What treatment path is most effective for Opioid Use Disorder?

What is the real-world effectiveness of different treatment pathways for opioid use disorder?

A new study was just published, using insurance claims from 40,000 adults with opioid use disorder. The study wanted to see which treatment paths led to reduced chance of overdose or drug related ER visits. 

The study compared 6 different treatment pathways:
(1) no treatment,
(2) inpatient detoxification or residential services,
(3) intensive behavioral health (IOP),
(4) buprenorphine (Suboxone) or methadone,
(5) naltrexone (Vivitrol)
(6) nonintensive behavioral health

What kind of treatment path was the most common? The most common treatment pathway was nonintensive behavioral health (59%), followed by inpatient detox or residential rehab (16%) and buprenorphine/suboxone or methadone (13%). Five percent received no treatment, which was more common than naltrexone (2.4%) or intensive behavioral health (4.8%). Average length of stay in inpatient detoxification or residential services was one week. Average length of buprenorphine/suboxone or methadone use was two months. 

What did the results tell us about real-world effectiveness of different treatment pathways? Only treatment with buprenorphine/suboxone or methadone was associated with reduced risk of overdose and serious opioid-related acute care. For those on medication for the opioid use disorder, longer medication was better. The best results in the study was for those who used their medications for at least six months (1% experienced an overdose in the 12 months). 

What can we learn from this study? Despite the known benefit of medication treatment with buprenorphine or methadone, only 12.5% initiated these evidence-based treatments. Instead, most received psychosocial services alone or inpatient detoxification, both of which are less effective than medication alone. Considering this, removing barriers to medication use may help with medication initiation and retention and reduce overdose and drug related emergency medical problems.