Journal article
Association Between Buprenorphine for Opioid Use Disorder and Mortality Risk
American journal of preventive medicine, Vol.61(3), pp.418-427
09/2021
DOI: 10.1016/j.amepre.2021.02.026
PMCID: PMC8384722
PMID: 34023160
Abstract
Veterans with opioid use disorder have an increased risk of suicide and overdose compared with the general population. Buprenorphine, a U.S. Food and Drug Administration–approved medication to treat opioid use disorder, has shown benefits, including decreased risk of illicit drug use and overdose. This study assesses the mortality outcomes with buprenorphine pharmacotherapy among Veterans up to 5 years from treatment initiation.
This was a retrospective cohort study of Veterans receiving buprenorphine (2008–2017) across any Veterans Health Administration facility. Buprenorphine pharmacotherapy was evaluated as a time-varying covariate. The primary outcome was death up to 5 years from treatment initiation by suicide and overdose combined; secondary outcomes included suicide, overdose, opioid-specific overdose, and all-cause death. Secondary analyses included evaluating the risk of mortality in recent discontinuation and effect modification by select characteristics. All analyses were conducted in 2020.
Veterans who were not receiving buprenorphine were 4.33 (adjusted hazard ratio; 95% CI=3.60, 5.21) times more likely to die by suicide/overdose than those receiving buprenorphine pharmacotherapy on any given day, with similar protective associations with treatment across secondary outcomes. The risk of suicide/overdose was highest 8–14 days from treatment discontinuation (adjusted hazard ratio=6.54, 95% CI=4.32, 9.91) than in currently receiving buprenorphine pharmacotherapy. There was no evidence of effect modification by the selected covariates.
Mortality risk was greater among Veterans who were not receiving buprenorphine pharmacotherapy than among those who were. Providers should consider whether buprenorphine pharmacotherapy, either intermittent or continuous, may provide health benefits for their patients and prevent mortality.
Details
- Title: Subtitle
- Association Between Buprenorphine for Opioid Use Disorder and Mortality Risk
- Creators
- Priyanka Vakkalanka - Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IowaBrian C Lund - Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IowaStephan Arndt - Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IowaWilliam Field - Department of Occupational and Environmental Health, University of Iowa College of Public Health, Iowa City, IowaMary Charlton - Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IowaMarcia M Ward - Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IowaRyan M Carnahan - Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- American journal of preventive medicine, Vol.61(3), pp.418-427
- DOI
- 10.1016/j.amepre.2021.02.026
- PMID
- 34023160
- PMCID
- PMC8384722
- NLM abbreviation
- Am J Prev Med
- ISSN
- 0749-3797
- eISSN
- 1873-2607
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100000030, name: Centers for Disease Control and Prevention; DOI: 10.13039/100015615, name: National Institute on Drug Abuse Treatment Clinical Trials Network
- Language
- English
- Date published
- 09/2021
- Academic Unit
- Psychiatry; Occupational and Environmental Health; Health Management and Policy; Epidemiology; Emergency Medicine; Biostatistics; Nursing; Injury Prevention Research Center
- Record Identifier
- 9984214701702771
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