Association of Opioid Use Disorder Treatment With Alcohol-Related Acute Events

Abstract

Importance: Persons with opioid use disorder (OUD) and co-occurring alcohol use disorder (AUD) are understudied and undertreated. It is unknown whether the use of medications to treat OUD is associated with reduced risk of alcohol-related morbidity.

Objective: To determine whether the use of OUD medications is associated with decreased risk for alcohol-related falls, injuries, and poisonings in persons with OUD with and without co-occurring AUD.

Design, setting, and participants: This recurrent-event, case-control, cohort study used prescription claims from IBM MarketScan insurance databases from January 1, 2006, to December 31, 2016. The sample included persons aged 12 to 64 years in the US with an OUD diagnosis and taking OUD medication who had at least 1 alcohol-related admission. The unit of observation was person-day. Data analysis was performed from June 26 through September 28, 2020.

Exposures: Days of active OUD medication prescriptions, with either agonist (ie, buprenorphine or methadone) or antagonist (ie, oral or extended-release naltrexone) treatments compared with days without OUD prescriptions.

Main outcomes and measures: The primary outcome was admission for any acute alcohol-related event defined by International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Conditional logistic regression was used to compare OUD medication use between days with and without an alcohol-related event. Stratified analyses were conducted between patients with OUD with and without a recent AUD diagnostic code.

Results: There were 8 424 214 person-days of observation time among 13 335 participants who received OUD medications and experienced an alcohol-related admission (mean [SD] age, 33.1 [13.1] years; 5884 female participants [44.1%]). Agonist treatments (buprenorphine and methadone) were associated with reductions in the odds of any alcohol-related acute event compared with nontreatment days, with a 43% reduction for buprenorphine (odds ratio [OR], 0.57; 95% CI, 0.52-0.61) and a 66% reduction for methadone (OR, 0.34; 95% CI, 0.26-0.45). The antagonist treatment naltrexone was associated with reductions in alcohol-related acute events compared with nonmedication days, with a 37% reduction for extended-release naltrexone (OR, 0.63; 95% CI, 0.52-0.76) and a 16% reduction for oral naltrexone (OR, 0.84; 95% CI, 0.76-0.93). Naltrexone use was more prevalent among patients with OUD with recent AUD claims than their peers without AUD claims.

Conclusions and relevance: These findings suggest that OUD medication is associated with fewer admissions for alcohol-related acute events in patients with OUD with co-occurring AUD.

Figure 1.. Flowchart for Development of Analytical Sample

Chart shows derivation of the study’s final analytical sample during follow-up. After application of inclusion and exclusion criteria, there were 13 335 unique patients with opioid use disorder (OUD), all of whom had received OUD medication during insurance enrollment. The analytical sample was subsequently restricted to observations within 1 year before and 1 year after index alcohol-related acute event to decrease heterogeneity in observation time, contributing a total of 8 424 214 person-days in the study database.

Figure 2.. Adjusted Odds of Alcohol-Related Acute Events Associated With Opioid Use Disorder (OUD) Treatment Days Compared With Nontreatment Days

Plot shows adjusted odds of alcohol-related acute events associated with OUD treatment days compared with nontreatment days, stratified for all participants, patients with OUD with recent alcohol use disorder (AUD) claims, and patients with OUD without recent AUD claims.