Among People Admitted for an Overdose, Opioid Agonist Treatment is Associated With a Decreased Risk of Future Overdose

Overdose is a major risk for people who use drugs. This study assessed the impact of various treatment modalities on the risk of subsequent overdose in a cohort of people (N=4089) with a non-fatal opioid-related overdose admitted to a hospital or emergency department in Connecticut, May 2016–December 2017.

• The average age was 41 years; 65 percent of the cohort was male, and 74 percent identified as non-Hispanic White.
• Overall, 56 percent of the cohort did not receive substance use disorder treatment in the 12 months following the index overdose; 35 percent received opioid agonist treatment (OAT; 25 percent buprenorphine, 13 percent methadone), and 21 percent received inpatient treatment (19 percent for withdrawal, 8 percent for extended inpatient treatment).
• Following the index overdose, 11 percent (n=467) experienced another opioid-related overdose within 12 months; 19 percent (n=87) of these overdoses had a fatal outcome, representing 2 percent of the overall sample.
• In adjusted survival analyses,* receipt of methadone or buprenorphine was associated with a decreased risk of subsequent overdose (adjusted hazard ratio [aHR], 0.41 and 0.72, respectively).
• Medically managed opioid withdrawal or extended inpatient treatment were not associated with a decreased risk of subsequent overdose (aHR, 1.08 and 0.90, respectively).
• No treatment modality was significantly associated with a decreased risk of fatal overdose.
• Exposure to benzodiazepines was associated with an increased risk of any overdose and of fatal overdose (aHR, 1.46 and 2.65, respectively).

* Adjusted for demographics, incarceration, receipt of opioids besides OAT, and receipt of benzodiazepines.

Comments: While this study likely lacked power to assess the impact of treatment modalities on fatal overdose, it underscores the critical importance of OAT for opioid use disorder. As only a minority of patients in this cohort received OAT, public health and policy interventions should support widespread access to OAT in order to prevent subsequent overdoses.

Nicolas Bertholet, MD, MSc

Reference: Howell BA, Black A, Lin HJ, et al. Receipt of addiction treatment after nonfatal opioid overdose and risk of subsequent overdose: A retrospective cohort study. Drug Alcohol Depend. 2025;273:112679.