Opioid treatment linked to lower mortality

Being on opioid agonist treatment was associated with much lower mortality than being off treatment.
*Retrospective nationwide cohort study; Level 2 (OCEBM).

Citation

Dupouy J, Druel V, Verges Y, Pariente A, Lapeyre-Mestre M. Lancet Public Health. 2026;11:e449-e456.

Background

Opioid agonist treatment reduces overdose and death risk, but long-term primary care data are limited where buprenorphine is widely used. France offers a useful setting because buprenorphine is commonly prescribed in primary care.

Patients

175,191 French patients aged 15 years or older who newly started opioid agonist treatment from 2010 to 2022. Patients were excluded if younger than 15, not new users, lacked two consecutive dispensings within 35 days, or started in 2023.

Intervention

Time periods when patients were receiving buprenorphine, methadone, or buprenorphine-naloxone.

Control

Time periods when the same patients were off opioid agonist treatment.

Outcome

Primary outcome: all-cause death at 1 year. Secondary outcomes: all-cause death at 2, 5, and 7 years, plus cause-specific death.

Follow-up Period

Median 3320 days; outcomes assessed through 7 years.

Results

Outcome Finding
All-cause death at 1 year (primary) Adjusted hazard ratio 0.41 (95% CI 0.37-0.44); 21.45 fewer deaths per 1000 person-years; NNT ≈ 47 person-years.
All-cause death at 2, 5, and 7 years Adjusted hazard ratios: 0.36, 0.36, and 0.40, respectively.
Buprenorphine at 1 year Adjusted hazard ratio 0.16 (95% CI 0.14-0.18).
Methadone at 1 year Adjusted hazard ratio 0.58 (95% CI 0.53-0.64).
Cause-specific deaths at 1 year Lower injury or poisoning deaths, drug-related deaths, accidental overdose deaths, infection-related deaths, and suicide.

CI: confidence interval; NNT: number needed to treat.

Analyses used time-dependent treatment status. The comparison was off-treatment time, not another active standard treatment.

Limitations

Observational design cannot prove causation. Treatment exposure was based on dispensing records, not confirmed use. Buprenorphine may appear especially protective partly because lower-risk patients received it. Results may not fully apply where fentanyl is common or health coverage differs.

Funding

French public agencies; funders had no study role.

Clinical Application

Clinicians should actively offer and maintain opioid agonist treatment, especially accessible primary care-based care, to reduce mortality in opioid use disorder.