Ross 2024: Vivitrol vs buprenorphine for opioid use disorder in Medicaid

What they tested

Researchers used Medicaid claims from New Jersey and California for 2016–19. They compared adults aged 18–64 who started either extended-release naltrexone, the monthly shot sold as Vivitrol, or sublingual buprenorphine, taken under the tongue, for opioid use disorder, and who hadn't used any opioid use disorder medicine in the 90 days before.

They tracked two combined outcomes for up to 180 days: stopping the medicine or dying, and overdose or dying.

What they found

In adjusted analyses, 75.9% of extended-release naltrexone patients had stopped the medicine or died by the end of follow-up, against 62.2% of buprenorphine patients, a risk difference of 13.7 percentage points.

Overdose or death differed little: 3.9% on naltrexone and 3.3% on buprenorphine, a risk difference of 0.5 percentage points with a confidence interval from -0.4 to 1.5.

The results held across sensitivity analyses. Most patients stopped their medicine within 6 months, whichever one they started.

Limits

• It was observational, so people who started the naltrexone shot may have differed from those on buprenorphine in ways the adjustments didn't capture.
• It covered Medicaid patients in two states, so results may differ elsewhere or with other insurance.
• Follow-up lasted only 180 days.

What it means if you're considering naltrexone

For opioid use disorder, people in this study stayed on buprenorphine longer than on the naltrexone shot, but the short-term risk of overdose or death was about the same. Most people stopped within 6 months on either medicine.