Study Shows Veterans Receiving Buprenorphine for Opioid Use Disorder Have Lower Risk of Suicide/Overdose Mortality
Opioid use disorder (OUD) is a significant public health burden in the US, with nearly 450,000 people dying from an overdose involving opioids between 1999 and 2018. Veterans have an increased risk of opioid use disorder, with previous research showing that a diagnosis of OUD among VA patients is nearly seven times greater than among patients in commercial health plans. Medication for opioid use disorder (MOUD), such as buprenorphine, is an effective treatment and because OUD is a risk factor for suicide and overdose, it is important to examine the relationship between the status of buprenorphine pharmacotherapies and long-term health outcomes such as mortality. This retrospective cohort study sought to determine the association between buprenorphine pharmacotherapy and suicide, overdose, and all-cause mortality among Veterans initiating buprenorphine within VA. Using VA data, investigators identified a national cohort of 29,054 Veterans who were diagnosed with OUD and treated with buprenorphine or buprenorphine/naloxone within the VA healthcare system between January 1, 2008 and December 31, 2017. The primary outcome was death by suicide and/or overdose combined up to five years from treatment initiation; secondary outcomes included all-cause mortality. Investigators also examined sociodemographics and comorbidities. Prescription data were used to calculate periods when Veterans were or were not receiving buprenorphine.
- Veterans who were not receiving buprenorphine pharmacotherapy on any given day had more than a four-fold increase in suicide/overdose death compared to those who received buprenorphine, even when accounting for time periods on other MOUD.
- Over the 5-year follow-up from the initial buprenorphine prescription, 3% died from suicide or overdose, and 8% died of any cause. Among suicide/overdose deaths, the majority (90%) were due to overdose and 71% of overdoses involved a prescription or illicit opioid.
- Of the Veterans in this study cohort, about 3% (n=892) had >1 methadone prescription, and 7% (n=2,137) had >1 naltrexone prescription.
- Psychiatric comorbidities were prevalent in this study cohort: 73% were diagnosed with depression; 61% with anxiety disorders; and 50% with at least one other substance dependence.
- Providers should consider whether buprenorphine pharmacotherapy, whether intermittent or continuous, could provide health benefits for their patients and prevent mortality.
- Veterans may have received pharmacotherapies outside VA.
- Suicide and overdose classification were determined from death certificates, which may under-report true event rates.
Dr. Lund is part of HSR&D’s Center for Access and Delivery Research and Education (CADRE) in Iowa City, IA.
Vakkalanka JP, Lund B, Arndt S, et al. Association between Buprenorphine for Opioid Use Disorder and Mortality Risk. American Journal of Preventive Medicine. May 19, 2021; online ahead of print.