Small Minority of Patients Who OD on Opioids Receive Medication to Prevent Another OD
For those who have experienced a nonfatal opioid overdose, access to medication for opioid use disorder—naltrexone, methadone, and buprenorphine—are crucial, as these patients are at a higher risk for subsequent nonfatal and fatal overdoses. These medications are known to reduce opioid withdrawal symptoms and suppress the desire to use opioids.
However, new study findings indicate1
that just 3 in 10 patients revived in an emergency department or ambulance were given follow-up medication to prevent another overdose. In addition to low rates of treatment with these medications, the average treatment lasted less than 6 months.
The study focused on residents in Massachusetts, as the state has been particularly affected by the epidemic, with opioid overdose deaths tripling from 2010 to 2016. Researchers used 7 individually linked data sets from Massachusetts government agencies. A total of 17,568 people who had experienced a nonfatal opioid overdose between January 2012 and December 2014 were identified.
Following the overdose, 11% of participants received methadone for a median of 5 months. For these patients, all-cause and opioid-related mortality rates were cut by 50% compared to those not on any medication after 1 year. For the 17% of patients who received buprenorphine for a median of 4 months, their risk of mortality dropped by 40% after 1 year.
Meanwhile, for the small percentage of patients (6%) who were treated with naltrexone for a median of 1 month, there was no observed association. The researchers noted that this finding could be due to the limited treatment size.
According to an accompanying editorial2
, stigma is at the root of these low rates, and short treatment courses highlight a need for interventions to facilitate treatment retention.
They also note that: “Treatment facilities often lack medical personnel who can prescribe medications; even if staff at opioid treatment programs are able to dispense methadone, they may not be waivered to prescribe buprenorphine. In addition, insurers may not cover all forms of medication-assisted treatment, and when they do, coverage is usually subjected to limits on duration that lessen treatment effectiveness.”
However, there are several strategies that can increase medication-assisted treatment delivery to those at risk of an overdose, including initiating treatment in the emergency department and linking them to treatment by a primary care physician waivered to continue proving the medication, and engaging people with opioid use disorder in the criminal justice setting into treatment to reduce opioid use and overdoses after they reenter the community.
“A great part of the tragedy of this opioid crisis is that, unlike in previous crises American 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,” the authors wrote.
In an effort to improve access to and affordability of these treatment options for those who need it, the FDA approved the first generic version of Suboxone
(buprenorphine and naloxone) last week. Along with the approval, FDA Commissioner Scott Gottlieb, MD, highlighted the importance of addressing the stigma surrounding medication-assisted treatments, stating that, when coupled with other social, medical, and psychological services, these treatments are often the most effective approach for opioid dependence.
1. Larochelle M, Bernson D, Land T, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study [published online June 19, 2018]. Ann Intern Med
. doi: 10.7326/M17-3107.
2. Volkow N, Wargo E. Overdose presention through medical treatment of opioid use disorders [published online June 19, 2018]. Ann Intern Med
. doi: 10.7326/M18-1397.