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

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 = 0.30–0.79of 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 = 1.44–3.39. 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.