Study data published in JAMA Network Open suggest that medications used to treat opioid use disorder (OUD) may also reduce the risk for alcohol-related acute events. In a nationwide study of patients with OUD, buprenorphine, methadone, and naltrexone were each associated with substantially reduced risk for subsequent alcohol-related hospital admissions. These data support the use of OUD pharmacologic treatment for patients with co-occurring OUD and alcohol use disorder (AUD).
Investigators conducted a case-control cohort study using prescription claims extracted from the IBM MarketScan Insurance databases between January 1, 2006 and December 31, 2016. The analytic sample comprised individuals aged 12-64 years in the United States with a diagnosis of OUD.
Eligible patients had received an OUD medication at least once and had at least 1 prior alcohol-related hospital admission. Patients entered the cohort at the first event subsequent to first initiation of OUD.
The primary outcome was hospital admission for any acute alcohol-related event. Exposures of interest included days of active OUD medication prescription and type of OUD medication.
Logistic regression was used to examine the relationship between OUD therapy and hospital admission for alcohol-related acute events. Stratified analyses were also conducted to compare patients with OUD only and patients with co-occurring OUD and AUD.
The final study cohort comprised 13,335 unique patients with OUD, among whom 44.1% were women. Mean age at index date was 33.1 ± 13.1 years and mean observation time was 627.6 days per patient.
In total, 19.6% of patients had claims for more than 1 acute alcohol-related event. The distribution of patients by OUD treatment was as follows: 6299 (47.2%) received buprenorphine in the year before and after the index event; 24.3% received oral naltrexone; 1096 (8.2%) received extended-release naltrexone; and 667 (5.0%) received methadone. In regression models, buprenorphine (odds ratio [OR], 0.57; 95% CI, 0.52-0.61) and methadone (OR, 0.34; 95% CI, 0.26-0.45) were each associated with substantially reduced risk for alcohol-related acute events.
Treatment with naltrexone was also associated with reduced risk for hospitalization compared with non-treatment, with a 37% reduction for extended-release naltrexone (OR, 0.63; 95% CI, 0.52-0.76) and a 16% reduction for oral naltrexone (OR, 0.84; 95% CI, 0.76-0.93). The impact of naltrexone on alcohol-related acute events was more pronounced in patients with recent AUD claims compared to patients without recent AUD claims.
Results from this study support the use of OUD pharmacologic treatments for patients with OUD and co-occurring AUD. These medications also reduced the risk for alcohol-related acute events in patients with OUD only, though the relationship was less pronounced. The primary study limitation was the use of insurance claims data, which naturally excludes uninsured individuals. Additionally, adherence to OUD medications was unknown.
“The findings of this study suggest that OUD medications are associated with decreased hospital admissions for alcohol-related acute events among persons with OUD,” the investigators wrote. “[Our] study raises key questions about the potential of OUD medications for reducing alcohol-related events and highlights the need for additional research in this area.”
Xu KY, Presnall N, Mintz CM, et al. Association of opioid use disorder treatment with alcohol-related acute events. JAMA Netw Open. 2021;4(2):e210061. doi:10.1001/jamanetworkopen.2021.0061