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. 2020 Aug;115(8):1496-1508.
doi: 10.1111/add.14964. Epub 2020 Feb 25.

Association between mortality rates and medication and residential treatment after in-patient medically managed opioid withdrawal: a cohort analysis

Alexander Y Walley  1   2 , Sara Lodi  3 , Yijing Li  1 , Dana Bernson  2 , Hermik Babakhanlou-Chase  2 , Thomas Land  4 , Marc R Larochelle  1
Affiliations

Association between mortality rates and medication and residential treatment after in-patient medically managed opioid withdrawal: a cohort analysis

Alexander Y Walley et al. Addiction. 2020 Aug.

Abstract

Background and aim: Medically managed opioid withdrawal (detox) can increase the risk of subsequent opioid overdose. We assessed the association between mortality following detox and receipt of medications for opioid use disorder (MOUD) and residential treatment after detox.

Design: Cohort study generated from individually linked public health data sets.

Setting: Massachusetts, USA.

Participants: A total of 30 681 opioid detox patients with 61 819 detox episodes between 2012 and 2014.

Measurements: Treatment categories included no post-detox treatment, MOUD, residential treatment or both MOUD and residential treatment identified at monthly intervals. We classified treatment exposures in two ways: (a) 'on-treatment' included any month where a treatment was received and (b) 'with-discontinuation' individuals were considered exposed through the month following treatment discontinuation. We conducted multivariable Cox proportional hazards analyses and extended Kaplan-Meier estimator cumulative incidence for all-cause and opioid-related mortality for the treatment categories as monthly time-varying exposure variables.

Findings: Twelve months after detox, 41% received MOUD for a median of 3 months, 35% received residential treatment for a median of 2 months and 13% received both for a median of 5 months. In on-treatment analyses for all-cause mortality compared with no treatment, adjusted hazard ratios (AHR) were 0.34 [95% confidence interval (CI) = 0.27-0.43] for MOUD, 0.63 (95% CI = 0.47-0.84) for residential treatment and 0.11 (95% CI = 0.03-0.43) for both. In with-discontinuation analyses for all-cause mortality, compared with no treatment, AHRs were 0.52 (95% CI = 0.42-0.63) for MOUD, 0.76 (95% CI = 0.59-0.96) for residential treatment and 0.21 (95% CI = 0.08-0.55) for both. Results were similar for opioid-related overdose mortality.

Conclusions: Among people who have undergone medically managed opioid withdrawal, receipt of medications for opioid use disorder, residential treatment or the combination of medications for opioid use disorder and residential treatment were associated with substantially reduced mortality compared with no treatment.

Keywords: Detox; medically managed withdrawal; medication for opioid use disorders; mortality; overdose; residential treatment.

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Conflict of interest statement

Declaration of competing interests: Not applicable

Figures

Figure 1.
Figure 1.
Cohort exclusions for detox episodes, Massachusetts, 2012–2014
Figure 2.
Figure 2.
Receipt of treatment for OUD before and after the detox episode - Massachusetts 2012–2014 (n=61,819)
Figure 3.
Figure 3.
Receipt of Medication for OUD before and after detox episode - Massachusetts 2012–2014 (n=61,819)
Figure 4a.
Figure 4a.
Cumulative incidence of all-cause mortality, On Treatment analyses - Massachusetts 2012–2014
Figure 4b.
Figure 4b.
Cumulative incidence of opioid-related mortality, On Treatment analyses - Massachusetts 2012–2014
Figure 5a.
Figure 5a.
Cumulative incidence of all-cause mortality, With Discontinuation analysis - Massachusetts 2012–2014
Figure 5b.
Figure 5b.
Cumulative incidence of opioid-related mortality, With Discontinuation analysis - Massachusetts 2012–2014
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