Vast Majority of US Adults Experiencing Nonfatal Opioid Overdose Do Not Receive Treatment

In the US, few people who could benefit from opioid use disorder (OUD) treatment receive it, including those who experience nonfatal opioid overdoses. This study used 5 years of claims data for 6451 commercially insured adults who were treated for opioid overdose in an emergency department to investigate OUD treatment receipt within 90 days of the overdose. OUD treatment receipt was defined as receiving buprenorphine or naltrexone, or inpatient or outpatient treatment encounters. Methadone was not covered by insurance for these patients during the study period, so it was not included.

• 17% of patients received OUD treatment within 90 days post-overdose.
• The majority of patients (n=5769) had not received OUD treatment in the 90 days before their overdose, and only 11% of these patients received OUD treatment in the 90 days post-overdose.
• Patients with prescription opioid overdoses were less likely to receive OUD treatment than those with heroin overdoses.
• In stratified analyses examining patients who were not receiving OUD treatment in the 90 days before their overdose, Black, Hispanic, female, and younger patients were less likely to receive OUD treatment than white, male, and older patients.

Comments: Despite study limitations, including an inability to determine patients’ access to methadone, these data demonstrate that even commercially insured patients rarely receive OUD treatment following an overdose. Initiating buprenorphine in the emergency department is feasible and effective, and other interventions are needed to facilitate treatment entry following an overdose. However, a better understanding why people do not enter treatment following an overdose is most critical for designing patient-centered treatment and harm-reduction interventions that could reduce overdose deaths.

Aaron D. Fox, MD

Reference: Kilaru AS, Xiong A, Lowenstein M, et al. Incidence of treatment for opioid use disorder following nonfatal overdose in commercially insured patients. JAMA Netw Open. 2020;3(5):e205852.