians can help reduce the risk of overdose and ensure that patients receive the best care for opioid use disorder.
