{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:49:48Z","timestamp":1788922188821,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T00:00:00Z","timestamp":1738540800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health","award":["1R01DA050470"],"award-info":[{"award-number":["1R01DA050470"]}]},{"name":"National Institutes of Health","award":["5R01DA058659-02"],"award-info":[{"award-number":["5R01DA058659-02"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Methadone and buprenorphine can reduce overdose-related mortality. Behavioral approaches can also reduce fatal overdoses. The current study examined the relationship between methadone and buprenorphine and overdose history and overdose prevention and treatment behaviors. Methods: Between December 2022 and August 2024, 647 individuals who used opioids in the prior month enrolled in a community recruited study on overdose. Participants were administered a face-to-face survey. Key behaviors assessed included overdose recency, testing drugs for potency, ingesting drugs slowly, using fentanyl test strips, using drugs alone, and carrying naloxone. Chi-square and logistic regression models examined the relationships between methadone and buprenorphine and overdose-related outcomes. Results: In total, 32.9% of participants were currently taking methadone and 15.5% buprenorphine. Most (69.2%) reported ever overdosing, and among those, 33.7% had overdosed within the prior 6 months. There were no significant associations between methadone or buprenorphine status and overdose prevention and care behaviors. In the multivariable logistic regression model, methadone use was associated with a lower odds ratio (aOR = 0.49, 95% CI = 0.30\u20130.79of a recent overdose compared to buprenorphine. Daily or almost daily crack use was associated with greater odds of a recent overdose (aOR = 2.21, 95% CI = 1.44\u20133.39. Discussion: Findings suggest the importance of promoting overdose prevention and care behaviors to people in drug treatment and training them to promote overdose prevention and care behaviors among their drug-using network members and other community members.<\/jats:p>","DOI":"10.3390\/ijerph22020213","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T05:36:32Z","timestamp":1738560992000},"page":"213","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Relationship Between Methadone and Buprenorphine Enrollment and Overdose Prevention and Treatment Behaviors Among a Community Sample of People Who Use Opioids in Baltimore, Maryland"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7931-2116","authenticated-orcid":false,"given":"Carl A.","family":"Latkin","sequence":"first","affiliation":[{"name":"Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1400-3670","authenticated-orcid":false,"given":"Lauren","family":"Dayton","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Davey-Rothwell","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abenaa","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, University Park, PA 16802, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Garnett, M.F., and Mini\u00f1o, A.M. (2025, January 22). Drug Overdose Deaths in the United States, 2003\u20132023. no. 522, Available online: https:\/\/stacks.cdc.gov\/view\/cdc\/170565.","DOI":"10.15620\/cdc\/170565"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"917","DOI":"10.2105\/AJPH.2012.301049","article-title":"Opioid Agonist Treatments and Heroin Overdose Deaths in Baltimore, Maryland, 1995\u20132009","volume":"103","author":"Schwartz","year":"2013","journal-title":"Am. J. Public Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/j.1360-0443.2007.02090.x","article-title":"Exposure to Opioid Maintenance Treatment Reduces Long-Term Mortality","volume":"103","author":"Gibson","year":"2008","journal-title":"Addiction"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1016\/S0140-6736(18)33078-2","article-title":"Management of Opioid Use Disorder in the USA: Present Status and Future Directions","volume":"393","author":"Blanco","year":"2019","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1001\/jamainternmed.2014.5416","article-title":"Association of Opioid Agonist Therapy with Lower Incidence of Hepatitis C Virus Infection in Young Adult Injection Drug Users","volume":"174","author":"Tsui","year":"2014","journal-title":"JAMA Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e1920622","DOI":"10.1001\/jamanetworkopen.2019.20622","article-title":"Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder","volume":"3","author":"Wakeman","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/QAI.0000000000000165","article-title":"HIV Risk Reduction With Buprenorphine\u2013Naloxone or Methadone: Findings From a Randomized Trial","volume":"66","author":"Woody","year":"2014","journal-title":"JAIDS J. Acquir. Immune Defic. Syndr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/add.13238","article-title":"Long-term Outcomes after Randomization