Affiliation:
1. Department of Epidemiology, Mailman School of Public Health Columbia University New York NY USA
2. Department of Psychiatry Columbia University Irving Medical Center New York NY USA
3. New York State Psychiatric Institute New York NY USA
4. Department of Population Health New York University New York NY USA
5. Department of Biostatistics, Bloomberg School of Public Health Johns Hopkins University Baltimore MD USA
Abstract
AbstractBackground and aimsExtended‐release naltrexone (XR‐NTX) and sublingual buprenorphine (SL‐BUP) are both approved for opioid use disorder (OUD) treatment in any medical setting. We aimed to compare the real‐world effectiveness of XR‐NTX and SL‐BUP.Design and settingThis was an observational active comparator, new user cohort study of Medicaid claims records for patients in New Jersey and California, USA, 2016–19.Participants/casesThe participants were adult Medicaid patients aged 18–64 years who initiated XR‐NTX or SL‐BUP for maintenance treatment of OUD and did not use medications for OUD in the 90 days before initiation. Our cohort included 1755 XR‐NTX and 9886 SL‐BUP patients.MeasurementsWe examined two outcomes up to 180 days after medication initiation: (1) composite of medication discontinuation and death and (2) composite of overdose and death.FindingsIn adjusted analyses, treatment with XR‐NTX was more likely to result in discontinuation or death by the end of follow‐up than treatment with SL‐BUP: cumulative risk 75.9% [95% confidence interval (CI) = 73.9%, 77.9%] versus 62.2% (95% CI = 61.2%, 63.2%), respectively (risk difference = 13.7 percentage points, 95% CI = 11.4, 16.0). There was minimal difference in the cumulative risk of overdose or death by the end of follow‐up: XR‐NTX 3.9% (95% CI = 3.0%, 4.8%) versus SL‐BUP 3.3% (95% CI = 2.9%, 3.7%); risk difference = 0.5 percentage points, 95% CI = –0.4, 1.5. Results were consistent across sensitivity analyses.ConclusionsMedicaid patients in California and New Jersey, USA, receiving treatment for opioid use disorder stayed in treatment longer on sublingual buprenorphine than on extended‐release naltrexone, but the risk of overdose was similar. Most patients in this study discontinued medication within 6 months, regardless of which medication was initiated.
Funder
National Institute on Drug Abuse