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Journal Club

Journal Club. Alcohol, Other Drugs, and Health: Current Evidence November–December 2018. Featured Article. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study Larochelle MR , et al. Ann Intern Med . 2018;169(3):137–145.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence November–December 2018 www.aodhealth.org

  2. Featured Article Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study Larochelle MR, et al. Ann Intern Med. 2018;169(3):137–145. www.aodhealth.org

  3. Study Objective • Among opioid overdose survivors, to determine the risk of subsequent fatal overdose, and assess the association between the receipt of medication for opioid use disorder (MOUD) and subsequent mortality. www.aodhealth.org

  4. Study Design • Retrospective cohort of (N=17,568) opioid overdose survivors, created by linking multiple Massachusetts administrative systems (2011-2015) www.aodhealth.org

  5. Assessing Validity of an Article about Prognosis • Are the results valid? • What are the results? • How can I apply the results to patient care? www.aodhealth.org

  6. Are the Results Valid? • Was the sample representative? • Were the subjects sufficiently homogeneous with respect to prognostic risk? • Was follow-up sufficiently complete? • Were objective and unbiased outcome criteria used? www.aodhealth.org

  7. Was the sample representative? • Yes, of opioid overdose survivors who received medical care following the index overdose event. www.aodhealth.org

  8. Were the subjects sufficiently homogeneous with respect to prognostic risk? • Yes. Participants were 17,568 adults without cancer who had all survived an opioid overdose between 2012 and 2014. www.aodhealth.org

  9. Was follow-up sufficiently complete? • Yes www.aodhealth.org

  10. Were objective and unbiased outcome criteria used? • Yes, primary outcome was all-cause and opioid-related mortality www.aodhealth.org

  11. What Are the Results? • How likely are the outcomes over time? • How precise are the estimates of likelihood? www.aodhealth.org

  12. How likely are the outcomes over time? • For the 12 months after the index overdose, the all-cause death rate was 4.7 per 100 patient-years and the opioid-related death rate was 2.1 per 100 patient-years. • Compared with no MOUD, the adjusted hazard ratio for all-cause mortality was 0.47 for methadone, 0.63 for buprenorphine, and 1.44 (but non-significant) for naltrexone. • Similar hazard ratios were found for opioid-related mortality. www.aodhealth.org

  13. How precise are the estimates of likelihood? • Compared with no MOUD, the adjusted hazard ratio for all-cause mortality was 0.47 (95% CI 0.32-0.71) for methadone, 0.63 (95% CI 0.46-0.87) for buprenorphine, and 1.44 (95% CI 0.84-2.46) for naltrexone. www.aodhealth.org

  14. How Can I Apply the Resultsto Patient Care? • Were the study patients and their management similar to those in my practice? • Was follow-up sufficiently long? • Can I use the results in the management of patients in my practice? www.aodhealth.org

  15. Were the study patients similar to those in my practice? • The study population was large, drawn from one state, and sampled on recent opioid overdose survivors. www.aodhealth.org

  16. Was follow-up sufficiently long? • Yes, one year. www.aodhealth.org

  17. Can I use the results in the management of patients in my practice? • Yes. Methadone and buprenorphine are both strongly associated with reduced risk of death among acute opioid overdose survivors • Unfortunately, less than one-third of study patients received any MOUD in the year following non-fatal overdose. • Addressing the opioid crisis will require changes in systems of care to increase engagement and retention of high-risk groups in methadone or buprenorphine treatment. www.aodhealth.org

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