Buprenorphine/naloxone Was Superior to Extended-release Naltrexone for Opioid Use Disorder Treatment Retention Among Medicaid Patients

The comparative effectiveness of buprenorphine/naloxone (SL-BUP) and extended-release naltrexone (XR-NTX) for opioid use disorder (OUD) treatment has been the subject of clinical trials and observational studies. This observational study evaluated the relative treatment retention and overdose risk of SL-BUP and SR-NTX among New Jersey and California Medicaid patients from 2016 to 2019.

• The cohort included 1755 patients who were initiated on XR-NTX and 9886 initiated on SL-BUP who had not received medication for OUD (MOUD) in the preceding 90 days.
• The cumulative risk of treatment discontinuation or death within six months was 76 percent for patients receiving XR-NTX and 62 percent for those receiving SL-BUP, with a significant risk difference of 14 percent favoring SL-BUP.
• The cumulative risk of overdose or death within six months was 3.9 percent for patients receiving XR-NTX and 3.3 percent for those receiving SL-BUP, with a statistically insignificant risk difference of 0.5 percent favoring SL-BUP.

Comments: SL-BUP has significant advantages over XR-NTX for OUD treatment, primarily its comparative ease of initiation, though some carceral settings favor its use. This study demonstrates that even among patients who initiate XR-NTX, real-world treatment retention is lower than among those receiving SL-BUP. While no differences in overdose risk were seen in this study, reliance on Medicaid claims data to identify overdose likely underestimates these events and limits medication comparisons.

Joseph Merrill, MD, MPH

Reference: Ross RK, Nunes EV, Olfson M, et al. Comparative effectiveness of extended-release naltrexone and sublingual buprenorphine for treatment of opioid use disorder among Medicaid patients. Addiction. 2024 Nov;119(11):1975–1986.