Mortality Associated With Time in and Out of Buprenorphine Treatment in French Office-Based General Practice: A 7-Year Cohort Study

Julie Dupouy; Aurore Palmaro; Mélina Fatséas; Marc Auriacombe; Joëlle Micallef; Stéphane Oustric; Maryse Lapeyre-Mestre

doi:10.1370/afm.2098

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Table 1

Characteristics of Outpatients Initiating Buprenorphine Treatment for Opioid Use Disorders, Overall and According to Vital Status

Characteristic	Overall (N=713)	Vital Status

		Alive (n=684)	Deceased (n=29)	P Value
Sex, No. (%)				.16
Male	535 (75.0)	510 (74.6)	25 (86.2)
Female	178 (25.0)	174 (25.4)	4 (13.8)
Age at first buprenorphine claim, mean (SD), y	32.9 (9.0)	32.6 (8.9)	41.0 (9.2)	<.001
Status of beneficiary related to health				.21
insurance affiliation, No. (%)
Insured	678 (95.1)	649 (94.9)	29 (100.0)
Relative	35 (4.9)	35 (5.1)	0 (0.0)
Universal insurance coverage, No. (%)	296 (41.5)	284 (41.5)	12 (41.4)	.99
Specialty of first buprenorphine prescriber, No. (%)				1.00
General practitioner	683 (95.8)	654 (95.6)	29 (100.0)
Psychiatrist	10 (1.4)	10 (1.5)	0 (0.0)
Other specialist	9 (1.3)	9 (1.3)	0 (0.0)
Not determined	11 (1.5)	11 (1.6)	0 (0.0)
Practice of first buprenorphine prescriber, No. (%)				.69
Private practice	604 (84.7)	579 (84.6)	25 (86.2)
Salaried in a private establishment	92 (12.9)	88 (12.9)	4 (13.8)
Not determined	17 (2.4)	17 (2.5)	0 (0.0)
Deprivation index (FDep08^a), mean (SD)	0.4 (1.6)	0.4 (1.6)	0.1 (1.5)	.41
Charlson comorbidity index,^b No. (%)				.006
0	606 (85.0)	587 (85.8)	19 (65.5)
1	85 (11.9)	78 (11.4)	7 (24.1)
≥2	22 (3.1)	19 (2.8)	3 (10.3)
Health insurance coverage for a psychiatric disorder, No. (%)	55 (7.7)	51 (7.5)	4 (13.8)	.21
Hospitalization, No. (%)
For a psychiatric disorder	25 (3.5)	23 (3.4)	2 (6.9)	.31
For another disorder	106 (14.9)	100 (14.6)	6 (20.7)	.37
Use of opioid analgesics, No. (%)	429 (60.2)	417 (61.0)	12 (41.4)	.04
Morphine	39 (5.5)	36 (5.3)	3 (10.3)	.21
Codeine, combinations	212 (29.7)	207 (30.3)	5 (17.2)	.13
Dextropropoxyphene, combinations	133 (18.7)	127 (18.6)	6 (20.7)	.77
Tramadol	134 (18.8)	129 (18.9)	5 (17.2)	.83
Tramadol, combinations	227 (31.8)	221 (32.3)	6 (20.7)	.19
Use of other medications, No. (%)
Benzodiazepines and similar	538 (75.5)	512 (74.9)	26 (89.7)	.08
Antidepressants	304 (42.6)	286 (41.8)	18 (62.1)	.03
Antipsychotics	216 (30.3)	206 (30.1)	10 (34.5)	.62
Antiepileptics	107 (15.0)	100 (14.6)	7 (24.1)	.18
Drugs for alcohol dependence	72 (10.1)	69 (10.1)	3 (10.3)	.96

↵a An ecological estimator of social deprivation. Range is generally −1 (most socially disadvantaged) to +1 (least socially disadvantaged).
↵b Range is 0 to 37; higher scores indicate greater comorbidity and predict higher 1-year mortality.

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Table 2

Factors Associated With Mortality Among Outpatients With Opioid Use Disorder Treated With Buprenorphine, in Univariate and Multivariate Cox Models

Factor	Crude Hazard Ratio (95% CI)	P Value	Adjusted Hazard Ratio (95% CI)	P Value
Buprenorphine treatment: out vs in	33.22 (11.56–95.50)	<.001	29.04 (10.04–83.99)	<.001
Age, y
<30	Ref		Ref
30–40	1.37 (0.42–4.48)	.61	1.08 (0.33–3.54)	.90
>40	6.47 (2.40–17.43)	<.001	3.94 (1.45–10.69)	.007
Charlson comorbidity index
0	Ref		–	–
1	2.68 (1.23–6.37)	.03
≥2	4.75 (1.41–16.08)	.01
Sex: female vs male	0.49 (0.17–1.41)	.18	–	–
Medication use
Opioid analgesics	0.40 (0.19–0.83)	.01	0.37 (0.18–0.79)	.01
Antidepressants	2.06 (0.97–4.37)	.06	–	–
Benzodiazepines (and similar)	2.61 (0.79–8.62)	.12	–	–

Ref=reference group.

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The Article in Brief

Mortality Associated With Time in and Out of Buprenorphine Treatment in French Office-Based General Practice: A 7-year Cohort Study

Julie Dupouy , and colleagues

Background This study investigates mortality in outpatients in France with opioid use disorder treated by buprenorphine, focusing on periods in and out of buprenorphine treatment.

What This Study Found Buprenorphine reduces mortality for those with opioid use disorder, but periods off treatment are associated with much higher mortality rates. The mortality rate for study subjects was 0.63/100 person-year, compared to 0.24/100 person-year for other individuals of the same age range during the same time period.

Implications

The authors encourage physicians to avoid interruption of treatment and encourage patients to remain in treatment for a sufficient amount of time.