Characterizing the Association Between Traumatic Brain Injury and Discontinuation of Medications for Opioid Use Disorder in a Commercially Insured Adult Population.

TBI status was determined by insurance diagnosis codes, which likely underestimates prevalence, especially for mild injuries where patients did not seek medical attention. The study only looked at TBI diagnoses within two years prior to starting treatment, so it may miss older injuries. Methadone was excluded because it is rarely covered by commercial insurance, so findings do not apply to patients on methadone. The sample was limited to adults with employer-sponsored insurance, so results may not generalize to Medicaid, Medicare, or uninsured populations. The study did not account for TBI severity or specific cognitive deficits, only the presence of a diagnosis.

The authors declared no known competing financial interests or personal relationships. The study was supported by the National Institutes of Health.

Do not assume TBI is the primary driver of treatment failure. While TBI increased risk by 13%, the choice of medication (oral naltrexone vs. buprenorphine) had a much larger impact on discontinuation rates (63% increased risk for oral naltrexone).