to Buprenorphine\/Naloxone versus Methadone in a Multi-site Trial","volume":"111","author":"Hser","year":"2016","journal-title":"Addiction"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"83","DOI":"10.2105\/AJPH.85.1.83","article-title":"Heroin Use during Methadone Maintenance Treatment: The Importance of Methadone Dose and Cocaine Use","volume":"85","author":"Hartel","year":"1995","journal-title":"Am. J. Public Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9","DOI":"10.2147\/SAR.S221618","article-title":"Opioid and Polydrug Use Among Patients in Opioid Maintenance Treatment","volume":"11","author":"Carlsen","year":"2020","journal-title":"Subst. Abuse Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"106655","DOI":"10.1016\/j.addbeh.2020.106655","article-title":"Long Term Pre-Treatment Opioid Use Trajectories in Relation to Opioid Agonist Therapy Outcomes among People Who Use Drugs in a Canadian Setting","volume":"112","author":"Dong","year":"2021","journal-title":"Addict. Behav."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1017\/S146114570700836X","article-title":"Retention Rate and Substance Use in Methadone and Buprenorphine Maintenance Therapy and Predictors of Outcome: Results from a Randomized Study","volume":"11","author":"Soyka","year":"2008","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"567","DOI":"10.15585\/mmwr.mm7325a1","article-title":"Treatment for Opioid Use Disorder: Population Estimates\u2014United States, 2022","volume":"73","author":"Dowell","year":"2024","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s12954-018-0232-z","article-title":"Toots, Tastes and Tester Shots: User Accounts of Drug Sampling Methods for Gauging Heroin Potency","volume":"15","author":"Mars","year":"2018","journal-title":"Harm Reduct. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1001\/jamainternmed.2023.0116","article-title":"Universal Precautions for People at Risk of Opioid Overdose in North America","volume":"183","author":"Wood","year":"2023","journal-title":"JAMA Intern. Med."},{"key":"ref_16","first-page":"120","article-title":"Understanding Clinician Knowledge, Attitudes, and Practices Relating to Nonpharmaceutical Fentanyl and Harm Reduction","volume":"46","author":"Whitney","year":"2025","journal-title":"Subst. Use Addict. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e37483","DOI":"10.2196\/37483","article-title":"\u201cThere\u2019s No Heroin Around Anymore. It\u2019s All Fentanyl.\u201d Adaptation of an Opioid Overdose Prevention Counseling Approach to Address Fentanyl Overdose: Formative Study","volume":"6","author":"McMahan","year":"2022","journal-title":"JMIR Form. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1001\/jama.281.11.1000","article-title":"Moderate- vs High-Dose Methadone in the Treatment of Opioid Dependence: A Randomized Trial","volume":"281","author":"Strain","year":"1999","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s13011-023-00538-x","article-title":"Drug Use Patterns and Factors Related to the Use and Discontinuation of Medications for Opioid Use Disorder in the Age of Fentanyl: Findings from a Mixed-Methods Study of People Who Use Drugs","volume":"18","author":"Hughto","year":"2023","journal-title":"Subst. Abuse Treat. Prev. Policy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1007\/s00213-021-05782-2","article-title":"Beyond Abstinence and Relapse II: Momentary Relationships between Stress, Craving, and Lapse within Clusters of Patients with Similar Patterns of Drug Use","volume":"238","author":"Panlilio","year":"2021","journal-title":"Psychopharmacology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"109464","DOI":"10.1016\/j.drugalcdep.2022.109464","article-title":"The Impact of Opioid Agonist Treatment on Fatal and Non-Fatal Drug Overdose among People with a History of Opioid Dependence in NSW, Australia, 2001\u20132018: Findings from the OATS Retrospective Linkage Study","volume":"236","author":"Jones","year":"2022","journal-title":"Drug Alcohol Depend."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1111\/j.1360-0443.2007.02025.x","article-title":"Risk of Fatal Overdose during and after Specialist Drug Treatment: The VEdeTTE Study, a National Multi-site Prospective Cohort Study","volume":"102","author":"Davoli","year":"2007","journal-title":"Addiction"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Carlisle, V.R., Maynard, O.M., Bagnall, D., Hickman, M., Shorrock, J., Thomas, K., and Kesten, J. (2023). Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021526"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1080\/15332560802224576","article-title":"Challenges to Implementing the Harm Reduction Approach","volume":"8","author":"Mancini","year":"2008","journal-title":"J. Soc. Work Pract. Addict."