A recent study has revealed that individuals with opioid use disorder (OUD) who undergo inpatient medically managed withdrawal treatment, commonly known as detox, often do not receive subsequent treatment such as medication for OUD or additional inpatient care. However, those who do receive further treatment, including medication (methadone, buprenorphine, or naltrexone) or residential treatment, demonstrate higher survival rates at the 12-month mark. The findings, published in Addiction, underscore the significance of ensuring ongoing engagement in treatment for individuals with opioid use disorder to enhance their chances of survival.
Detoxification, or inpatient medically managed withdrawal, is a widely used approach for individuals seeking treatment for opioid use disorder. While individuals enter detox with the intention of improving their condition, many do not pursue additional treatment specifically targeting their OUD, including medication, following discharge. Without ongoing medication for OUD, their opioid tolerance decreases, putting them at a higher risk of overdose compared to when they initially entered detox. It’s important to note that residential treatment programs typically do not incorporate medications for OUD during the treatment regimen.
Dr. Alexander Walley, a physician specializing in general internal medicine and a researcher at the Grayken Center for Addiction, both at Boston Medical Center, explained, “Previous studies have demonstrated that FDA-approved medications for opioid use disorder work by reducing opioid use, promoting treatment retention, and, in the case of methadone and buprenorphine, decreasing mortality. In this study, we specifically examined post-discharge mortality rates after detox based on further treatment with medication for opioid use disorder and residential treatment.”
In collaboration with the Massachusetts Department of Public Health, researchers from Boston Medical Center analyzed linked data sets of individuals aged 18 and above in Massachusetts with health insurance. The study focused on individuals who underwent detox between January 2012 and December 2014, allowing for a 12-month observation period before and after the initial recorded detox. The researchers investigated the 12-month all-cause and opioid-related mortality rates for individuals who were discharged and fell into the following categories: no treatment for OUD, received medication for OUD after discharge, received residential treatment (discontinuing medication), or received both residential treatment and medication for OUD.
The data indicated that the all-cause mortality rate for individuals who received no treatment after detox was high, at 2 percent per year, with overdose being the primary cause. Among those who received medication for OUD in the month following detox, those who remained in treatment experienced a 66 percent reduction in all-cause mortality compared to those who received no treatment. Seventeen percent of individuals received residential treatment, leading to a 37 percent decrease in all-cause mortality compared to those who received no treatment. Only three percent of the study participants received both medication for OUD and residential treatment, resulting in an 89 percent reduction in all-cause mortality compared to those who received no treatment.
“Opioid use disorder is a chronic condition that requires ongoing treatment,” stated Dr. Walley, who is also an associate professor of medicine at Boston University School of Medicine. “The data from our study demonstrates that medication and residential treatment for opioid use disorder reduce the risk of overdose and death, but these treatments need to be continued to be effective.”
The study revealed that less than half of the individuals included in the analysis received further treatment after detox, and sustained engagement in care, both in inpatient and outpatient settings, was not commonly observed. The authors highlighted the potential effectiveness of combining medication and residential treatment for individuals at the highest risk.
“It is crucial to consider initiating medication during detox and expanding the healthcare system to facilitate better collaboration between residential treatment centers and medication for opioid use disorder programs. This would improve access to medication and increase the number of people remaining in treatment