Buprenorphine tops naltrexone for reducing opioid overdose risk

  • Morgan JR & al.
  • Drug Alcohol Depend
  • 3 May 2019

  • International Clinical Digest
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Takeaway

  • Buprenorphine was the only approved medication for opioid use disorder (MOUD) that was significantly associated with a decrease in opioid-related overdose deaths among commercially insured patients with opioid use disorder (OUD).

Why this matters

  • Opioid overdose deaths in the United States increased 28% between 2015 and 2016.
  • Oral naltrexone, extended-release injectable naltrexone (XR-NTX), and buprenorphine are FDA-approved for OUD, but which is the most effective is unclear.

Study design

  • Study of 46,846 commercially insured patients with OUD between 2010 and 2016.
  • Funding: National Institute on Drug Abuse.

Key results

  • Rate of opioid-related overdose was 4.98 overdoses per 100 person-years in patients who received no treatment, and 2.08 overdoses per 100 person-years in those who received buprenorphine.
  • Patients receiving buprenorphine therapy had significantly lower risk for overdose vs no treatment (aHR, 0.40; P<.01>
  • Current treatment with either XR-NTX or oral naltrexone was not protective against overdose (aHR, 0.74 [P=.31]; aHR, 0.93 [P=.60], respectively).
  • Use of another substance use disorder was associated with an increased risk for overdose: alcohol (aHR, 1.33; P<.01 cannabis p cocaine and sedatives>

Limitations

  • Retrospective design.

Coauthored with Antara Ghosh, PhD