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/add.12333","article-title":"Treatment Retention among Patients Randomized to Buprenorphine\/Naloxone Compared to Methadone in a Multi-site Trial","volume":"109","author":"Hser","year":"2014","journal-title":"Addiction"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.drugpo.2014.07.013","article-title":"High Risk and Little Knowledge: Overdose Experiences and Knowledge among Young Adult Nonmedical Prescription Opioid Users","volume":"26","author":"Frank","year":"2015","journal-title":"Int. J. Drug Policy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e56755","DOI":"10.2196\/56755","article-title":"Barriers to, and Facilitators of, Checking Drugs for Adulterants in the Era of Fentanyl and Xylazine: Qualitative Study","volume":"8","author":"Aronson","year":"2024","journal-title":"JMIR Form. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"104645","DOI":"10.1016\/j.drugpo.2024.104645","article-title":"\u201cTethered to This Ball and Chain\u201d: Women\u2019s Perspectives on Bodily Agency within Opioid Treatment Programs","volume":"134","author":"McCracken","year":"2024","journal-title":"Int. J. Drug Policy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"104290","DOI":"10.1016\/j.drugpo.2023.104290","article-title":"Motivators of and Barriers to Drug Checking Engagement in British Columbia, Canada: Findings from a Cross-Sectional Study","volume":"123","author":"Tobias","year":"2024","journal-title":"Int. J. Drug Policy"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.drugalcdep.2009.05.021","article-title":"Mortality among Clients of a State-Wide Opioid Pharmacotherapy Program over 20 Years: Risk Factors and Lives Saved","volume":"105","author":"Degenhardt","year":"2009","journal-title":"Drug Alcohol Depend."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1111\/add.14991","article-title":"Opioid Agonist Treatment and Fatal Overdose Risk in a State-wide US Population Receiving Opioid Use Disorder Services","volume":"115","author":"Krawczyk","year":"2020","journal-title":"Addiction"},{"key":"ref_32","unstructured":"Alderks, C.E. (2025, January 20). Trends in the Use of Methadone, Buprenorphine, and Extended-Release Naltrexone at Substance Abuse Treatment Facilities: 2003\u20132015 (Update), The CBHSQ Report, Available online: https:\/\/europepmc.org\/article\/NBK\/nbk469748."},{"key":"ref_33","unstructured":"(2025, January 20). 2019 State Profile\u2014Maryland: National Survey of Substance Abuse Treatment Services (N-SSATS), Available online: https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/quick_statistics\/state_profiles\/NSSATS-MD19.pdf."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e200117","DOI":"10.1001\/jamanetworkopen.2020.0117","article-title":"Association of Take-Home Naloxone and Opioid Overdose Reversals Performed by Patients in an Opioid Treatment Program","volume":"3","author":"Katzman","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"103421","DOI":"10.1016\/j.drugpo.2021.103421","article-title":"Non-Fatal Opioid Overdose, Naloxone Access, and Naloxone Training among People Who Recently Used Opioids or Received Opioid Agonist Treatment in Australia: The ETHOS Engage Study","volume":"96","author":"Conway","year":"2021","journal-title":"Int. J. Drug Policy"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jsat.2012.07.004","article-title":"Opioid Overdose Prevention with Intranasal Naloxone among People Who Take Methadone","volume":"44","author":"Walley","year":"2013","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1016\/S0140-6736(10)62353-7","article-title":"Reduction in Overdose Mortality after the Opening of North America\u2019s First Medically Supervised Safer Injecting Facility: A Retrospective Population-Based Study","volume":"377","author":"Marshall","year":"2011","journal-title":"Lancet"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.drugalcdep.2011.03.006","article-title":"Potential Role of Safer Injection Facilities in Reducing HIV and Hepatitis C Infections and Overdose Mortality in the United States","volume":"118","author":"Semaan","year":"2011","journal-title":"Drug Alcohol Depend."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.drugpo.2018.10.008","article-title":"Arguments Supporting and Opposing Legalization of Safe Consumption Sites in the US","volume":"63","author":"Barry","year":"2019","journal-title":"Int. J. Drug Policy"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1007\/s40615-022-01384-6","article-title":"The Opioid Epidemic: A Crisis Disproportionately Impacting Black Americans and Urban Communities","volume":"10","author":"Abijo","year":"2023","journal-title":"J. Racial Ethn. Health Disparities"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/2\/213\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:26:04Z","timestamp":1760027164000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/2\/213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,3]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["ijerph22020213"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22020213","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,3]]}}}