Study: Extended MOUD treatment significantly increases the probability of survival

Study: Extended MOUD treatment significantly increases the probability of survival

A new study of over 32,000 U.S. veterans found that the longer people take opioid use disorder medications (buprenorphine, methadone, or extended-release naltrexone), the greater their likelihood of short- and medium-term survival. This benefit continues to increase for at least four years of ongoing treatment, significantly longer than most patients currently remain on treatment.

People with opioid use disorder are at risk of dying from an accidental overdose, but opioid use disorder also increases the risk of dying from other health conditions, particularly infectious diseases. People who receive buprenorphine and other medications for opioid use disorder (MOUD) have fewer drug cravings, better social functioning, and a better quality of life than those who do not, and these improvements reduce their risk of death.

It is unusual for patients to take MOUD for four years or even a year. Most standards of care specify a minimum treatment duration goal of 6 months, and more than 25% of patients report wanting even shorter treatment durations. This study shows that the recommended treatment duration should be years longer to get the most benefit from MOUD. If patients are encouraged to continue treatment for at least four years, their chances of survival increase significantly.

This study was published in the journalSeeksmeasured relative predicted survival probability as the ratio of the predicted probability of survival to 6 years if a patient were treated for 1 year instead of 6 months, 2 years instead of 6 months, etc. Longer duration of therapy increased expected relative survival, with greater gains at longer time horizons. Higher risk patients saw greater benefits over shorter time horizons than lower risk patients.

For example (see figure), a 50-year-old man with no other health risk factors who remained on MOUD treatment for two years was 4% more likely to survive than a 50-year-old man who discontinued treatment after six months. In contrast, it was expected that a 30-year-old woman with no other health risk factors would achieve a 4% higher probability of survival only after approximately 5 years of MOUD duration. Furthermore, in the lowest risk patients, improvements in relative survival for each additional year of therapy began to decline with increasing duration of therapy, with no statistical difference evident after 4 years.

The study included 19,666 buprenorphine users, 8,675 methadone users, and 4,007 sustained-release naltrexone users. After four years of treatment with MOUD, the additional treatment duration may no longer increase the relative predicted probability of survival.

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