Question: What is the prevalence and comparative effectiveness associated with buprenorphine and naltrexone in individuals with opioid use disorder (OUD) and cooccurring substance use disorders (SUDs)?

Findings: This comparative effectiveness study evaluated 179 280 individuals with OUD using insurance claims. Individuals with OUD and co-occurring SUDs were less likely to receive buprenorphine and more likely to receive extended-release naltrexone than peers without polysubstance use; buprenorphine and extended-release naltrexone were comparable in their protective associations with drug-related poisonings in both populations.

Meaning: These findings suggest that individuals with cooccurring SUDs were less likely to receive buprenorphine despite buprenorphine’s association with protecting against overdose in this population.