Table 2.
Association Between Buprenorphine Pharmacotherapy Receipt and Suicide/Overdose With up to 5 Years of Follow-Up From Treatment Initiation Among Veterans in the VHA, 2008–2017 (N=29,054)
| Buprenorphine pharmacotherapy status | Person-days at risk | n, deaths | IR | UHR (95% CI) | AHR (95% CI)a |
|---|---|---|---|---|---|
| Treated | 15,094,978 | 142 | 0.94 | ref | ref |
| Not treated, overall | 20,191,645 | 822 | 4.07 | 4.61 (3.84, 5.54) | 4.33 (3.60, 5.21) |
| Treated | 15,094,978 | 142 | 0.94 | ref | ref |
| Not treated, stratified | |||||
| ≤7 days since the last treatment | 543,673 | 28 | 5.15 | 5.13 (3.40, 7.75) | 4.56 (3.01, 6.90) |
| 8–14 days since the last treatment | 388,091 | 28 | 7.21 | 7.47 (4.95, 11.28) | 6.54 (4.32, 9.91) |
| 15–30 days since the last treatment | 708,080 | 26 | 3.67 | 3.95 (2.59, 6.04) | 3.45 (2.25, 5.29) |
| >30 days since the last treatment | 18,551,801 | 740 | 3.99 | 4.51 (3.74, 5.43) | 4.29 (3.55, 5.17) |
Note: Boldface indicates statistical significance (p<0.05). Suicide/overdose indicates suicide/overdose deaths (n=964). IR indicates deaths per 100,000 person-days.
Adjusted for demographics (age, sex, race, rural, homelessness, year initiating buprenorphine), clinical comorbidities (depression, peripheral vascular disease, liver disease), concurrent substance dependence (alcohol, cannabis), medications (antipsychotics, mood stabilizers), other MOUD (naltrexone, methadone), and healthcare utilization (overdose in ED, inpatient admission for substance use or dependence).
AHR, adjusted hazard ratio; ED, emergency department; IR, incidence rate MOUD, medications for opioid use disorder; UHR, unadjusted hazard ratio; VHA, Veterans Health Administration.