Opioid Overdose Crisis: Medications Prevent Subsequent Overdoses

Drug overdose is the number one cause of accidental death in Connecticut, where someone is more likely to die from a drug overdose than from a car accident.

Researchers are seeking to understand how to best prevent overdoses. A new Yale-led retrospective cohort study published in Drug and Alcohol Dependence examined the efficacy of a range of treatments for patients who survived an opioid overdose and identified treatments that are most successful in preventing subsequent overdoses.

The investigators examined data of over 4,000 overdose survivors spanning a 19-month period, homing in on treatment modalities like medication and inpatient rehabilitation. The analysis found that people who took methadone or buprenorphine had a lower risk of further overdoses compared to those who did not take the medications.

“This real-world experience confirms what we see in clinical trials,” says Benjamin Howell, MD, MPH, assistant professor of medicine (general medicine) at Yale School of Medicine (YSM) and lead author of the study. “Medications are shown to improve a range of outcomes like treatment retention, drug use, criminalized behavior, and even employment.”

Methadone and buprenorphine are controlled substances, and are available by prescription only. These medications are used to curb opioid withdrawal symptoms and in ongoing treatment.

“Our access to a unique combination of state-level datasets allowed us to consider multiple treatments in our statistical models and draw meaningful conclusions about people’s risk for overdose,” says Anne C. Black, PhD, associate professor of medicine (general medicine) at YSM and co-author.

The research team also found no statistical differences between inpatient treatment, such as rehabilitation or detox, and receiving no treatment. This means inpatient treatment has no independent effect on subsequent overdoses. The finding, Howell notes, highlights the need for medications to be provided in conjunction with inpatient treatment.

“These medications are considered the gold standard for the treatment of opioid use disorder by the National Institutes of Health and other authoritative bodies, and they are effective because they prevent withdrawal and decrease craving,” says co-author David Fiellin, MD, professor of medicine (general medicine) and of emergency medicine at YSM and of health policy and management at Yale School of Public Health (YSPH).

The study emphasizes the need for public health awareness on the importance of the use of medications to treat patients with opioid use disorder. Researchers hope the data will inform public policy and regulations at the local, state, and federal levels.

“Medications prevent overdoses and ultimately save lives. So it follows that we should continue to pursue efforts to reduce barriers to accessing them,” adds William Becker, MD, professor of medicine (general medicine).

Yale School of Medicine and YSPH faculty partnered with several agencies for the study, including the Department of Mental Health and Addiction Services, the U.S. Food and Drug Administration (FDA) Center for Drug Evaluation and Research, and the Office of Surveillance and Epidemiology of the FDA.

The research reported in this news article was supported by the FDA (award U01FD005938), the National Institute on Drug Abuse (award 5K12DA033312), and Yale University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the FDA or the National Institutes of Health.

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