Meds reduce risk of fatal opioid OD

Methadone, buprenophine a step forward in treatment

Using methadone and buprenorphine following non-fatal opioid overdoses can save lives, a new study funded by the National Institutes of Health has found.

The data, while not surprising to local experts, represents a step forward in treating the growing crisis of opioid dependency, they said.

“Both of those drugs have the ability to reduce cravings without giving patients the same amount of euphoria” as heroin and other opioids, said Dr. Michael Werdmann, emergency physician at Bridgeport Hospital. “That’s why it’s been accepted as a reasonable therapy.”

Methadone and buprenorphine — which is used in such products as Suboxone — are both opioids themselves but have long been used to help treat opioid dependence. Supporters of the medications say they reduce withdrawal and prevent relapse; critics say that, since the drugs also have abuse potential, treatment with them is tantamount to replacing one addiction with another.

Authors of the NIH study analyzed data from 17,568 adults in Massachusetts who survived an opioid overdose between 2012 and 2014. The researchers found that, compared with those who did not receive treatment with any medications, those who

received treatment with methadone had a 59 percent lower rate of opioid overdose deaths a year after the initial overdose, and those treated with buprenorphine had a 38 percent lower death rate.

The authors weren’t able to draw conclusions about the effectiveness of a third medication used to treat opioid dependence — naltrexone — because it didn’t have a large enough sample group using the product.

The NIH study backs up research that’s been done in the past.

In 2015, Dr. Gail D’Onofrio, chair of the department of emergency medicine at the Yale School of Medicine, led a study looking at how buprenorphine affected the rate of patient treatment after initial emergency department visits. The study showed that the drug doubled the rate of those still in treatment 30 days after the first visit.

D’Onofrio and colleague Dr. Edward Melnick are working on a project to research widespread implementation of buprenorphine treatment for opioid dependence at the emergency department level. Melnick, assistant professor of emergency medicine at Yale, did not find anything

revolutionary in the new NIH study. “It’s not a surprise — the efficacy of these medications for opioid use disorder is well-established,” he said.

However, there are still some barriers to the widespread use of the buprenorphine and other medications at the emergency department level. One of

the main barriers is the relative newness of the treatment, Melnick said.

“It’s not part of routine care,” he said. “People aren’t familiar with it.”

Indeed, the NIH study found that, in the first year following an overdose, less than one third of patients were provided any medication for opioid dependence. Only 11 percent were given methadone, 17 percent were given buprenorphine and 6 percent were given naltrexone. About 5 percent were given more than one medication.

Opioid addiction is a growing health crisis, nationally and in Connecticut. In 2017, there were 1,038 accidental drug deaths in the state — the highest number since at least 2012. Many of these deaths involved opioids in some way.

The NIH data is valuable, and proves what many health professionals have known for some time, said Andre Newfield, chair of psychiatry at St. Vincent’s Medical Center in Bridgeport. When people detox from opiates, but aren’t given any kind of prescription treatment, they can be especially vulnerable to a fatal overdose.

“We want to protect patients by not just getting them into detox, but getting them care that puts them at a lower risk (of death,)” Newfield said.