March 4, 2020

JAMA Compares Effectiveness of Treatment Pathways for Opioid Use Disorder

The Journal of the American Medical Association (JAMA) recently published Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. This study compared the effectiveness of six different treatment pathways across 40,885 adults with OUD, including:

  • Only non-intensive behavioral health (outpatient counseling) – which applied to 59.3% of patients
  • Inpatient detoxification or residential services – which applied to 15.8% of patients
  • Buprenorphine or methadone – which applied to 12.5% of patients
  • No treatment – which applied to 5.2% of patients
  • Intensive behavioral health, including intensive outpatient or partial hospitalization – which applied to 4.8% of patients
  • Naltrexone – which applied to 2.4% of patients

Primary outcomes included changes to overdose levels or serious opioid-related acute care use, defined as emergency department visits or hospitalization with a primary opioid diagnosis code. A secondary outcome was admission to detoxification or readmission for those who initiated treatment via inpatient detox.

All outcomes were evaluated three months and 12 months after treatment initiation.

The study found that individuals receiving buprenorphine or methadone were 76% less likely to experience an overdose within three months, and 59% less likely to overdose within 12 months. This cohort was also 32% less likely to experience serious opioid-related acute care within three months, and 26% less likely to experience serious opioid-related acute care within 12 months.

The study found that all other treatment groups were more likely to have a post-treatment admission to inpatient detoxification, citing established research that advocates for access to buprenorphine and methadone for OUD, while also exploring barriers to this care. According to this study, maintaining health insurance was challenging for patients, as 48.1% of patients were disenrolled within 12 months.

Approximately 53.8% of patients utilizing buprenorphine and methadone treatments were disenrolled within 12 months.

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