Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Aug;118(8):1527-1539.
doi: 10.1111/add.16178. Epub 2023 Mar 20.

Does opioid agonist treatment reduce overdose mortality risk in people who are older or have physical comorbidities? Cohort study using linked administrative health data in New South Wales, Australia, 2002-17

Sarah Larney  1   2   3 , Nicola R Jones  3 , Matthew Hickman  4 , Suzanne Nielsen  5 , Robert Ali  3   6 , Louisa Degenhardt  3
Affiliations
Observational Study

Does opioid agonist treatment reduce overdose mortality risk in people who are older or have physical comorbidities? Cohort study using linked administrative health data in New South Wales, Australia, 2002-17

Sarah Larney et al. Addiction. 2023 Aug.

Abstract

Aims: To quantify the association between opioid agonist treatment (OAT) and overdose death by age group; test the hypothesis that across different age groups, opioid overdose mortality is lowest during OAT with buprenorphine compared with time out of treatment or OAT with methadone; and test associations between OAT and opioid overdose mortality in the presence of chronic circulatory, respiratory, liver and kidney diseases.

Design: Retrospective observational cohort study using linked administrative data.

Setting: New South Wales, Australia.

Participants: A total of 37 764 people prescribed OAT, 1 August 2002 and 31 December 2017.

Measurements: OAT exposure, opioid overdose mortality and key confounders were measured using linked population data sets on OAT entry and exit, hospitalization, mental health care, incarceration and mortality. ICD-10 codes were used to define opioid overdose mortality and chronic disease groups of interest.

Findings: Relative to time out of treatment, time in OAT was associated with a lower risk of opioid overdose death across all age groups and chronic diseases. Among people aged 50 years and older, there was weak evidence that buprenorphine may be associated with greater protection against opioid overdose death than methadone [generalized estimating equation (GEE) adjusted incident rate ratio (aIRR) = 0.47; 95% confidence interval (CI) = 0.21, 1.02; marginal structural models (MSM) aIRR = 0.49; 95% CI = 0.17, 1.41]. Buprenorphine was associated with greater protection against overdose death than methadone for clients with circulatory (MSM aIRR = 0.27; 95% CI = 0.11, 0.67) or respiratory (MSM aIRR = 0.26; 95% CI = 0.07, 0.94) diseases, but not liver (MSM aIRR = 0.59; 95% CI = 0.14, 2.43) or kidney (MSM aIRR = 1.16; 95% CI = 0.31, 4.36) diseases.

Conclusions: Opioid agonist treatment (OAT) appears to reduce mortality risk in people with opioid use disorder who are older or who have physical comorbidities. Opioid overdose mortality during OAT with buprenorphine appears to be lower and reduced in clients with circulatory and respiratory diseases compared with OAT with methadone.

Keywords: Buprenorphine; comorbidity; methadone; multi-morbidity; older adults; opioid agonist treatment; overdose.

PubMed Disclaimer

Conflict of interest statement

Declarations of interests: In the past three years, LD has received investigator-initiated untied educational grants for studies of opioid medications in Australia from Indivior and Seqirus. SN has received investigator-initiated untied educational grants from Seqirus, and is a named investigator on an implementation trial funded by Indivior. SL has previously received an untied educational grant from Indivior.

Figures

Figure 1:
Figure 1:
Cohort definition
Figure 2:
Figure 2:
Crude opioid overdose mortality rates, stratified by age group and circulatory disease (panel A) and respiratory disease (panel B).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Santo T Jr, Clark B, Hickman M, Grebely J, Campbell G, Sordo L, et al. Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021. Sep 1;78(9):979–93. - PMC - PubMed
    1. Kimber J, Larney S, Hickman M, Randall D, Degenhardt L. Mortality risk of opioid substitution therapy with methadone versus buprenorphine: A retrospective cohort study. Lancet Psychiatry. 2015;2:901–8. - PubMed
    1. Pearce LA, Min JE, Piske M, Zhou H, Homayra F, Slaunwhite A, et al. Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study. BMJ. 2020. Mar 31;368:m772. - PMC - PubMed
    1. EMCDDA. Treatment and care for older drug users. Lisbon: European Monitoring Centre for Drugs and Drug Addiction; 2010.
    1. Lynch A, Arndt S, Acion L. Late- and Typical-Onset Heroin Use Among Older Adults Seeking Treatment for Opioid Use Disorder. Am J Geriatr Psychiatry. 2020;((Lynch, Arndt) Department of Psychiatry (AL, SA), University of Iowa, Iowa City, IA, United States(Acion) Instituto de Calculo, Universidad de Buenos Aires-CONICET (LA), Argentina). - PubMed

Publication types