Introduction
Opioid-involved overdose mortality is a persistent public health challenge, yet limited
evidence exists on the relationship between opioid use disorder treatment after a
nonfatal overdose and subsequent overdose death.
Methods
National Medicare data were used to identify adult (aged 18–64 years) disability beneficiaries
who received inpatient or emergency treatment for nonfatal opioid-involved overdose
in 2008–2016. Opioid use disorder treatment was defined as (1) buprenorphine, measured using medication days’ supply, and (2)
psychosocial services, measured as 30-day exposures from and including each service
date. Opioid-involved overdose fatalities were identified in the year after nonfatal
overdose using linked National Death Index data. Cox proportional hazards models estimated
the associations between time-varying treatment exposures and overdose death. Analyses
were conducted in 2022.
Results
The sample (N=81,616) was mostly female (57.3%), aged ≥50 years (58.8%), and White
(80.9%), with a significantly elevated overdose mortality rate, compared with the
general U.S. population (standardized mortality ratio=132.4, 95% CI=129.9, 135.0).
Only 6.5% of the sample (n=5,329) had opioid use disorder treatment after the index overdose. Buprenorphine
(n=3,774, 4.6%) was associated with a significantly lower risk of opioid-involved overdose
death (adjusted hazard ratio=0.38, 95% CI=0.23, 0.64), but opioid use disorder–related
psychosocial treatment (n=2,405, 2.9%) was not associated with risk of death (adjusted hazard ratio=1.18, 95%
CI=0.71, 1.95).
Conclusions
Buprenorphine treatment after nonfatal opioid-involved overdose was associated with
a 62% reduction in the risk of opioid-involved overdose death. However, fewer than
1 in 20 individuals received buprenorphine in the subsequent year, highlighting a
need to strengthen care connections after critical opioid-related events, particularly
for vulnerable groups.
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Published online: March 10, 2023
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