Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Mortality
Authors: Marc R. Larochelle, Thomas J. Stopka, Ziming Xuan, Jane M. Liebschutz, Alexander Y. Walley
Journal: Annals of Internal Medicine (2019)

Letters19 March 2019Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and MortalityMarc R. Larochelle, MD, MPH, Thomas J. Stopka, PhD, MHS, Ziming Xuan, ScD, SM, Jane M. Liebschutz, MD, MPH, and Alexander Y. Walley, MD, MScMarc R. Larochelle, MD, MPHClinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts (M.R.L.), Thomas J. Stopka, PhD, MHSTufts University School of Medicine, Boston, Massachusetts (T.J.S.), Ziming Xuan, ScD, SMBoston University School of Public Health, Boston, Massachusetts (Z.X.), Jane M. Liebschutz, MD, MPHCenter for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (J.M.L.), and Alexander Y. Walley, MD, MScClinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center and Bureau of Substance Addiction Services, Massachusetts Department of Public Health, Boston, Massachusetts (A.Y.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0685 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Brennan suggests that not accounting for motivation as a potential confounder compromised our study's findings of reduced mortality in patients treated with methadone or buprenorphine after a nonfatal opioid overdose. We reiterate that unmeasured confounding is a limitation of our study and that findings should be interpreted as associative rather than causal. However, dismissing the results on the basis of this contention fails to acknowledge the broader context of what is known. Many high-quality randomized clinical trials have shown a consistent benefit of methadone and buprenorphine in improving the outcomes of opioid use disorder, including treatment retention ...References1. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009:CD002209. [PMID: 19588333] doi:10.1002/14651858.CD002209.pub2 CrossrefMedlineGoogle Scholar2. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014:CD002207. [PMID: 24500948] doi:10.1002/14651858.CD002207.pub4 CrossrefMedlineGoogle Scholar3. Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, et al; National Institute on Drug Abuse Clinical Trials Network. Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend. 2006;81:301-12. [PMID: 16169159] CrossrefMedlineGoogle Scholar4. Werb D, Kamarulzaman A, Meacham MC, Rafful C, Fischer B, Strathdee SA, et al. The effectiveness of compulsory drug treatment: a systematic review. Int J Drug Policy. 2016;28:1-9. [PMID: 26790691] doi:10.1016/j.drugpo.2015.12.005 CrossrefMedlineGoogle Scholar5. Chou R, Korthuis PT, Weimer M, Bougatsos C, Blazina I, Zakher B, et al. Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings. Technical Brief no. 28. Rockville: Agency for Healthcare Research and Quality; December 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts (M.R.L.)Tufts University School of Medicine, Boston, Massachusetts (T.J.S.)Boston University School of Public Health, Boston, Massachusetts (Z.X.)Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (J.M.L.)Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center and Bureau of Substance Addiction Services, Massachusetts Department of Public Health, Boston, Massachusetts (A.Y.W.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3107. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMedication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality Marc R. Larochelle , Dana Bernson , Thomas Land , Thomas J. Stopka , Na Wang , Ziming Xuan , Sarah M. Bagley , Jane M. Liebschutz , and Alexander Y. Walley Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Mortality Lawrence V. Brennan Metrics Cited byRacial and ethnic disparities in emergency department–initiated buprenorphine across five health care systemsBuprenorphine treatment episode duration, dosage, and concurrent prescribing of benzodiazepines and opioid analgesics: The effects of Medicaid prior authorization policiesThe feasibility and safety of training patients in opioid treatment to serve as peer recovery support service interventionistsProvider perceptions of medication for opioid used disorder (MOUD): A qualitative study in communities with high opioid overdose death ratesAssociation between treatment setting and outcomes among oregon medicaid patients with opioid use disorder: a retrospective cohort studyThe Massachusetts public health data warehouse and the opioid epidemic: A qualitative study of perceived strengths and limitations for advancing researchThe impact of opioid agonist treatment on fatal and non-fatal drug overdose among people with a history of opioid dependence in NSW, Australia, 2001–2018: Findings from the OATS retrospective linkage studyUser centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trialUsing Extended Release Buprenorphine Injection to Discontinue Sublingual Buprenorphine: A Case SeriesFederal Opioid Grant Funding Favors Least Populous States, Not States With Greatest NeedHospitalisations for non-fatal overdose among people with a history of opioid dependence in New South Wales, Australia, 2001–2018: Findings from the OATS retrospective cohort studyA qualitative study of big data and the opioid epidemic: recommendations for data governanceEvaluation of a personally-tailored opioid overdose prevention education and naloxone distribution intervention to promote harm reduction and treatment readiness in individuals actively using illicit opioidsA brief telephone-delivered peer intervention to encourage enrollment in medication for opioid use disorder in individuals surviving an opioid overdose: Results from a randomized pilot trialMissed Opportunities to Save Lives—Treatments for Opioid Use Disorder After OverdoseCorrelates of death during outpatient treatment for opioid use disorder: A national study 19 March 2019Volume 170, Issue 6Page: 430-431KeywordsCohort studiesDisclosureDrugsMotivationOpioidsPatientsPrevention, policy, and public health ePublished: 19 March 2019 Issue Published: 19 March 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. 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