Historique
Article de Périodique
Receipt of addiction treatment after nonfatal opioid overdose and risk of subsequent overdose: A retrospective cohort study (2025)
Auteur(s) :
HOWELL, B. A. ;
BLACK, A. ;
LIN, H. J. ;
LIBERATORE, M. A. ;
GREENE, C. R. ;
D’ONOFRIO, G. ;
HEIMER, R. ;
GRAU, L. E. ;
HAWK, K. ;
FIELLIN, D. A. ;
BECKER, W. C.
Année
2025
Page(s) :
art. 112679
Langue(s) :
Anglais
Domaine :
Autres substances / Other substances ; Drogues illicites / Illicit drugs
Thésaurus géographique
ETATS-UNIS
Thésaurus mots-clés
ETUDE RETROSPECTIVE
;
COHORTE
;
OPIOIDES
;
SURDOSE
;
FACTEUR DE RISQUE
;
TRAITEMENT DE MAINTENANCE
;
METHADONE
;
BUPRENORPHINE
;
SEVRAGE
;
COMPARAISON
;
BENZODIAZEPINES
;
TRAITEMENT
Résumé :
Background: Opioid overdose survivors are at high risk for subsequent overdose. There are few evaluations using real-world data to compare overdose risk after receipt of different addiction treatment modalities.
Objective: To assess the association between receipt of different addiction treatment modalities and risk of subsequent opioid overdose among opioid overdose survivors.
Design: Survival analysis comparing time-to-subsequent overdose within a cohort of opioid overdose survivors using a linked state-wide individual level data of different addiction treatment modalities: opioid agonists treatments (OAT, i.e., methadone or buprenorphine) and non-medication based inpatient addiction treatments (medically supervised opioid withdrawal and extended inpatient treatment).
Subjects: Opioid-involved overdose survivors (N = 4089) admitted to a hospital or emergency department in Connecticut between May 2016 and December 2017.
Main measures: Time-to-subsequent overdose (fatal or non-fatal) and time-to-subsequent fatal overdose.
Key results: Following the index overdose, 467 (11.4%) experienced another overdose event within 12 months (87 fatal and 380 non-fatal), 35% received OAT (25% buprenorphine and 13% methadone), and 21% received inpatient addiction treatment (19% medically supervised opioid withdrawal and 8% extended inpatient treatment). In survival analyses adjusted for demographics, incarceration, and receipt of non-OAT opioids or benzodiazepines, receipt of methadone (aHR 0.41, 95% CI: 0.26-0.66) or buprenorphine (aHR 0.72, 95% CI: 0.53-0.98) was associated with a decreased risk of subsequent overdose compared to no receipt of methadone or buprenorphine, respectively. Neither medically supervised opioid withdrawal (aHR 1.08, 95% CI: 0.77-1.50) nor extended inpatient treatment (aHR 0.90, 95% CI: 0.53-1.54) was associated with reduced risk of subsequent overdose. Neither OAT nor non-medication based inpatient treatment modalities were associated with a change in risk of subsequent fatal overdose; benzodiazepine exposure was associated with increased risk (aHR 2.65, 95% CI: 1.66-4.23).
Conclusion: Using statewide data, our findings underscore the importance of OAT to reduce risk of subsequent overdose following a non-fatal opioid overdose. [Author's abstract]
Highlights:
In overdose survivors, use of methadone or buprenorphine is associated with decreased risk of a subsequent opioid overdose.
Use of medically supervised opioid withdrawal or extended inpatient treatment did not reduce risk of a subsequent overdose.
Use of prescribed benzodiazepines was associated with higher risk of subsequent overdose.
Only 1 in 3 opioid overdose survivors accessed OAT treatment in the 12 months following their overdose.
Objective: To assess the association between receipt of different addiction treatment modalities and risk of subsequent opioid overdose among opioid overdose survivors.
Design: Survival analysis comparing time-to-subsequent overdose within a cohort of opioid overdose survivors using a linked state-wide individual level data of different addiction treatment modalities: opioid agonists treatments (OAT, i.e., methadone or buprenorphine) and non-medication based inpatient addiction treatments (medically supervised opioid withdrawal and extended inpatient treatment).
Subjects: Opioid-involved overdose survivors (N = 4089) admitted to a hospital or emergency department in Connecticut between May 2016 and December 2017.
Main measures: Time-to-subsequent overdose (fatal or non-fatal) and time-to-subsequent fatal overdose.
Key results: Following the index overdose, 467 (11.4%) experienced another overdose event within 12 months (87 fatal and 380 non-fatal), 35% received OAT (25% buprenorphine and 13% methadone), and 21% received inpatient addiction treatment (19% medically supervised opioid withdrawal and 8% extended inpatient treatment). In survival analyses adjusted for demographics, incarceration, and receipt of non-OAT opioids or benzodiazepines, receipt of methadone (aHR 0.41, 95% CI: 0.26-0.66) or buprenorphine (aHR 0.72, 95% CI: 0.53-0.98) was associated with a decreased risk of subsequent overdose compared to no receipt of methadone or buprenorphine, respectively. Neither medically supervised opioid withdrawal (aHR 1.08, 95% CI: 0.77-1.50) nor extended inpatient treatment (aHR 0.90, 95% CI: 0.53-1.54) was associated with reduced risk of subsequent overdose. Neither OAT nor non-medication based inpatient treatment modalities were associated with a change in risk of subsequent fatal overdose; benzodiazepine exposure was associated with increased risk (aHR 2.65, 95% CI: 1.66-4.23).
Conclusion: Using statewide data, our findings underscore the importance of OAT to reduce risk of subsequent overdose following a non-fatal opioid overdose. [Author's abstract]
Highlights:
In overdose survivors, use of methadone or buprenorphine is associated with decreased risk of a subsequent opioid overdose.
Use of medically supervised opioid withdrawal or extended inpatient treatment did not reduce risk of a subsequent overdose.
Use of prescribed benzodiazepines was associated with higher risk of subsequent overdose.
Only 1 in 3 opioid overdose survivors accessed OAT treatment in the 12 months following their overdose.
Affiliation :
Section of General Medicine, Yale School of Medicine, New Haven, CT, USA