Medication-assisted therapy tied to arrhythmia in patients with opioid use disorder

In patients diagnosed with opioid use disorders, those who received medication-assisted therapy (MAT) prescriptions have a higher risk of cardiac arrhythmia than those who did not, reports a study.

Additionally, naltrexone appears to contribute to an increased risk of arrhythmia, suggesting caution in its use, particularly among opioid use disorder patients with pre-existing heart conditions.

This multicentre retrospective cohort study included patients aged ≥18 years who had been diagnosed with opioid use disorder using the International Classification of Diseases, 10th revision, Clinical Modification without baseline arrhythmia in 2018–2019. Each participant required 1 year of continuous enrolment prior to and after the diagnosis.

MAT patients were propensity-score matched to those without MAT. The authors then examined the difference across three medications (ie, methadone, naltrexone, and buprenorphine) using a multivariable logistic regression model, adjusted for patient’s demographic and comorbidity.

A total of 66,083 patients with opioid use disorder had been identified, of which only 14.1 percent received MAT prescriptions in the 12 months after diagnosis.

Diagnoses of new-onset arrhythmia were more common among MAT users than nonusers (4.86 percent vs 3.92 percent), with a 29-percent risk of incident arrhythmias among patients on MAT prescription, even after adjusting for relevant confounders (adjusted odds ratio [aOR], 1.29, 95 percent confidence interval [CI], 1.11‒1.52).

Arrhythmia incidence varied by drugs, being more frequent with naltrexone (9.57 percent) compared with methadone (5.71 percent) and buprenorphine (3.81 percent). This variation persisted even after adjusting for covariates (aOR, 2.44, 95 percent CI, 1.63‒3.4; buprenorphine: aOR, 0.77, 95 percent CI, 0.59‒1.00, with methadone as the reference drug).

“Understanding MAT medications with the least risk of arrhythmia can guide clinical decision-making,” the authors said.