New Data Strongly Support Opioid Agonists for Addiction

Megan Brooks

February 28, 2020

Noa Krawczyk, PhD

A new study provides strong support for the use of opioid agonists, methadone, or buprenorphine in the treatment of opioid use disorder (OUD).

Investigators found that patients treated with an anti-opioid drug had an 80% lower risk of dying from an opioid overdose while in treatment compared with their peers receiving treatment without such medication. Yet, the authors note that many addiction programs don't offer these medications as a standard part of OUD treatment.  

"We know from national studies that in specialty treatment only about 40% of people get some kind of medication treatment. It's a huge problem and there are multiple barriers to accessing medication treatment, lead investigator Noa Krawczyk, PhD, told Medscape Medical News.

"This study really highlights what a difference we could make in the population if we were to close the gap in terms of how many people are receiving medication," said Krawczyk, of the Center for Opioid Epidemiology and Policy, Department of Population Health at NYU Langone Health.

The study was published online February 24 in Addiction.

Major Reduction in Overdose Deaths

The longitudinal retrospective study included data on more than 48,000 patients receiving treatment for OUD in publicly funded outpatient specialty treatment programs in Maryland over 2 years (2015 and 2016). These data were linked to mortality data from Maryland's Office of the Chief Medical Examiner.

In all, 72% of patients in treatment received medication during the study period, while 28% did not.

During the study period, there were 371 opioid overdose deaths. Periods when patients were in medication treatment were associated with substantially reduced risk of opioid overdose death compared with periods in nonmedication treatment (adjusted hazard ratio [aHR], 0.18; 95% CI, 0.08 - 0.40).

However, the risk of overdose death was substantially increased after treatment ended in both those who had been on medication (aHR, 5.85; 95% CI, 3.10 - 11.02) and those who had been receiving nonmedication treatment (aHR, 5.45; 95% CI, 2.80 - 9.53).

"Once people were no longer in treatment, their risk of overdose went up substantially for both groups, whether they had been receiving medication or not," said Krawczyk.

"Getting people in the door and started on medication treatment is a great first step, but retention in treatment is equally important," Krawczyk added in a statement. "Because of this, we need to remove barriers to continuation of care, adopt more harm reduction approaches, and employ better strategies to encourage and enable people to stay in treatment."

"Overwhelming Evidence"

Commenting on the study for Medscape Medical News, Marc Larochelle, MD, MPH, a primary care physician specializing in addiction at Boston Medical Center, Massachusetts, said the findings add to the "overwhelming evidence" that medications for OUD reduce opioid overdose death.

"Perhaps, not surprisingly, the benefit was only seen during periods of active treatment. In addition to getting more individuals access to start medication, much work needs to be done to keep them on medication once started," Larochelle said.

"While acceptance and access to medication for OUD is increasing, there are still many who believe they should be used only as a bridge or short-term treatment.

"We know that OUD is a chronic, relapsing condition, and long-term use of these medications is effective. We need to ensure that our policies and healthcare delivery system change to improve access to these medications for all who need them and for as long as they need them — without limit," he added.

Funding for the study was supported by a grant awarded to the Maryland Department of Health by the Bureau of Justice Assistance of the US Department of Justice and by the National Institute on Drug Abuse. Krawczyk and Larochelle have reported no relevant financial relationships.

Addiction. Published online February 24, 2020. Abstract

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