America remains in the grip of an opioid use crisis. In 2016, more than 42,000 people died from an opioid overdose. Since then, the monthly rate of opioid overdoses has continued to rise. Overdoses can be caused by either prescription opioids or their illegal counterparts, such as heroin.
Not all opioid overdoses are fatal. But people who experience a non-fatal overdose are at increased risk of a later fatal overdose. Three drugs are currently approved by the FDA for the treatment of opioid-use disorder: methadone, buprenorphine, and naltrexone. These drugs have been shown to reduce opioid use and its health consequences. But whether they can reduce the risk of death after a non-fatal opioid overdose hasn’t been clear.
Researchers led by Dr. Marc Larochelle of the Boston University School of Medicine examined this question using hospital and death records in Massachusetts from 2012 to 2014. They tracked the treatment of more than 17,000 adults who had a nonfatal overdose during that period. People with a recent cancer diagnosis were excluded because of their higher risk of death overall. The study was funded by NIH’s National Center for Advancing Translational Sciences (NCATS) and National Institute on Drug Abuse (NIDA). Results appeared online on June 19, 2018, in the Annals of Internal Medicine.
In the year after a non-fatal overdose, 807 study participants died of any cause. Of those, 368 died of an opioid overdose. Less than a third of participants were prescribed one or more medications to treat opioid use disorder after their overdose. Only 11% received methadone, 17% received buprenorphine, and 6% received naltrexone. The median duration of treatment for all three drugs was less than six months.
During treatment with methadone, people were 59% less likely to die of an opioid overdose than people who didn’t receive medication for opioid-use disorder. People who received buprenorphine were 38% less likely to die of an opioid overdose during the same time period. No association was seen between naltrexone use and risk of death. However, this might be because of the small number of people who were prescribed naltrexone.
The results also showed that guidelines about prescription opioid use are often not followed. In the year after a non-fatal overdose, 34% of participants received a new prescription for opioid painkillers. In addition, 26% percent received a prescription for benzodiazepines, which increase the risk of an overdose if taken with opioids.
“A great part of the tragedy of this opioid crisis is that, unlike in previous such crises America has seen, we now possess effective treatment strategies that could address it and save many lives, yet tens of thousands of people die each year because they have not received these treatments,” says NIDA Director Dr. Nora Volkow.