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. 2024 Oct 23;5(5):e13338.
doi: 10.1002/emp2.13338. eCollection 2024 Oct.

Buprenorphine, oxycodone, hydrocodone, and methadone mortality in the United States (2010‒2017)

Karilynn M Rockhill  1 , Gabrielle E Bau  1 , Angela DeVeaugh-Geiss  2 , Howard Chilcoat  2   3 , Richard Dart  1 , Janetta Iwanicki  1 , Joshua C Black  1
Affiliations

Buprenorphine, oxycodone, hydrocodone, and methadone mortality in the United States (2010‒2017)

Karilynn M Rockhill et al. J Am Coll Emerg Physicians Open. .

Abstract

Objective: Opioid overdose survivors present to emergency departments (EDs) and many EDs have developed programs to initiate buprenorphine. The impact of the increasing use of buprenorphine in ED and by other providers is unknown while opioid mortality continues to rise. Public mortality data do not distinguish buprenorphine from other prescription opioids. Our objective was to determine when changes in overdose mortality trends occurred comparing deaths involving buprenorphine to oxycodone, hydrocodone, and methadone.

Methods: This observational study utilized the drug-involved mortality database including US death certificates (2010‒2017) in which buprenorphine, oxycodone, hydrocodone, or methadone were contributing causes of death (determined through textual analysis). Population- and drug utilization-adjusted mortality rates were examined using disjointed linear regression. Buprenorphine-involved deaths were stratified by polysubstance involvement.

Results: The population-adjusted mortality rates for buprenorphine-involved deaths were lowest compared to other opioids; however, the change in rate for buprenorphine increased faster than oxycodone, hydrocodone, and methadone at 8.9% each quarter-year (95% confidence interval [CI]: 8.0, 9.8) from 2010 to mid-2016 when it stabilized. After adjusting for changes in dispensing over the study period, buprenorphine-involved mortality rates were increasing at 5.3% (95% CI: 4.6, 6.1) each quarter-year. In 2017, 94% buprenorphine-involved deaths had at least one other drug contributing to the cause of death.

Conclusions: Given the low mortality, high proportions of polysubstance mortality, and the mixed agonist/antagonist mechanism of action, use of buprenorphine alone likely presents a lower risk for overdose than comparators. Mortality rose faster than dispensing, signaling need to ensure people understand buprenorphine risks, particularly polysubstance use, balanced against importance for treating opioid use disorders.

Keywords: buprenorphine; medication‐assisted therapies; overdose mortality; polysubstance.

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Conflict of interest statement

Karilynn Rockhill, Gabrielle E. Bau, Richard Dart, Dr. Iwanicki, and Joshua C. Black are employed by the Denver Health and Hospital Authority. The RADARS system is supported by subscriptions from pharmaceutical manufacturers, government and non‐government agencies for surveillance, and research and reporting services. RADARS system is the property of Denver Health and Hospital Authority, a political subdivision of the State of Colorado. Subscribers neither participate in data collection nor do they have access to the raw data. Angela DeVeaugh‐Geiss and Howart Chilcoat are employees of Indivior, Inc. and own stock in the company. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Research Data Center, National Center for Health Statistics (NCHS), or the US Centers for Disease Control and Prevention.

Figures

FIGURE 1
FIGURE 1
Trends over time for quarterly adjusted mortality rates by drug (2010‒2017). Overall buprenorphine involved deaths rates are lower than that of oxycodone, hydrocodone, and methadone. Buprenorphine population‐adjusted rates had an identified joinpoint at 2016Q3; whereas,) no joinpoint was identified in utilization‐adjusted rates. Trends are displayed on log‐transformed rate scale to show percent change over time. Dispensing data available beginning in 2010Q3; methadone dosage units dispensed mortality rates not shown due to known underestimate of methadone dispensing in data.
FIGURE 2
FIGURE 2
Quarterly dosage units dispensed per capita by drug (2010‒2017). Buprenorphine dispensing per capita remains lower than hydrocodone and oxycodone. However, buprenorphine dispensing per capita rose across all census regions, with dispensing per capita being greatest in the Northeast and lowest in the West. Dispensing data available beginning in 2010Q3; methadone dosage units dispensed not shown due to known underestimate of methadone dispensing in data.
FIGURE 3
FIGURE 3
Annual regional population‐adjusted morality rates by census region and drug (2010‒2017). Morality rates per 1,000,000 population by drug differ across census region, with general increases in buprenorphine involved deaths in all regions. Buprenorphine rates from 2010 in the Midwest and West had fewer than 10 deaths and were suppressed for confidentiality reasons.
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