Opioid Use Disorder Treatment is Associated with Decreased Alcohol-Related Acute Events

Introduction: Persons with opioid use disorder (OUD) and co-occurring alcohol use are understudied and undertreated. It is unknown if OUD medication can reduce the risk of alcohol-related morbidity.

Objective: To determine if the use of OUD medications is associated with decreased risk for alcohol-related accidents and poisonings in persons with OUD with and without co-occurring AUD.

Methods: This case-crossover study utilized prescription claims from IBM® MarketScan® insurance databases from January 1, 2006 to December 31, 2016. The sample included persons (ages 12-64) in the United States with an OUD diagnosis and taking OUD medication who had at least one alcohol-related admission Unit of observation was person-day. There were 8,424,214 person-days of observation time among 13,335 OUD patients. Exposures included days of active OUD medication prescriptions, with either agonist treatments (buprenorphine, methadone) or naltrexone (oral, extended-release) compared to days without OUD prescriptions. The primary outcome was admission for any acute alcohol-related event defined by ICD-9 and 10 codes. We used conditional logistic regression to compare OUD medication use between days with and without an alcohol-related event. Stratified analyses were conducted between OUD patients with and without a recent AUD diagnostic code.

Results:  13,335 participants who received OUD medications and experienced an alcohol-related admission (mean age 33 years, 44% female) were included in the study. Agonist treatments, buprenorphine and methadone, were respectively associated with 43% (OR=0.57, 95% CI: 0.52-0.61) and 66% (0.34 [0.26-0.45]) reductions in odds of any alcohol-related acute event relative to non-treatment days. Antagonist treatments, naltrexone extended-release and oral, were associated with 37% (0.63 [0.52-0.76]) and 16% (0.84 [0.76-0.93]) reductions in events compared to non-medication days. Naltrexone was more prevalent among OUD patients with recent AUD claims than peers without AUD claims.

CONCLUSIONS and RELEVANCE: OUD medication is associated with fewer admissions for alcohol-related acute events in OUD patients with co-occurring alcohol use.

References: 1. Cicero TJ, Ellis MS, Kasper ZA. Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis. Am J Public Health. 2020;110(2):244-250.
2. Jones CM, McCance-Katz EF. Co-occurring substance use and mental disorders among adults with opioid use disorder. Drug Alcohol Depend. 2019;197:78-82.
3. Witkiewitz K, Vowles KE. Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcohol Clin Exp Res. 2018;42(3):478-488.
4. Dong H. HK, Milloy M-J., DeBeck, K., Singer, J., Wong, H., Wood, E., Kerr T. Changes in substance use in relation to opioid agonist therapy among people who use drugs in a Canadian setting. Drug Alcohol Depend. 2020;212:108005.
5. Hickman M, Lingford-Hughes A, Bailey C, Macleod J, Nutt D, Henderson G. Does alcohol increase the risk of overdose death: the need for a translational approach. Addiction. 2008;103(7):1060-1062.