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Member Research and Reports

Columbia: Opioid Overdose Risk Is High after Medical Treatment Ends

People with opioid addiction face a high risk of overdose after ending treatment with buprenorphine, even when treated for 18 months, a new Columbia study has found. The paper is one of the first to look at the effect of long-term durations of buprenorphine treatment on subsequent outcomes. Columbia University Mailman School of Public Health epidemiologist Dr. Mark Olfson, and Dr. Hillary Samples, a post-doctoral research fellow in epidemiology were co-authors. The findings are published in The American Journal of Psychiatry.

About 5 percent of people treated with buprenorphine for 6 to 18 months needed medical treatment for an opioid overdose in the 6 months after ending buprenorphine and rates may have been higher as the study was unable to account for overdose events that did not present to healthcare settings.

The rate at which individuals relapsed and overdosed after ending treatment was alarmingly high, suggesting that discontinuing buprenorphine is a life-threatening event.

The study also found that the longer patients continued with treatment, the lower their risk of other types of adverse outcomes, implying that buprenorphine treatment may be most effective as a long-term therapy for those with opioid use disorder.

Of the one million individuals annually prescribed the treatment, as many as 80 percent discontinue treatment within several weeks or months. Also many insurance plans limit treatment with buprenorphine to six months.

To understand whether treatment duration impacted outcomes, the researchers analyzed Medicaid claims of nearly 9,000 adults who remained in continual treatment for at least 6 months and for as many as 18 months. They found that in the 6 months after ending buprenorphine, approximately 1 in 20 received treatment for an opioid overdose at least once.

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