People who experience an opioid overdose are at greater risk of death, but data on which opioid agonist treatments are most effective in supporting this high-risk population are limited.In a retrospective cohort study of opioid overdose survivors, starting methadone was associated with a reduced risk of death during the subsequent year compared with starting buprenorphine-naloxone.In an accompanying commentary, experts questioned whether methadone is truly "intrinsically superior" to buprenorphine-naloxone.
For opioid overdose survivors, starting methadone was associated with a reduced risk of death during the subsequent year compared with starting buprenorphine-naloxone, a retrospective cohort study from Canada suggested.
Using a target trial emulation among over 5,800 individuals with past-year opioid overdose, 5.6% of those who started methadone died within 1 year compared with 7.1% of those who started buprenorphine-naloxone (HR 0.78, 95% CI 0.63-0.95, P=0.01), reported Robert A. Kleinman, MD, MSc, of the Center for Addiction and Mental Health in Toronto, and co-authors.
Of the 375 individuals who died within 1 year, opioid overdose was identified as a cause of death in 264. Of those who started on methadone, 3.8% died of an opioid overdose versus 5.1% of those in the buprenorphine-naloxone group, they reported in JAMA Network Open.
