A new study from Boston Medical Center researchers underscores the importance of keeping people struggling with opioid addiction engaged with treatment to increase their chances of survival after inpatient detox.
The study, published Tuesday in the journal Addiction, found that people who received further treatment, either medication-assisted or residential treatment, after completing inpatient detox for opioid use disorder were more likely to survive in the 12 months following their discharge.
“Opioid use disorder is a chronic condition best addressed with ongoing treatment,” Alexander Walley, a researcher at BMC’s Grayken Center for Addiction who was involved with the study, said in a statement. “The data from our study shows that medication and residential treatment for opioid use disorder reduce the risk of overdose and death, but these treatments need to continue in order to be effective.”
Inpatient, medically-managed withdrawal detox remains one of the most common ways people struggling with opioid addiction seek treatment, the researchers said. But many people do not seek continued treatment after they are discharged. Without the medication-assisted treatment, people struggling with addiction end up leaving detox with a reduced opioid tolerance, which increases their risk of overdose to rates higher than when they entered inpatient treatment, according to BMC.
“Previous studies have shown that FDA-approved medications for opioid use disorder work by reducing opioid use, keeping people in treatment and, for methadone and buprenorphine, decreasing mortality,” Walley said. “For this study, we looked specifically at mortality after discharge from detox based on further treatment with medication for opioid use disorder and residential treatment.”
For the study, the BMC researchers, in collaboration with the Massachusetts Department of Public Health, focused on people 18 and older in the Bay State who went through detox between January 2012 and December 2014, examining the mortality rates in the 12 months after detox for people who received treatment, either medication-assisted or residential, and those who did not.
Less than half of the individuals included in the study received further treatment after detox, according to BMC.
The researchers found a high all-cause mortality rate for individuals who received no treatment after detox, 2 percent per year, with overdoses as the primary cause of death.
Researchers found 15 percent of the individuals in the study received medication-assisted treatment in the month following their discharge, and for those who continued with the treatment — compared to those who received no treatment — mortality was decreased by 66 percent. For the 17 percent of individuals who opted for residential treatment, which typically does not include medication, mortality was reduced by 37 percent.
“Only three percent of those in the study received both medication for OUD and residential treatment, and their all-cause mortality was reduced by 89 percent compared to those who received no treatment,” BMC said in a statement.
The findings of the study emphasize how medication-assisted and residential treatment can be especially effective in helping increase the chances of survival for those at the highest risk struggling with opioid addiction, researchers said.
“It is important to consider the initiation of medication during detox, as well as the expansion of the care system that would enable better collaboration between residential treatment centers and [medication for opioid use disorder] programs to improve access to medication and increase the number of people remaining in treatment,” Walley said.
Earlier this month, Massachusetts health officials announced that the rate of opioid-related overdose deaths in the state declined 5 percent in 2019 from the peak seen in 2016. There were 2,023 confirmed and estimated opioid-related overdose deaths in 2019. Fentanyl, the deadly synthetic opioid, remains the driver of opioid-related overdose deaths; it was present in 93 percent of the opioid-related overdoses from January to September of 2019.