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However, little is known about the role of such medications compared with non\u2010medication treatments in mitigating overdose risk among US patient populations receiving treatment in usual care settings. This study compared overdose mortality among those in medication versus non\u2010medication treatments in specialty care settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study using state\u2010wide treatment data linked to death records. Survival analysis was used to analyze data in a time\u2010to\u2010event framework.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Services delivered by 757 providers in publicly funded out\u2010patient specialty treatment programs in Maryland, USA between 1\u00a0January 2015 and 31\u00a0December 2016.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A total of 48\u2009274 adults admitted to out\u2010patient specialty treatment programs in 2015\u201316 for primary diagnosis of opioid use disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Main exposure was time in medication treatment (methadone\/buprenorphine), time following medication treatment, time exposed to non\u2010medication treatments and time following non\u2010medication treatment. Main outcome was opioid overdose death during and after treatment. Hazard ratios were calculated using Cox proportional hazard regression. Propensity score weights were adjusted for patient information on sex, age, race, region of residence, marital and veteran status, employment, homelessness, primary opioid, mental health treatment, arrests and criminal justice referral.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>The study population experienced 371 opioid overdose deaths. Periods in medication treatment were associated with substantially reduced hazard of opioid overdose death compared with periods in non\u2010medication treatment [adjusted hazard ratio (aHR)\u00a0=\u00a00.18, 95% confidence interval (CI)\u00a0=\u00a00.08\u20130.40]. Periods after discharge from non\u2010medication treatment (aHR\u00a0=\u00a05.45, 95% CI\u00a0=\u00a02.80\u20139.53) and medication treatment (aHR\u00a0=\u00a05.85, 95% CI\u00a0=\u00a03.10\u201311.02) had similar and substantially elevated risks compared with periods in non\u2010medication treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among Maryland patients in specialty opioid treatment, periods in treatment are protective against overdose compared with periods out of care. Methadone and buprenorphine are associated with significantly lower overdose death compared with non\u2010medication treatments during care but not after treatment is discontinued.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.14991","type":"journal-article","created":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T05:00:31Z","timestamp":1582606831000},"page":"1683-1694","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":166,"title":["Opioid agonist treatment and fatal overdose risk in a state\u2010wide US population receiving opioid use disorder services"],"prefix":"10.1111","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7396-3938","authenticated-orcid":false,"given":"Noa","family":"Krawczyk","sequence":"first","affiliation":[{"name":"Department of Population Health NYU School of Medicine  New York NY USA"},{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin","family":"Mojtabai","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Stuart","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Fingerhood","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"},{"name":"Johns Hopkins School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Agus","sequence":"additional","affiliation":[{"name":"Department of Mental Health Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Casey","family":"Lyons","sequence":"additional","affiliation":[{"name":"Maryland Department of Health Office of Provider Engagement and Regulation  Catonsville MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan P.","family":"Weiner","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9013-3023","authenticated-orcid":false,"given":"Brendan","family":"Saloner","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,24]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"1419","article-title":"Drug and opioid\u2010involved overdose deaths\u2014United States, 2013\u20132017","volume":"67","author":"Scholl L.","year":"2019","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0033354918793627"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2018.1546862"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.12.028"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1402780"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/HRP.0000000000000075"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2009.10.006"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2017.06.009"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.05162"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0b013e3181d41ddb"},{"key":"e_1_2_8_12_1","unstructured":"Substance Abuse and Mental Health Services Administration (SAMHSA). 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