Excited to share study @LarochelleMarc @darshaksanghavi, others & I did comparing effectiveness of different #opioid use disorder treatments. Bottom line- only methadone or buprenoprhine associated w/ reduced #overdose at 3 and 12 months jamanetwork.com/journals/jaman…
We looked at claims data for nearly 41,000 individuals w/ OUD and compared outpatient counseling, IOP, detox/residential, naltrexone, or methadone/buprenorphine to no treatment on outcomes of overdose or opioid-related ED or hospitalization at 3 months.
1st takeaway: despite evidence supporting MOUD w/ opioid agonist therapy, in this insured population only 12.5% of cohort received methadone/buprenorphine and average treatment duration was shorter than would be recommended at ~150 days.
2nd takeaway: only methadone/buprenorphine assoc w/ reduced OD at 3 and 12 months; also assoc w/ reduced opioid-related ED visits and hospitalizations at 3 & 12 months. Treatment w/ methadone/buprenorphine assoc w/ 76% reduction in OD at 3 months! These are lifesaving meds.
Treatment duration matters. Ppl treated w/ methadone or buprenorphine for <30 days were nearly 6 times more likely to experience an #overdose than those treated >180 days. Need systems of care that not only offer immediate access but also prioritize engagement and retention.
We also looked at association btwn different tx and likelihood of subsequent “detox” admission. Compared to methadone/buprenorphine tx all other pathways more likely to have post-treatment “detox” admit. AHR 3.76 for those who started w/ “detox” and 2.64 for naltrexone.
This is not about being “pro-medication” or “anti” other treatments. I am pro science, pro things that keep people alive, healthy, & happy. Patients & families deserve evidence to make informed decisions that are right for them. Just like with any other illness.
For insurers & policymakers: too much evidence to continue to support barriers to access to meds. Prior auths, arbitrary dose/duration limits, discrimination in housing/corrections/employment against ppl on agonist therapy=harm. #XtheXWaiver & office-based methadone also needed.
Lastly, as someone who lost a family member to a type of substance use disorder for which we don’t have lifesaving medication treatment, I would’ve given anything for meds like these for my loved one! If you love someone w/ OUD talk to them about medication treatment 💜 (fin!)
