Buprenorphine Treatment Associated With Decreased Risk of Fatal Overdose

Male adult talks to doctor about medication
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If you’ve never heard of buprenorphine or buprenorphine treatment for opioid use disorder (OUD), we’re not surprised – but we are concerned.

A report published by the Centers for Disease Control (CDC) that analyzed drug overdose fatalities over a 20-year period in the U.S. – from 2001 to 2021 – showed that during that period, drug overdose fatalities increased by over 450 percent.

Here are the numbers:

  • Total fatal drug overdose, 2001: 19,934
    • Opioid-related: 9,486
  • Total fatal drug overdose, 2021: 106,699
    • Opioid-related: 80,411

Overdose fatalities increased dramatically over those twenty years. The percentage of overdose fatalities involving opioids increased dramatically as well. In 2001, 48 percent of fatal overdoses involved opioids. In 2021, 75 percent of fatal overdoses involved opioids. That 27-point increase means the share of opioid-related overdose fatalities rose by 56 percent from 2001 to 2021.

The first reason we’re concerned that you haven’t heard of buprenorphine or buprenorphine treatment for opioid use disorder is in the data above. Those figures describe an ongoing public health crisis in the U.S. It’s called the opioid addiction and overdose crisis. To read the latest news on the opioid crisis, please navigate to the blog section of our website and read this article:

The Mainstreaming Addiction Treatment (MAT) Act: Will We Keep COVID-Era Changes?

We’re concerned because evidence shows treatment with buprenorphine and other medications for opioid use disorder – in combination with therapy, counseling, and social support – is the gold-standard, most effective approach to helping people with OUD move past the cycles of addiction and achieve long-term recovery.

We’re not surprised because medications for opioid use disorder are underutilized, even among treatment professionals and people who know about buprenorphine. We discuss this phenomenon in our article Medication for Opioid Overdose Underused.

The second reason we’re concerned about the lack of awareness of buprenorphine is a fact revealed by recent research:

After a nonfatal overdose, treatment with buprenorphine can reduce risk of a subsequent fatal overdose.

Most treatment professionals know this already. However, this new research shows – with numbers derived from a large sample set – the significant extent to which buprenorphine treatment can reduce fatal overdose risk after an initial, nonfatal overdose.

Buprenorphine Treatment for Opioid Used Disorder After Nonfatal Opioid Overdose

The study “Buprenorphine After Nonfatal Opioid Overdose: Reduced Mortality Risk in Medicare Disability Beneficiaries,” published in March 2023, contains important information related to the opioid crisis. The data are especially relevant for anyone involved in buprenorphine treatment for OUD, anyone who needs buprenorphine treatment for OUD, or anyone with a friend or loved one with OUD who may need to explore the various treatment options available.

In the study, researchers examined National Medicare records for 81,616 adults age 18-64 who received inpatient treatment or treatment in a hospital emergency room for nonfatal, opioid-related overdose between 2008 and 2016. Researchers analyzed data in 2022. They divided people who received treatment for opioid use disorder after the initial overdose incident into three categories:

  1. Those who received any treatment for opioid use disorder
  2. Among those who received treatment, those who received buprenorphine treatment
  3. Those who received psychosocial services/ psychosocial support

Before we report their results, we should clarify some of the language we use in the introduction above. We identify buprenorphine as one of three medications approved by the Food and Drug Administration (FDA) for treatment of opioid use disorder. These three medications – buprenorphine, methadone, and naltrexone – are known as MOUDs and form an integral component of an approach to treatment for OUD called medication-assisted treatment (MAT).

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as follows:

“MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

To learn more about this approach to treatment, please visit our Medication-Assisted Treatment page. That resource provides an overview of MAT, its benefits and how MAT treatment works. It’s important to understand that an MAT program is not only about medication. MAT is about using a combination of treatment modalities to facilitate long-term recovery for patients diagnosed with opioid use disorder.

In the study we introduce above, researchers followed patients for a year after a non-fatal overdose event. They compared outcomes for patients who received buprenorphine treatment against outcomes for patients who did not receive buprenorphine treatment. Let’s take a look at what they found.

