{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:47:26Z","timestamp":1789055246347,"version":"build-2803163510"},"reference-count":56,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n In 2017, British Columbia guidelines changed the preferred first-line treatment for opioid use disorder from methadone to buprenorphine\/naloxone. Systematic reviews have consistently shown better treatment retention associated with methadone, while studies have reported a reduced risk of mortality associated with buprenorphine\/naloxone, causing confusion in interpretation for clinical guidelines.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To estimate the population-level health benefits and harms associated with buprenorphine\/naloxone vs methadone for treatment of opioid use disorder, accounting for differences in treatment retention and risk of mortality while receiving treatment.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, and participants<\/jats:title>\n This decision analytic model analysis was conducted from January 1, 2010, to March 17, 2020, using a semi-Markov cohort model and linked population-level health administrative data on all individuals presenting for opioid agonist treatment in British Columbia, Canada. Hazard ratios were estimated for the association of buprenorphine\/naloxone vs methadone with treatment discontinuation (breaks in dispensations lasting \u22655 days for methadone and \u22656 days for buprenorphine\/naloxone) and mortality while receiving treatment (per protocol). Treatment episodes in primary analysis were based on the medication initiated (initiator analysis). Probabilistic (mean estimates and 95% credible intervals from 10\u202f000 simulations) and deterministic sensitivity analyses were conducted. Data were analyzed between August 2023 and October 2024.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Alternative treatment policies in which buprenorphine\/naloxone or methadone were exclusively available to individuals presenting for opioid agonist treatment.<\/jats:p>\n <\/jats:sec>\n \n Main outcome and measures<\/jats:title>\n Incremental life-years, fatal overdoses, and all-cause deaths.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study population included 40\u202f461 individuals with 109\u202f126 cumulative person-years of follow-up (median [IQR] age, 33 [23-43] years; 66.0% [range, 56.0%-76.0%] male). A policy of exclusively buprenorphine\/naloxone was estimated to have \u22121602 incremental life-years (95% credible interval, \u22123249 to \u2212549 life-years) compared with methadone, with an additional 221 fatal overdoses (95% credible interval, 119 to 376 overdoses) and 303 all-cause deaths (95% credible interval, 120 to 589 deaths) over a 10-year period.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and relevance<\/jats:title>\n Results from this study suggest that any advantages from a reduced risk of mortality with treatment with buprenorphine\/naloxone were outweighed by deficits in treatment retention. Evaluated in a jurisdiction where both medications were available in office-based settings, these findings do not support recommendations of buprenorphine\/naloxone as first-line treatment over methadone.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.51337","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T16:30:47Z","timestamp":1766766647000},"page":"e2551337","source":"Crossref","is-referenced-by-count":5,"title":["Population-Level Health Benefits and Harms Associated With Buprenorphine\/Naloxone vs Methadone"],"prefix":"10.1001","volume":"8","author":[{"given":"Benjamin","family":"Enns","sequence":"first","affiliation":[{"name":"Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda Carolina","family":"Guerra-Alejos","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong Eun","family":"Min","sequence":"additional","affiliation":[{"name":"Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Addie","family":"Carter","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Siebert","sequence":"additional","affiliation":[{"name":"Center for Health Decision Science, Harvard University T.H. 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