Drug Treatment After Opioid Overdose Grossly Underused
By Megan Brooks
NEW YORK—Treatment with buprenorphine or methadone after an opioid overdose significantly reduces the risk of death from opioids or any cause, but few people receive it, according to a study from Massachusetts.
Following nonfatal overdose, "methadone and buprenorphine reduced deaths by around 50%, but only 3 in 10 got a medication approved by the (U.S. Food and Drug Administration) for opioid disorder afterwards," first author Dr. Marc Larochelle of Boston Medical Center and Boston University School of Medicine told Reuters Health by phone.
This study "further solidifies the evidence of the benefits of methadone and buprenorphine in preventing opioid-related deaths" and also "highlights the gross underuse of these effective medications," Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), and Dr. Eric Wargo in NIDA's Office of Science Policy and Communication, write in an editorial published with the study online June 18 in Annals of Internal Medicine.
Using a Massachusetts public health database, the researchers analyzed associations between use (or nonuse) of approved medications for opioid use disorder (methadone maintenance treatment or MMT, buprenorphine and naltrexone) and mortality among 17,568 opioid overdose survivors (62% male, 69% younger than 45).
In the years after a nonfatal overdose, only a minority of individuals received treatment: 11% enrolled in MMT for a median of five months, 17% received buprenorphine for a median of four months, and 6% received naltrexone for a median of one month.
Over 12 months of follow-up, 807 individuals died of any cause and 368 died of an opioid-related overdose.
Compared with no drug treatment for opioid use disorder, MMT was associated with significantly decreased death from any cause and from opioids (adjusted hazard ratios, 0.47 and 0.41, respectively).
Buprenorphine was also associated with significantly decreased all-cause and opioid-related mortality (aHR, 0.63 and 0.62). No association was found for treatment with naltrexone, although this might reflect the limited number of individuals who received it, the authors say.
"There is a huge treatment gap with medications that have tremendous opportunity to reduce mortality, so we have a lot of work to do to try to get more people into treatment," Dr. Larochelle told Reuters Health.
"Unfortunately," he said, the number of patients getting treatment after opioid overdose in Massachusetts are "probably optimistic compared to most states because we have a more robust treatment system here and near universal insurance, so those barriers to getting treatment are less here than in other places."
Drs. Volkow and Wargo say the results of this study are also "alarming" because, despite having an opioid use disorder and experiencing an overdose, many of the patients were given prescriptions for opioids (34%) or benzodiazepines (26%) in the 12 months after the overdose.
"This indicates that guidelines cautioning against prescription opioids and their co-use with benzodiazepines are not being followed," they write.
Summing up, they say, "A great part of the tragedy of this opioid crisis is that, unlike in previous such crises America has seen, we now possess effective treatment strategies that could address it and save many lives, yet tens of thousands of people die each year because they have not received these treatments. Larochelle and colleagues' study reveals the challenges in changing attitudes toward MAT and overcoming infrastructural barriers across the health care system to treat opioid use disorder. Ending the crisis will require changing policies to make these medications more accessible and educating primary care and emergency providers, among others, that opioid addiction is a medical illness that must be treated aggressively with the effective tools that are available. To do this, we must remove the stigma from the disease of addiction and from the medications that can be used to treat it."
The study had no commercial funding and the authors have no relevant disclosures.
Ann Intern Med 2018.
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