Longer treatment with medications for opioid use disorder associated with greater probability of survival

A new study of over 32,000 US veterans has found that the longer people stay on medications for opioid use disorder (buprenorphine, methadone, or extended-release naltrexone), the greater the probability of short- and medium-term survival. This benefit continues to increase for at least four years of ongoing treatment, considerably longer than most patients currently stay in treatment.

People with opioid use disorder run the risk of dying from accidental overdose, but opioid use disorder also increases the risk of death from other health conditions, most notably infectious disease. People who receive buprenorphine and other medications for opioid use disorder (MOUD) have fewer drug cravings, improved social functioning, and better quality of life than those who do not, and those improvements decrease their risk of mortality.

Current treatment durations and patient preferences

It’s unusual for patients to stay on MOUD for four years, or even for one year. Most standards of care specify six months as the minimum target for treatment duration, and more than 25% of patients say they want even shorter durations.

This study shows that to get the greatest benefit from MOUD, the recommended treatment duration should be years longer. Encouraging patients to continue treatment for at least four years will significantly increase their chances of survival.

Study findings on survival probability

The study, published in Addiction, measured relative predicted survival probability as the ratio of the predicted probability of surviving to six years if a patient was treated for one year instead of six months, two years instead of six months, and so on. Longer time on therapy increased expected relative survival, with larger gains in longer time horizons. Higher-risk patients saw greater benefits over shorter time horizons than lower-risk patients.

For example, a 50-year-old male with no other health risk factors who remained in MOUD treatment for two years had a 4% higher survival probability than a 50-year-old male who stopped treatment at six months.

In contrast, a 30-year-old female with no other health risk factors was not projected to achieve a 4% greater survival probability until around five years of MOUD duration. Additionally, for the lowest risk patients, the improvements in relative survival for each additional year of therapy started to diminish as duration increased, with no statistically discernible difference beyond four years.

The study included 19,666 buprenorphine users, 8,675 methadone users, and 4,007 extended-release naltrexone users. After four years of receiving MOUD, additional time in treatment may not continue to increase the relative predicted probability of survival.

Provided by
Society for the Study of Addiction