Buprenorphine-Naloxone vs Extended-Release Naltrexone Following Opioid Withdrawal Treatment.
Buprenorphine-naloxone associated with lower risk of nonfatal opioid overdose than naltrexone
Buprenorphine-Naloxone vs Extended-Release Naltrexone Following Opioid Withdrawal Treatment.
IMPORTANCE: Buprenorphine-naloxone and extended-release (XR) naltrexone are both efficacious medications for opioid use disorder that reduce unregulated opioid use and improve opioid cravings and treatment retention.
To compare the effectiveness of buprenorphine-naloxone vs XR naltrexone after medically managed opioid withdrawal (medically managed opioid withdrawal) treatment.
DESIGN, SETTING, AND PARTICIPANTS: This observational comparative effectiveness study using a target trial emulation framework leveraged individually linked administrative data from the Massachusetts Public Health Data Warehouse to emulate the protocol of the Extended-Release Naltrexone vs Buprenorphine for Opioid Treatment randomized clinical trial.
buprenorphine-naloxone cut nonfatal overdose risk more than naltrexone
By 28 days after medically managed opioid withdrawal discharge, initiation of buprenorphine-naloxone was observed among 14 194 discharge episodes (13.4%) and initiation of XR naltrexone was observed among 4734 (4.5%) episodes.
The adjusted 24-week cumulative incidence of all-cause mortality after medically managed opioid withdrawal discharge was 1.4% (95% CI, 1.2%-1.7%) for buprenorphine-naloxone and 1.4% (95% CI, 1.1%-1.8%) for XR naltrexone, corresponding to a risk difference of 0.0 percentage points (pp) (95% CI, -0.4 to 0.4 pp).
In this comparative effectiveness study of buprenorphine-naloxone vs XR naltrexone, initiating buprenorphine-naloxone after medically managed opioid withdrawal discharge was associated with a lower risk of nonfatal opioid overdose at 24 weeks than initiating XR naltrexone, but a similar risk of all-cause mortality.