A44-22 Effects of Methadone and Buprenorphine/Naloxone on COPD Exacerbations in U.S. Military Veterans With Opioid Use Disorder

Background U.S. military Veterans with coexisting chronic obstructive pulmonary disease (COPD) and opioid use disorder (OUD) are prescribed opioid substitution therapy (OST), such as methadone or buprenorphine/naloxone, as indicated. However, the long-term effects of OST on COPD exacerbations is uncertain. Accordingly, the purpose of this single site, retrospective, quality improvement project was to begin to address this issue by determining the effects of methadone and buprenorphine/naloxone on COPD exacerbations in U.S. military Veterans with COPD and OUD. Methods We reviewed the electronic health records of 22 Veterans diagnosed with COPD and OUD who were prescribed either methadone (n = 16) or buprenorphine/naloxone (n = 6) since October 1, 2022, at the Jesse Brown VA Medical Center, Chicago, Illinois. Demographics, smoking status, pulmonary function tests (PFTs), and the number of physician-diagnosed exacerbations of COPD in 12 months preceding and following initiation of OST were extracted from each record. Data are presented as means±SD where appropriate. Statistical analyses were performed using Student’s t- and chi-square tests where appropriate. P < 0.05 was considered statistically significant. Results The methadone group (n = 16) and buprenorphine/naloxone group (n = 6) were comparable in sex, race, age, body mass index, baseline PFTs, and duration of COPD (p > 0.05 for all comparisons). Current smoking rate was similar in both groups (88% and 83%, respectively; p > 0.05). The number of COPD exacerbations in the methadone group increased during treatment from 0.75±1.2 before to 1.63±0.9 events/year while in the buprenorphine/naloxone group the number decreased from 1.33±2.3 before to 0.33±0.52 events/year. The difference in yearly COPD exacerbation rate between both groups was statistically significant (p < 0.05). Conclusions These preliminary data suggest that buprenorphine/naloxone could be the OST of choice for Veterans with COPD and OUD. We speculate that naloxone expresses anti-inflammatory effects in these Veterans. Accordingly, a prospective, randomized clinical trial is warranted to support or refute our initial observations.