Background: Opioid use disorder (OUD) is a chronic disease with a high health care and societal burden from overdose and complications requiring hospitalization. Though clinical trials demonstrate effectiveness of methadone and buprenorphine, most patients do not have access to these medications.
Study design: Retrospective comparative effectiveness study.
Setting: Nationwide claims database of commercial and Medicare Advantage Enrollees.
Synopsis: A total of 40,885 individuals aged 16 years or older with OUD were studied in an intent-to-treat analysis of six unique treatment pathways. Though used in just 12.5% of patients, only treatment with buprenorphine or methadone was protective against overdose at 3 and 12 months, compared with no treatment. Additionally, these medications and nonintensive behavioral health counseling were associated with lower incidence of acute care episodes from complications of opioid use. Notably, those treated with buprenorphine or methadone for more than 6 months received the greatest benefit. With use of only health care encounters, the results may underestimate incidence of complications of ongoing opioid misuse.
Bottom line: Buprenorphine and methadone for OUD were associated with reduced overdose and opioid-related morbidity, compared with opioid antagonist therapy, inpatient treatment, or intensive outpatient behavioral interventions and should be considered a first-line treatment.
Citation: Wakeman SE et al. Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Netw Open. 2020 Feb 5;3(2):e1920622..
Dr. Inofuentes is assistant professor of medicine, section of hospital medicine, at the University of Virginia School of Medicine, Charlottesville.