Medications to Treat Opioid Addiction Reduce Overdose Fatalities and Improve Patient Outcomes

Medications for opioid use disorder (MOUD) help stabilize brain chemistry, reduce or block the opioid’s euphoric effects, relieve cravings, and help patients engage in other aspects of treatment (NIDA, 2025). The three formulations approved by the Food and Drug Administration (FDA) to treat opioid use disorder include methadone, buprenorphine, and naltrexone. 

Proven Effectiveness of MOUD

Decades of research have shown that MOUDs are effective in reducing opioid use, overdose, recidivism, infectious disease transmission, death, and other adverse health and behavioral consequences (National Academies, 2019). These medications are also effective in improving social functioning—helping individuals manage withdrawal, gain and maintain employment, stay in treatment longer, and enhance their overall quality of life (National Academies, 2019; NIDA, 2025). 

The following includes several groundbreaking studies on the effectiveness of MOUDs.

MOUD Reduces the Risk of Overdose by 76% at 3 Months and 59% Within a Year

A national study of more than 40,800 individuals receiving community-based treatment found that buprenorphine or methadone was associated with a 76% reduction in overdose risk within three months and a 59% reduction at 12 months (Wakeman et al., 2020). Participants also experienced fewer emergency department and intensive care visits, with reductions of 32% at three months and 26% at one year.

Higher Daily Buprenorphine Doses May Improve Patient Outcomes, Especially During the Fentanyl Era 

Emerging research highlights the potential benefits of providing higher daily buprenorphine doses, particularly in the context of widespread fentanyl use. A 2024 study found that individuals prescribed doses above the FDA’s recommended 16 mg per day had significantly better outcomes, including fewer emergency and inpatient behavioral health visits (Axeen et al., 2024).

In the study, patients receiving higher daily doses of buprenorphine (>16 to 24 mg) went 20% longer before having a new emergency or inpatient care visit, compared to individuals prescribed standard 8-16 mg doses. In addition, those prescribed more than 24 mg doses went 50% longer before requiring such care.

These findings are particularly relevant amid the rise of fentanyl, a synthetic opioid up to 100 times more potent than morphine (DEA, 2024). For individuals exposed to fentanyl, higher buprenorphine doses may be necessary for treatment and to avoid withdrawal symptoms or cravings.

MOUD Reduces Risk of Overdose and Increases Treatment Engagement Among Justice-involved Populations

Substance use disorders are highly prevalent among individuals involved in the criminal justice system, with estimates suggesting that 58% of individuals in state prisons and 64% in jails meet the criteria (Bronson et al., 2020). The period immediately following release from incarceration is especially high-risk, with studies showing that the likelihood of death from all causes is 4 to 11 times higher than in the general public, and the risk of overdose death is an alarming 129 times higher in the first two weeks post-release (Binswanger et al., 2007; Ranapurwala et al., 2018).

Providing MOUD during incarceration and continuing treatment after release has been shown to significantly reduce these risks. A landmark study of more than 16,400 individuals found that initiating methadone or buprenorphine during incarceration reduced the risk of death by up to 75% within one month of post-release (Degenhardt et al., 2014). Similarly, a study of Rhode Island’s statewide correctional MOUD program—the first state to provide all three formulations of MOUD in correctional facilities—found that overdose deaths among formerly incarcerated individuals dropped by 61% within one year (Green et al., 2018; Ryan et al., 2023). 

Building on this evidence, a 2025 study examined the impact of a Massachusetts legislative mandate that required county jails to provide all three MOUDs. The findings show that individuals who received MOUD while incarcerated were 60% more likely to initiate treatment within 30 days of release and 58% remained in treatment six months later (Friedmann et al., 2025). Individuals who received MOUD also experienced a 52% lower risk of fatal overdose, a 56% lower risk of death from any cause, and a 12% lower risk of reincarceration.

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References

Axeen, S., Pacula, R. L., Merlin, J. S., Gordon, A. J., & Stein, B. D. (2024). Association of Daily Doses of Buprenorphine With Urgent Health Care Utilization. JAMA Network Open, 7(9), e2435478. https://doi.org/10.1001/jamanetworkopen.2024.35478

Binswanger, I. A., Stern, M. F., Deyo, R. A., Heagerty, P. J., Cheadle, A., Elmore, J. G., & Koepsell, T. D. (2007). Release from prison--a high risk of death for former inmates. The New England journal of medicine, 356(2), 157–165. https://doi.org/10.1056/NEJMsa064115

Bronson. J., Stroop, J., Zimmer, S., & Berzofsky, M. (2017). Drug use, dependence, and abuse among state prisoners and jail inmates, 2007-2009. (Rev. 2020). Bureau of Justice Statistics. https://bjs.ojp.gov/content/pub/pdf/dudaspji0709.pdf

Degenhardt, L., Larney, S., Kimber, J., Gisev, N., Farrell, M., Dobbins, T., Weatherburn, D. J., Gibson, A., Mattick, R., Butler, T., & Burns, L. (2014). The impact of opioid substitution therapy on mortality post-release from prison: retrospective data linkage study. Addiction (Abingdon, England), 109(8), 1306–1317. https://doi.org/10.1111/add.12536

Friedmann, P. D., Wilson, D., Stopka, T. J., Bernson, D., Pivovarova, E., Ferguson, W., Hoskinson, R. A., Jr, Rottapel, R. E., Bovell-Ammon, B., Gaba, A., Morgan, J. R., Senst, T., Hayes, E., Evans, E. A., & MassJCOIN Research Hub (2025). Medications for Opioid Use Disorder in County Jails - Outcomes after Release. The New England journal of medicine, 393(10), 994–1003. https://doi.org/10.1056/NEJMsa2415987

Green, T. C., Clarke, J., Brinkley-Rubinstein, L., Marshall, B. D. L., Alexander-Scott, N., Boss, R., & Rich, J. D. (2018). Postincarceration Fatal Overdoses After Implementing Medications for Addiction Treatment in a Statewide Correctional System. JAMA psychiatry, 75(4), 405–407. https://doi.org/10.1001/jamapsychiatry.2017.4614

National Academies of Sciences, Engineering, and Medicine. (2019). Medications for Opioid Use Disorder Save Lives. https://doi.org/10.17226/25310

National Institute on Drug Abuse. (2025). Medications for Opioid Use Disorder. National Institutes of Health. https://nida.nih.gov/research-topics/medications-opioid-use-disorder

Ranapurwala, S. I., Shanahan, M. E., Alexandridis, A. A., Proescholdbell, S. K., Naumann, R. B., Edwards, D., Jr, & Marshall, S. W. (2018). Opioid Overdose Mortality Among Former North Carolina Inmates: 2000-2015. American journal of public health, 108(9), 1207–1213. https://doi.org/10.2105/AJPH.2018.304514

Ryan, D. A., Montoya, I. D., Koutoujian, P. J., Siddiqi, K., Hayes, E., Jeng, P. J., Cadet, T., McCollister, K. E., & Murphy, S. M. (2023). Budget impact tool for the incorporation of medications for opioid use disorder into jail/prison facilities. Journal of substance use and addiction treatment, 146, 208943. https://doi.org/10.1016/j.josat.2022.208943

U.S. Drug Enforcement Administration. (2024). Fentanyl. https://www.dea.gov/factsheets/fentanyl

Wakeman, S. E., Larochelle, M. R., Ameli, O., Chaisson, C. E., McPheeters, J. T., Crown, W. H., Azocar, F., & Sanghavi, D. M. (2020). Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Network Open, 3(2), e1920622. https://doi.org/10.1001/jamanetworkopen.2019.20622