Buprenorphine Treatment After Nonfatal Overdose: The Results

First, we’ll share the results on rates treatment after nonfatal overdose. Then we’ll look at treatment outcomes – with a focus on risk of fatal overdose – for people who received buprenorphine treatment compared to people who didn’t receive buprenorphine treatment.

One thing we should note about this study is the sample size. It’s rare to find a study that includes a large enough sample to make population level generalizations from the findings. A sample size of 80,000+ allows us to say, with confidence, that rates and percentages reported would be consistent for larger groups of people. That includes our population of just over 200 million adults between ages and 64.

Here are the rates of treatment engagement among the sample set:

  • Received any treatment for OUD:
    • 6.5%, or 5,329 people
  • Received buprenorphine:
    • 4.6%, or 3,774 people
  • Received psychosocial support:
    • 2.9%, or 2,405 people

We must editorialize here for a moment. Those treatment rates are far too low. They reveal a startling treatment gap. A treatment gap is the difference between people who need a specific treatment and those who receive that treatment.

In this study, the treatment gap was:

  • 93.5% percent overall
  • 95.4% for buprenorphine
  • 97.1% for psychosocial support

Let’s be clear:

The vast majority of patients in this study did not get the lifesaving treatment they needed.

But we digress.

The primary metric – after treatment receipt/engagement – researchers examined in this study was the impact of buprenorphine treatment on instances of fatal overdose after an initial non-fatal overdose event.

Here’s the data:

  • Patients who received buprenorphine showed a 62% decreased risk of fatal overdose in the year following a nonfatal overdose
  • Patients who did not receive buprenorphine showed a 38% increased risk of fatal overdose in the year following a nonfatal overdose
  • In this study, data showed that participation in psychosocial support only did not have a significant statistical impact on risk of fatal overdose

We can identify two top-line takeaways from this study. First, the treatment gap. Although it’s not the topic of this article, it could be. The small percentage of patients who experienced nonfatal overdose who received treatment is both surprising and concerning. When seen in light of the significant decrease in fatal overdose risk among patients who received buprenorphine treatment, it’s shocking.

The bottom line is this:

Buprenorphine treatment after nonfatal overdose saves lives.

The question now is this.

How do we address that treatment gap and get people who experience nonfatal overdose the lifesaving treatment they need?

Expanding Access and Reducing Barriers to Care

Interviewed in U.S. News and World Report, Dr. Hilary Samples, a lead researcher on the study and professor at Rutgers University School of Public Health, discusses the current treatment situation:

“Within the health care system, we need to expand availability and use of buprenorphine in general medical settings, including emergency departments and telehealth visits, and to continue working to reduce the stigma associated with substance use disorder and medication treatment more broadly.”

Increasing access means working to remove barriers to care for all individuals. We need to focus on people with limited resources and limited access to information about treatment. We also need to focus on people who live in rural areas where accessing even the most basic medical care is challenging.

Common barriers to care include:

  • Cost. We can work to reduce this barrier by connecting patients to public and private programs that support MAT programs.
  • Logistics. We can work to connect patients peer support specialists who can help arrange transportation and/or connect patients to voucher programs for public transportation. In addition, we can expand use of telehealth and virtual treatment for people unable to travel for other health reasons.
  • Stigma. Stigma, or bias against buprenorphine treatment and MAT treatment overall, is most often based either on misinformation or a misunderstanding of available information. The best counter to stigma is accurate information about the basic facts about buprenorphine and MAT.

With regards to that last bullet point, you can find accurate and reliable information about MAT and buprenorphine in this article and the sources we link to throughout this article. For a basic overview of MAT beyond what we provide here, please visit MAT Information Page maintained by the SAMHSA. For an in-depth examination of MAT and buprenorphine treatment, please read this SAMHSA publication: TIP 63: Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families (Updated 2021).

We’ll close this article by reminding anyone reading – whether you have OUD, a friend or loved one has OUD, or you’re simply interested in learning the facts about OUD and OUD treatment – this basic fact:

The sooner a person with OUD gets the treatment they need, the better the outcome.

We’ll add one thing to that.

For people with OUD who experience a nonfatal overdose, treatment is essential. Seeking support with buprenorphine or another MOUD can significantly decrease risk of subsequent fatal overdose. In other words, treatment can not only improve life for someone with OUD, but also save the life of someone with OUD.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.