ORN Summer 2026 - Towards Personalized Medicine for Opioid Use Disorder: Analyses of Data from the Veterans Health Administration-Handout - ORN Summer 2026

Handout - ORN Summer 2026 - Hayes

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This presentation summarizes two Veterans Health Administration studies on opioid use disorder (OUD) treatment with medications for opioid use disorder (MOUD): buprenorphine, methadone, and extended-release naltrexone.

<strong>Objective 1</strong> examined which patient characteristics were linked to early MOUD discontinuation and overdose. Using electronic health record data from veterans initiating MOUD between 2010 and 2020, the study found that preventing early discontinuation could substantially reduce overdose risk for <strong>buprenorphine</strong> patients. If all buprenorphine patients stayed on treatment for 180 days, projected overdose within one year would be much lower than if everyone discontinued early. For <strong>methadone</strong>, early discontinuation had little apparent effect on overdose rates. Factors associated with buprenorphine discontinuation were often social or structural rather than purely clinical: higher income, living in areas with lower racial/ethnic vulnerability, and lower prior hospitalization burden were protective, while prior non-psychiatric inpatient admissions and Black race were associated with greater risk of early discontinuation. The authors suggest these patterns likely reflect social determinants of health, stress, and barriers outside routine clinical care.

<strong>Objective 2</strong> asked whether the usual 180-day treatment duration is long enough. Using an illness-death survival model, the study found that <strong>longer MOUD duration was associated with better 6-year survival</strong> for all groups studied, with the largest gains among higher-risk patients, especially 50-year-old men. Benefits continued beyond 180 days and generally up to 2–4 years depending on subgroup, though gains tended to level off over time. No point was found where longer treatment reduced survival.

<strong>Bottom line:</strong> MOUD saves lives, longer treatment is often beneficial, and treatment duration should be individualized based on patient risk and preferences.

Keywords

opioid use disorder

MOUD

buprenorphine

methadone

naltrexone

overdose risk

treatment discontinuation

survival analysis

Veterans Health Administration

social determinants of health