In addition, we found consistent protective associations of both buprenorphine against drug-related poisonings across multiple types of cooccurring SUDs, with comparable associations observed for ER naltrexone. While naltrexone has been regarded as a promising treatment for individuals with OUD and polysubstance use, the effectiveness of naltrexone in clinical practice is limited by the requirement to complete detoxification prior to induction, elevated treatment discontinuation,13 and elevated overdose rates while receiving medication compared with buprenorphine.5,6 We found that oral naltrexone was not associated with significant protective associations against drug-related poisoning across most analyses; this is consistent with previous literature reporting high treatment discontinuation and overdose rates associated with oral naltrexone among individuals with OUD.21
