{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:37:04Z","timestamp":1790699824662,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,3,21]],"date-time":"2022-03-21T00:00:00Z","timestamp":1647820800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004726","name":"Ministry of Health, British Columbia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004726","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To characterize comparative risks and benefits of methadone versus buprenorphine\/naloxone in a contemporary cohort where the unregulated drug supply is dominated by fentanyl.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting and Participants<\/jats:title><jats:p>Population\u2010based propensity\u2010score matched cohort study conducted in Ontario, Canada among people aged 18+\u2009initiating opioid agonist therapy (OAT) for an opioid use disorder between October 2016 and December 2018 (<jats:italic>n<\/jats:italic>\u2009=\u200918\u2009880).<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>Initiation of methadone versus buprenorphine\/naloxone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>The primary outcome was opioid overdose (fatal and non\u2010fatal) while on treatment, with secondary outcomes including opioid overdose (first 30\u2009days of treatment), treatment discontinuation, health\u2010care interactions related to treatment of opioid use disorder, receiving a weekly supply of take\u2010home doses and opioid overdose within 30\u2009days of treatment discontinuation. Outcomes were assessed over 1\u2009year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Overall, 7517 people initiating buprenorphine were matched to an equal number of methadone\u2010treated individuals. Risk of opioid overdose while on treatment [hazard ratio (HR)\u2009=\u20090.50; 95% confidence interval (CI)\u2009=\u20090.37\u20130.68] or within the first 30\u2009days of treatment (HR =\u20090.51, 95% CI\u2009=\u20090.31\u20130.85) was lower among buprenorphine recipients compared to methadone recipients. In secondary analyses, people initiating buprenorphine had a higher risk of treatment discontinuation within the first year (median time to discontinuation 104 versus 265\u2009days, HR\u2009=\u20091.43, 95% CI\u2009=\u20091.37\u20131.49), had lower rates of health\u2010care interactions for OUD (186.4 versus 254.3 per person\u2010year; rate ratio\u2009=\u20090.73; 95% CI\u2009=\u20090.72\u20130.75), and a higher rate of receiving weekly take\u2010home doses (HR\u2009=\u20092.33; 95% CI\u2009=\u20092.20\u20132.46). Overdose rates in the period following OAT discontinuation were higher than those observed while on treatment, but did not differ significantly by OAT type.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although treatment retention is higher among methadone recipients, overdose risk is also elevated compared to buprenorphine recipients. These findings demonstrate the benefits of any OAT on avoidance of overdose, particularly following treatment discontinuation and with the increasingly unpredictable drug supply in North America.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.15862","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T08:38:38Z","timestamp":1646728718000},"page":"1972-1981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Duration of use and outcomes among people with opioid use disorder initiating methadone and buprenorphine in Ontario: a population\u2010based propensity\u2010score matched cohort study"],"prefix":"10.1111","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1468-1965","authenticated-orcid":false,"given":"Tara","family":"Gomes","sequence":"first","affiliation":[{"name":"Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada"},{"name":"Leslie Dan Faculty of Pharmacy University of Toronto Toronto Ontario Canada"},{"name":"ICES Toronto Ontario Canada"},{"name":"Institute for Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"McCormack","sequence":"additional","affiliation":[{"name":"ICES Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Bozinoff","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health Toronto Ontario Canada"},{"name":"Department of Family and Community Medicine University of Toronto Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Tadrous","sequence":"additional","affiliation":[{"name":"Leslie Dan Faculty of Pharmacy University of Toronto Toronto Ontario Canada"},{"name":"ICES Toronto Ontario Canada"},{"name":"Women's College Hospital Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada"},{"name":"ICES Toronto Ontario Canada"},{"name":"Department of Family and Community Medicine University of Toronto Toronto Ontario Canada"},{"name":"Department of Family and Community Medicine, St. Michael's Hospital Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Munro","sequence":"additional","affiliation":[{"name":"Ontario Drug Policy Research Network Lived Experience Advisory Group St Michael's Hospital Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonya","family":"Campbell","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute of St. Michael's Hospital Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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