BACKGROUND AND AIMS Evidence from randomized controlled trials establishes that medication treatment with methadone and buprenorphine reduces opioid use and improves treatment retention. However, little is known about the role of such medications compared with non-medication treatments in mitigating overdose risk among US patient populations receiving treatment in usual care settings. This study compared overdose mortality among those in medication versus non-medication treatments in specialty care settings. DESIGN Retrospective cohort study using state-wide treatment data linked to death records. Survival analysis was used to analyze data in a time-to-event framework. SETTING Services delivered by 757 providers in publicly funded out-patient specialty treatment programs in Maryland, USA between 1 January 2015 and 31 December 2016. PARTICIPANTS A total of 48 274 adults admitted to out-patient specialty treatment programs in 2015-16 for primary diagnosis of opioid use disorder. MEASUREMENTS Main exposure was time in medication treatment (methadone/buprenorphine), time following medication treatment, time exposed to non-medication treatments and time following non-medication treatment. Main outcome was opioid overdose death during and after treatment. Hazard ratios were calculated using Cox proportional hazard regression. Propensity score weights were adjusted for patient information on sex, age, race, region of residence, marital and veteran status, employment, homelessness, primary opioid, mental health treatment, arrests and criminal justice referral. FINDINGS The study population experienced 371 opioid overdose deaths. Periods in medication treatment were associated with substantially reduced hazard of opioid overdose death compared with periods in non-medication treatment [adjusted hazard ratio (aHR) = 0.18, 95% confidence interval (CI) = 0.08-0.40]. Periods after discharge from non-medication treatment (aHR = 5.45, 95% CI = 2.80-9.53) and medication treatment (aHR = 5.85, 95% CI = 3.10-11.02) had similar and substantially elevated risks compared with periods in non-medication treatments. CONCLUSIONS Among Maryland patients in specialty opioid treatment, periods in treatment are protective against overdose compared with periods out of care. Methadone and buprenorphine are associated with significantly lower overdose death compared with non-medication treatments during care but not after treatment is discontinued.

中文翻译：

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接受阿片类药物使用障碍服务的全州美国人群的阿片类药物激动剂治疗和致命的过量风险

背景和目的 来自随机对照试验的证据表明，使用美沙酮和丁丙诺啡进行药物治疗可减少阿片类药物的使用并提高治疗保留率。然而，对于在常规护理环境中接受治疗的美国患者人群，与非药物治疗相比，此类药物在减轻药物过量风险方面的作用知之甚少。该研究比较了在专业护理环境中接受药物治疗与非药物治疗的患者的过量死亡率。设计 回顾性队列研究使用与死亡记录相关的全州治疗数据。生存分析用于在事件时间框架中分析数据。2015 年 1 月 1 日至 2016 年 12 月 31 日期间，由 757 家提供者在美国马里兰州公共资助的门诊专科治疗项目中提供的服务。参与者 2015-16 年共有 48,274 名成年人因阿片类药物使用障碍的初步诊断而进入门诊专科治疗计划。测量主要暴露是药物治疗时间（美沙酮/丁丙诺啡）、药物治疗后时间、非药物治疗时间和非药物治疗时间。主要结局是治疗期间和治疗后阿片类药物过量死亡。使用 Cox 比例风险回归计算风险比。根据性别、年龄、种族、居住地区、婚姻和退伍军人状况、就业、无家可归、主要阿片类药物、心理健康治疗、逮捕和刑事司法转介等患者信息调整倾向评分权重。结果 研究人群经历了 371 例阿片类药物过量死亡。与非药物治疗期间相比，药物治疗期间阿片类药物过量死亡的风险显着降低 [调整后的风险比 (aHR) = 0.18，95% 置信区间 (CI) = 0.08-0.40]。与非药物治疗期间相比，非药物治疗（aHR = 5.45，95% CI = 2.80-9.53）和药物治疗（aHR = 5.85，95% CI = 3.10-11.02）出院后的风险相似且显着升高治疗。结论 在接受特殊阿片类药物治疗的马里兰州患者中，与治疗期间相比，治疗期间可以防止药物过量。与护理期间的非药物治疗相比，美沙酮和丁丙诺啡与显着降低的过量死亡相关，但在治疗停止后则不然。