1. Alcohol, Other Drugs, and Health: Current Evidence
Journal Club
Alcohol, Other Drugs, and Health: Current Evidence
November–December 2018

2. Larochelle MR, et al. Ann Intern Med. 2018;169(3):137–145.
Featured Article
Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study
Larochelle MR, et al. Ann Intern Med. 2018;169(3):137–145.

3. Study Objective
Among opioid overdose survivors, to determine the risk of subsequent fatal overdose, and assess the association between the receipt of medication for opioid use disorder (MOUD) and subsequent mortality.

4. Study Design
Retrospective cohort of (N=17,568) opioid overdose survivors, created by linking multiple Massachusetts administrative systems ( )

5. Assessing Validity of an Article about Prognosis
Are the results valid?
What are the results?
How can I apply the results to patient care?
Based on the Users’ Guides to the Medical Literature; for more information, see the following:

6. Are the Results Valid? Was the sample representative?
Were the subjects sufficiently homogeneous with respect to prognostic risk?
Was follow-up sufficiently complete?
Were objective and unbiased outcome criteria used?

7. Was the sample representative?
Yes, of opioid overdose survivors who received medical care following the index overdose event.

8. Were the subjects sufficiently homogeneous with respect to prognostic risk?
Yes. Participants were 17,568 adults without cancer who had all survived an opioid overdose between 2012 and 2014.

9. Was follow-up sufficiently complete?
Yes

10. Were objective and unbiased outcome criteria used?
Yes, primary outcome was all-cause and opioid-related mortality

11. What Are the Results? How likely are the outcomes over time?
How precise are the estimates of likelihood?

12. How likely are the outcomes over time?
For the 12 months after the index overdose, the all-cause death rate was 4.7 per 100 patient-years and the opioid-related death rate was 2.1 per 100 patient-years.
Compared with no MOUD, the adjusted hazard ratio for all-cause mortality was 0.47 for methadone, 0.63 for buprenorphine, and 1.44 (but non-significant) for naltrexone.
Similar hazard ratios were found for opioid-related mortality.

13. How precise are the estimates of likelihood?
Compared with no MOUD, the adjusted hazard ratio for all-cause mortality was 0.47 (95% CI ) for methadone, 0.63 (95% CI ) for buprenorphine, and 1.44 (95% CI ) for naltrexone.

14. How Can I Apply the Results to Patient Care?
Were the study patients and their management similar to those in my practice?
Was follow-up sufficiently long?
Can I use the results in the management of patients in my practice?

15. Were the study patients similar to those in my practice?
The study population was large, drawn from one state, and sampled on recent opioid overdose survivors.

16. Was follow-up sufficiently long?
Yes, one year.

17. Can I use the results in the management of patients in my practice?
Yes. Methadone and buprenorphine are both strongly associated with reduced risk of death among acute opioid overdose survivors
Unfortunately, less than one-third of study patients received any MOUD in the year following non-fatal overdose.
Addressing the opioid crisis will require changes in systems of care to increase engagement and retention of high-risk groups in methadone or buprenorphine treatment.