Clinical trials have demonstrated the superior effectiveness of medication to treat opioid use disorder (OUD) to nonpharmacologic treatments, but national data on the comparative effectiveness of real-world OUD treatment pathways have been lacking.
A team of investigators reviewed insurance claims of more than 40,000 people age 16 and older diagnosed with OUD. They looked at data for six different treatment pathways, including (1) no treatment, (2) the medications buprenorphine or methadone, (3) the medication naltrexone, (4) inpatient detoxification or residential services, (5) intensive behavioral health, including intensive outpatient counseling or partial hospitalization, and (6) nonintensive behavioral health, which included outpatient counseling. Scientists then reviewed follow up records of the patients receiving treatment at 3 and 12 months and compared their outcomes to those of people who received no treatment.
Only treatment with buprenorphine or methadone was associated with reduced risk of overdose at both time points. Indeed, treatment with either of these medications was associated with a 76% reduction in overdose at 3 months and a 59% reduction at 12 months. Compared with no treatment, buprenorphine or methadone treatment was also associated with a 32% and 26% relative reduction in serious opioid-related acute care use at 3 and 12 months, respectively. Serious opioid-related acute care use was defined as an emergency hospitalization with a primary opioid diagnosis code.
Despite these findings, treatment with buprenorphine or methadone is uncommon, recorded in only 12.5% of the patients in the study. The most common treatment pathway was nonintensive behavioral health (59.3%), followed by inpatient detoxification or residential services (15.8%), not receiving any treatment (5.2%), receiving naltrexone (2.4%), and intensive behavioral health (4.8%). Nonintensive behavioral treatment was also associated with reduced risk of overdose at 12 months and reduced risk of opioid-related acute care use, a finding that may reflect differences in the population of patients referred to this type of treatment. The authors discuss barriers to the use of methadone and buprenorphine and suggest strategies for increasing their use.
The analysis in this study was performed from April 2018 to June 2019. The research was supported by NIDA, the National Center for Advancing Translational Sciences, the Centers for Disease Control and Prevention, the US Food and Drug Administration, the Substance Abuse and Mental Health Services Administration, the Office of National Drug Control Policy, as well as the Laura and John Arnold Foundation.
- Sarah E. Wakeman, MD; Marc R. Larochelle, MD, MPH; Omid Ameli, MD, MPH; Christine E. Chaisson, MPH; Jeffrey Thomas McPheeters, BA; William H. Crown, PhD; Francisca Azocar, PhD; Darshak M. Sanghavi, MD. Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Network Open.