Leo Sher, M.D.

The research report “A comparison of mortality rates for buprenorphine versus methadone treatments for opioid use disorder” has been published in Acta Psychiatrica Scandinavica online ahead of print (1). Researchers compared all-cause mortality, overdose mortality, and suicide mortality rates for buprenorphine and methadone treatments among a large sample of U.S. Department of Veterans Affairs patients with opioid use disorder.

The cohort consisted of 61,997 patients with opioid use disorder who received opioid agonist treatment from 2010 to 2019. 92.7% of patients were male. The mean age of individuals included in the study was 47.9 (SD=14.1) years. Patients were followed for a median of 2 (IQR=1,4) calendar years. The total follow up time was 189,950 calendar years. Compared to patients who received methadone, those who received buprenorphine were more likely to be young, white, rural, housed, and physically healthy.

The authors found significant reductions in all-cause and suicide mortality for buprenorphine relative to methadone. The authors reported that this held true across several good analytic designs that can account for selection bias and unmeasured confounding. No difference was identified for overdose mortality.

The authors conclude that buprenorphine has substantial and statistically significant benefits over methadone for the outcomes of all-cause mortality and suicide mortality. The authors suggest that the results of the study support the less restrictive prescribing practices for buprenorphine as opioid agonist treatment in the U.S.

Reference

1. Gottlieb DJ, Shiner B, Hoyt JE, Riblet NB, Peltzman T, Teja N, Watts BV. A comparison of mortality rates for buprenorphine versus methadone treatments for opioid use disorder. Acta Psychiatr Scand. 2022 Jul 15. doi: 10.1111/acps.13477. Epub ahead of print.