Population-Level Health Benefits and Harms Associated With Buprenorphine/Naloxone vs Methadone
Bibliographic record
Abstract
Importance: In 2017, British Columbia guidelines changed the preferred first-line treatment for opioid use disorder from methadone to buprenorphine/naloxone. Systematic reviews have consistently shown better treatment retention associated with methadone, while studies have reported a reduced risk of mortality associated with buprenorphine/naloxone, causing confusion in interpretation for clinical guidelines. Objective: To estimate the population-level health benefits and harms associated with buprenorphine/naloxone vs methadone for treatment of opioid use disorder, accounting for differences in treatment retention and risk of mortality while receiving treatment. Design, setting, and participants: This decision analytic model analysis was conducted from January 1, 2010, to March 17, 2020, using a semi-Markov cohort model and linked population-level health administrative data on all individuals presenting for opioid agonist treatment in British Columbia, Canada. Hazard ratios were estimated for the association of buprenorphine/naloxone vs methadone with treatment discontinuation (breaks in dispensations lasting ≥5 days for methadone and ≥6 days for buprenorphine/naloxone) and mortality while receiving treatment (per protocol). Treatment episodes in primary analysis were based on the medication initiated (initiator analysis). Probabilistic (mean estimates and 95% credible intervals from 10 000 simulations) and deterministic sensitivity analyses were conducted. Data were analyzed between August 2023 and October 2024. Exposure: Alternative treatment policies in which buprenorphine/naloxone or methadone were exclusively available to individuals presenting for opioid agonist treatment. Main outcome and measures: Incremental life-years, fatal overdoses, and all-cause deaths. Results: The study population included 40 461 individuals with 109 126 cumulative person-years of follow-up (median [IQR] age, 33 [23-43] years; 66.0% [range, 56.0%-76.0%] male). A policy of exclusively buprenorphine/naloxone was estimated to have -1602 incremental life-years (95% credible interval, -3249 to -549 life-years) compared with methadone, with an additional 221 fatal overdoses (95% credible interval, 119 to 376 overdoses) and 303 all-cause deaths (95% credible interval, 120 to 589 deaths) over a 10-year period. Conclusions and relevance: Results from this study suggest that any advantages from a reduced risk of mortality with treatment with buprenorphine/naloxone were outweighed by deficits in treatment retention. Evaluated in a jurisdiction where both medications were available in office-based settings, these findings do not support recommendations of buprenorphine/naloxone as first-line treatment over methadone.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.027 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".