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Getting the latest healthcare news for you
Getting the latest healthcare news for you
After an opioid overdose, methadone was linked to slightly lower one-year mortality than buprenorphine-naloxone, but experts say the bigger crisis is that nearly 90% of patients stopped treatment within a year. A new study in JAMA Network Open argues that closing the debate over which medication is better is less urgent than fixing the barriers that drive patients away from treatment altogether.
A large retrospective cohort study published in JAMA Network Open compared methadone and buprenorphine-naloxone (bup-nx) in nearly 5,900 Ontarians who had an opioid overdose in the past year. Methadone starters had a modestly lower one-year mortality rate (5.6%) compared to bup-nx starters (7.1%), but the mortality difference disappeared when patients were actively on treatment — suggesting retention, not medication choice, is the key driver of survival.
Experts responding to the findings were quick to reframe the takeaway: the real alarm is that roughly 90% of patients in both groups discontinued treatment, the median time on bup-nx was just 16 days, and about 26% experienced another overdose within a year. Editorialists from UBC and the University of Arizona called these "persistently poor outcomes" and urged researchers, clinicians, and policymakers to shift focus from comparing medications to removing barriers to sustained treatment engagement.
Key Takeaways:
Why it matters: Both medications save lives, but the system is failing to keep patients engaged long enough to benefit. With fentanyl dominating the drug supply, short treatment durations can be fatal — making retention strategies and low-barrier access to opioid agonist therapy a critical public health priority.
