Methadone Beats Buprenorphine-Naloxone for 1-Year Survival After Overdose

This target trial emulation gives Pain and Palliative Care pharmacists comparative mortality data on opioid agonist treatment (OAT) selection in overdose survivors, a high-risk group underrepresented in prior head-to-head evidence.

methadonebuprenorphine-naloxoneopioid agonist treatmentopioid use disorderopioid overdosemortalitytarget trial emulationcohort studyaddiction medicineharm reduction Pain / Palliative Care

Background Information

Methadone shows improved survival in opioid overdose survivors.

Individuals who survive opioid overdoses remain at high risk of mortality, highlighting the need for effective treatment strategies. Methadone initiation was associated with a lower one-year mortality rate (5.6%) compared to buprenorphine-naloxone (7.1%) in overdose survivors. Methadone may reduce mortality post-overdose more effectively than buprenorphine-naloxone, though treatment duration remains a challenge. Confirmation through further studies is needed. Methadone shows lower one-year mortality than buprenorphine-naloxone in opioid overdose survivors.

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Authors: Kleinman RA, Larney S, Sule NO, Ma C, Hauck TS, Kurdyak P

Citation: Kleinman RA, Larney S, Sule NO, et al. Methadone vs Buprenorphine-Naloxone in Opioid Overdose Survivors. JAMA network open. 2026;9(8):e2629313. doi:10.1001/jamanetworkopen.2026.29313

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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