Longer treatment with medications for opioid use disorder is associated with greater probability of survival

A new study of over 32,000 US Veterans has found that the longer people stay on medications for opioid use disorder (buprenorphine, methadone, or extended-release naltrexone), the greater the probability of short- and medium-term survival.  This benefit continues to increase at least for four years of ongoing treatment, considerably longer than most patients currently stay in treatment.

People with opioid use disorder run the risk of dying from accidental overdose but opioid use disorder also increases the risk of death from other health conditions, most notably infectious disease.  People who receive buprenorphine and other medications for opioid use disorder (MOUD) have fewer drug cravings, improved social functioning, and better quality of life than those who do not, and those improvements decrease their risk of mortality.

It’s unusual for patients to stay on MOUD for four years, or even for one year.  Most standards of care specify 6 months as the minimum target for treatment duration, and more than 25% of patients say they want even shorter durations.  This study shows that to get the greatest benefit from MOUD, the recommended treatment duration should be years longer.  Encouraging patients to continue treatment for at least four years will significantly increase their chances of survival.

This study, published in the scientific journal Addiction, measured relative predicted survival probability as the ratio of the predicted probability of surviving to 6 years if a patient were treated for 1 year instead of 6 months, 2 years instead of 6 months, and so on. Longer time on therapy increased expected relative survival, with larger gains in longer time horizons. Higher-risk patients saw greater benefits over shorter time horizons than lower-risk patients.

For example (see figure), a 50-year-old male with no other health risk factors who remained in MOUD treatment for two years had a 4% higher survival probability than a 50-year-old male who stopped treatment at six months.   In contrast, a 30-year-old female with no other health risk factors was not projected to achieve a 4% greater survival probability until around 5 years of MOUD duration. Additionally, for the lowest risk patients, the improvements in relative survival for each additional year of therapy started to diminish as duration increased, with no statistically discernible difference beyond 4 years.

The study included 19,666 buprenorphine users, 8,675 methadone users, and 4,007 extended-release naltrexone users. After four years of receiving MOUD, additional time in treatment may not continue to increase the relative predicted probability of survival.

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For editors:

This paper is available to read online on the Wiley Online Library for one month after the embargo has lifted (https://onlinelibrary.wiley.com/doi/10.1111/add.70211) or you may request an early copy from Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org.

To speak with co-author Dr Corey J. Hayes about buprenorphine and opioid use disorder, please contact him at the University of Arkansas for Medical Sciences by email (cjhayes@uams.edu).

To speak with co-author Dr Rebecca A. Raciborski about the methods used in this article, please contact her at the Central Arkansas Veterans Healthcare System by email (Rebecca.raciborski@va.gov).

Full citation for article: Hayes CJ, Raciborski RA, Acharya M, Bin Noor N, Nunes EV, and Winhusen TJ. Evaluating the Optimal Duration of Medication Treatment for Opioid Use Disorder.  Addiction. 2025. DOI: 10.1111/add.70211.

Primary funding:  This work was supported by the National Institute on Drug Abuse of the National Institutes of Health [UG1DA013732-23S3] under the CTN-0142 protocol. Dr. Hayes was also supported by a VA Health Services Research & Development Career Development Award-2 [IK2HX003358] and by funding from the UAMS Vice Chancellor for Research and Innovation and the Arkansas Biosciences Institute.

Declaration of interests: None to declare.

Addiction (www.addictionjournal.org) is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, gambling, editorials, and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.