A cohort study examining the relationship among housing status, patient characteristics, and retention among individuals enrolled in low-barrier-to-treatment-access methadone maintenance treatment

A National Study of Homelessness, Social Determinants of Health, and Treatment Engagement Among Outpatient Medication for Opioid Use Disorder-Seeking Individuals in the United States

“…25 Our findings build off a recent study that found reduced retention and treatment completion at 90 days in outpatient OUD including MOUD by analyzing a more recent year of TEDS-D data and investigating longer-term treatment engagement, in addition to the expansion of social determinants and patient characteristics discussed above. 18 Our results agree with previous work showing homelessness was an independent risk factor for 12-month treatment discontinuation in low-barrier methadone treatment, where all treatment terminations were patient-initiated 31 to include different types of MOUD programs, such as those dispensing buprenorphine and naltrexone, and include program-initiated discharges. Prior work has indicated homelessness may be a risk factor for decreased retention in MOUD when including housing status as one potential covariate for treatment retention, 24,27,29,57 but these studies were in smaller samples and did not directly examine retention outcomes, such as length of time in treatment or reason for treatment termination, based on housing status.…”

“…This time point was selected to align with other studies of MOUD treatment retention that utilize between 180 and 365 days as a marker of longer-term retention 24,25 including one prior study which illustrated significantly decreased retention at 12-months between individuals enrolled in methadone treatment who reported experiencing homelessness at treatment entry compared to those who were living independently. 31 Demographic, Social, and Clinical Characteristics. A full codebook for the TEDS-D dataset is available at https:// www.datafiles.samhsa.gov/dataset/teds-d-2018-ds0001teds-d-2018-ds0001.…”

“…Studies investigating predictors of retention in methadone, [27][28][29] buprenorphine, 30 and MOUD generally, 25 demonstrate associations between housing and treatment engagement, but few prior studies directly compare MOUD outcomes based on housing status. 18,[31][32][33][34][35] A recent study found that homelessness is a significant independent predictor of reduced 12-month retention in low-barrier outpatient methadone treatment, even after adjusting for sociodemographic and clinical characteristics. 31 Studies examining potential associations between housing and engagement in buprenorphine have mixed results.…”

“…18,[31][32][33][34][35] A recent study found that homelessness is a significant independent predictor of reduced 12-month retention in low-barrier outpatient methadone treatment, even after adjusting for sociodemographic and clinical characteristics. 31 Studies examining potential associations between housing and engagement in buprenorphine have mixed results. 30,[33][34][35] One prior study utilized the 2018 Treatment Episode Dataset Discharges (TEDS-D), a national database of SUD treatment episodes across the United States in a given year, to examine factors associated with MOUD retention length greater than 6 months and found homelessness was one of several associated factors.…”

Peer-led safer supply and opioid agonist treatment medication distribution: a case study from rural British Columbia

“…Access to these necessities is an important indicator of whether or not people will be in a position to maintain access health services long-term. This is well supported by the literature, whereby people experiencing homelessness face additional barriers to substance use treatment access and are at an increased risk of OAT discontinuation 17 . Due to ongoing effects of colonialism, Indigenous peoples remain overrepresented among people experiencing overdose events and deaths 6 .…”