Available online 3 April 2024, 111281

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Little is known about buprenorphine use and outcomes after non-fatal overdose

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We analyzed the relationship between buprenorphine retention and adverse outcomes after an overdose

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61% (n=3,232) of subjects had an active buprenorphine prescription for ≥ 6 months

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Risk of adverse outcomes decreased 4%-5% with each month of buprenorphine

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Buprenorphine for ≥9 months appeared to be the threshold to reduce adverse outcomes

AbstractIntroduction

Patients receiving buprenorphine after a non-fatal overdose have lower risk of future nonfatal or fatal overdose, but less is known about the relationship between buprenorphine retention and the risk of adverse outcomes in the post-overdose year.

Objective

To examine the relationship between the total number of months with an active buprenorphine prescription (retention) and the odds of an adverse outcome within the 12 months following an index non-fatal overdose.

Materials and methods

We studied a cohort of people with an index non-fatal opioid overdose in Maryland between July 2016 and December 2020 and at least one filled buprenorphine prescription in the 12-month post-overdose observation period. We used individually linked Maryland prescription drug and hospital admissions data. Multivariable logistic regression models were used to examine buprenorphine retention and associated odds of experiencing a second non-fatal overdose, all-cause emergency department visits, and all-cause hospitalizations.

Results

Of 5,439 people, 25% (n=1,360) experienced a second non-fatal overdose, 78% had an (n=4,225) emergency department visit, and 37% (n=2,032) were hospitalized. With each additional month of buprenorphine, the odds of experiencing another non-fatal overdose decreased by 4.7%, all-cause emergency department visits by 5.3%, and all-cause hospitalization decreased by 3.9% (p<.0001, respectively). Buprenorphine retention for at least nine months was a critical threshold for reducing overdose risk versus shorter buprenorphine retention.

Conclusions

Buprenorphine retention following an index non-fatal overdose event significantly decreases the risk of future overdose, emergency department use, and hospitalization even among people already on buprenorphine.

Section snippetsINTRODUCTION

People who experience a non-fatal opioid overdose are especially vulnerable to future fatal and non-fatal overdose (Caudarella et al., 2016, Lowder et al., 2020, Olfson et al., 2018, Olfson et al., 2018, Warfield et al., 2021). Receiving buprenorphine, one of the three medications for opioid use disorder (MOUD), after a non-fatal overdose event substantially decreases that risk (Larochelle et al., 2018, Samples et al., 2023, Victor et al., 2021). In a study of national Medicare recipients,

METHODS

We conducted a retrospective analysis of trends in buprenorphine receipt and outcomes after an index non-fatal overdose in Maryland between 2016 and 2021. We used event-level data from Maryland’s DORM database (Maryland Department of Health, 2021). In this analysis, we used linked data from two sources: 1) the state’s prescription drug monitoring program (PDMP), which documents all prescriptions for controlled medications dispensed to outpatients within the state; 2) the Health Services Cost

RESULTS

The study sample included 5,439 people who received buprenorphine in the year following an index non-fatal overdose in Maryland. Descriptive statistics of the study sample are in Table 1. The greatest proportion of patients were age 25-34 (n=1,755; 32%), male (n=3,534; 65%), white (n=3,343; 62%), insured by Medicaid (n=3,825; 70%), lived in urban counties (n=5,287; 97%), and did not have an active buprenorphine prescription at the time of the index event (n=4371; 80%). Patients had an average

DISCUSSION

We examined the relationship between buprenorphine retention and overdose-related health care outcomes among Maryland residents within the year following an index non-fatal overdose event between July 2016 and December 2020. While most patients did not maintain a buprenorphine prescription all 12 months following the index event, we found that more months with an active buprenorphine prescription was associated with significantly decreased odds of experiencing a successive non-fatal overdose,

CONCLUSION

In our study of Maryland residents with an index non-fatal overdose between 2016 and 2020, each additional month of a buprenorphine prescription within the year following the index event decreased the odds of future non-fatal overdose, ED visit, or hospitalization by 5%. Nine months of buprenorphine was the threshold for the most greatly reduced odds of adverse outcomes. Even with buprenorphine access, overdose-related outcomes were still disparately higher among Black Maryland residents,

CRediT authorship contribution statement

Role of funding source: This work was supported by funding from Bloomberg Philanthropies and the Maryland Department of Health Opioid Operational Command Center.

Contributors: All authors (Olivia K. Sugarman, Brendan Saloner, Thomas M. Richards, Elyse C Lasser, Teresa Heath, Shima Idries, Jonathan P. Weiner, Sachini Bandara) have read and approved this submission. All authors contributed to writing and editing this manuscript. Dr. Sugarman lead conceptualization, data analysis, writing, and

CRediT authorship contribution statement

Olivia Kacsits Sugarman: Writing – original draft, Investigation, Formal analysis, Conceptualization. Thomas M. Richards: Writing – review & editing, Data curation. Brendan Saloner: Writing – review & editing, Supervision, Funding acquisition. Sachini Bandara: Writing – review & editing, Visualization, Conceptualization. Teresa Heath: Writing – review & editing. Elyse C Lasser: Writing – review & editing, Project administration, Data curation. Jonathan P. Weiner: Writing – review & editing,

Declarations of interest

None.

Acknowledgments

This project does not represent the position of Bloomberg Philanthropies or the Maryland Department of Health.

Conflicts of interest

No conflict declared.

. Diagnosis codes for non-fatal overdose

Code typeCodeDescriptionICD-9a96500Poisoning by opium96501Poisoning by heroin96502Poisoning by methadone96509Poisoning by other opiates and related narcoticsE8500Accidental poisoning by heroinE8501Accidental poisoning by methadoneE8502Accidental poisoning by other opiates and related narcoticsICD-10bT400*

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