A naturalistic study of predictors of retention in treatment among emerging adults entering first buprenorphine maintenance treatment for opioid use disorders

Dayal, Prabhoo; Balhara, Yatan Pal Singh

doi:10.1016/j.jsat.2017.06.004

Cited by 29 publications

(29 citation statements)

References 29 publications

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“…The majority of studies were conducted in the United States of America (n = 25) [33, 34, 37, 39, 40, 47, 50, 54, 56, 58, 61, 62, 64, 68-72, 75, 79, 82, 84, 86, 88, 93], China (n = 14) [31, 36, 45, 57, 65-67, 80, 90, 92, 94-97], Canada (n = 9) [42,46,52,53,74,77,78,87,89] and Europe (n = 9) [32,38,41,43,48,51,55,59,73]. The remaining studies were spread across Asia (n = 5) [60,81,83,85,91], Israel (n = 3) [35,75,76], India (n = 1) [49], Australia (n = 1) [44] and Africa (n = 1) [63].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Most studies provided a gender breakdown for their sample, with a higher proportion of men in all but two studies [37,50]. The mean age of participants ranged from 22.4 years [49] to 47 years [40] Primary outcome. All four RCTs reported on retention [31][32][33][34].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The most frequently used measure of dropout was time to discontinuation of OST (n = 32), with varying thresholds applied to identify date of dropout. Almost half the studies reporting on time to discontinuation did not specify a threshold for identifying dropout (n = 13) [37,40,42,43,45,56,62,65,68,69,85,91,94]; seven studies indicated that a patient was identified as having dropped out of OST if they missed more than 30 consecutive days of treatment [53,57,60,67,74,80,92]; six studies applied a threshold of seven days [44,46,49,78,96,97], and the remaining studies applied a threshold of five days [83], ten days [51], 14 days [58,66,95], 21 days [63]and two months [59]. The other six studies reporting on dropout used a binary measure, which identified patients as having dropped out of treatment after a specific period of follow-up [38,48,55,61,79,88].…”

Section: Study Characteristicsmentioning

confidence: 99%

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Retention of patients in opioid substitution treatment: A systematic review

et al. 2020

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Background Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout. Methods A systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided. Results 67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST. Conclusions Younger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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Retention of patients in opioid substitution treatment: A systematic review

et al. 2020

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“…Enhancing the level of counseling from group to individual format might have been helpful in this context. Particularly, individual counseling might help patients overcome their ambivalence regarding the need of treatment (Dayal & Balhara, ), which can be significantly associated with poppy husk use due to various factors such as lower complications and social sanctions. However, among those who used prescription and injection opioid use, level of counseling has not been found to be significantly associated with retention (Fiellin et al, ).…”

Section: Discussionmentioning

confidence: 99%

Buprenorphine/naloxone maintenance for “poppy husk” dependence: A retrospective study

Tikka

Singh

Mamidipalli

et al. 2019

Asia-Pacific Psychiatry

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Introduction: Despite a significant number of patients dependent on "poppy husk"in India, they are poorly characterized. Moreover, scarce data is available with respect to their treatment. Methods:A cohort of 148 patients with "poppy husk" dependence receiving substitution treatment with buprenorphine/naloxone were followed up for 4 years, using a retrospective chart-based assessment. Baseline demographic and substance-related characteristics were described. Retention rates (operationally redefined as "6 months of uninterrupted contact anytime during their visits") over the next 4 years and their predictors were assessed.Results: Mean age of onset of "poppy husk" use was found to be 27.51 years, and mean duration of dependence was 18.25 years. Mean amount of poppy husk consumed per month was 3.7 kg. Commonest reasons for initiating and quitting its use were enhancing work efficiency and lack of availability, respectively. Retention rates were 25%. Significant predictors of retention were age more than 40 years (OR = 2.295; 95%CI = 1. 015-5.19) and uninterrupted treatment duration for at least 1 month from first contact (for 1 month (OR = 5.625; 95%CI = 2.28-13.89), for 3 months (OR = 10.96; 95%CI = 4.65-25.85), and for 6 months (OR = 52.8; ). Discussion:Factors associated with occupation such as enhancing work efficiency and overcoming fatigue are related to use of "poppy husk." While the amount of intake is considerably large among treatment seekers who are dependent on it, their dependence duration is longer and retention rates lower than those reported for patients with prescription and injectable opioid dependence. Specific strategies to tap patients less than 40 years and to target uninterrupted contact in initial phases of maintenance should be developed.

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“…shame and stigma about medication [ 21 ], untreated psychiatric co-morbidity [ 22 ]), developmental (e.g. young age [ 23 , 24 ], difficulty accepting chronic illness and the concept of maintenance treatment [ 24 , 25 ], focus on identity, relationships, children, and work instead of treatment [ 26 , 27 ]) and logistical (e.g., living with others who are using such as siblings [ 23 ], far distance to clinic [ 28 ], lacking money for co-pay) causes are common. Provider-level causes include discord between patients and providers or counselors leading to withdrawal, as well as insufficient clinical and administrative support to monitor and address non-adherence through measures such as observed induction, supervised administration of medication, pill counts, and toxicology testing.…”

Section: Introductionmentioning

confidence: 99%

MySafeRx: a mobile technology platform integrating motivational coaching, adherence monitoring, and electronic pill dispensing for enhancing buprenorphine/naloxone adherence during opioid use disorder treatment: a pilot study

Schuman‐Olivier

Borodovsky

Steinkamp

et al. 2018

Addict Sci Clin Pract

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BackgroundWhile buprenorphine/naloxone (B/N) is approved for opioid use disorder treatment, effective delivery of B/N comes with significant challenges. Most notably, many patients do not take medication daily as prescribed; this non-adherence worsens treatment outcomes, increases healthcare costs, and leads to persistent worries of diversion among providers and policymakers. The present study examines the feasibility, usability, and acceptability of MySafeRx—a mobile technology platform integrating motivational coaching, adherence monitoring, and electronic pill dispensing designed to address the challenges of office-based opioid treatment (OBOT) with B/N.MethodsThe MySafeRx platform integrates electronic pill dispensers, text-messaging, and videoconferencing to provide supervised self-administration of medication and daily motivational coaching through an Android app interface. High-risk early adults (18–39 years old) who were enrolled in OBOT with B/N and had documented illicit opioid use in the past month during opioid agonist therapy (n = 12) participated in a 28-day single-arm observational study of the MySafeRx platform in addition to standard care.ResultsTwo-thirds of participants who completed the study achieved an average of > 5 days per week of supervised B/N self-administration. Visual confirmation of medication adherence was demonstrated for an average of 72% of study days among all participants. All participants achieved platform technical proficiency within 60 min, reporting good levels of usability and acceptability. Illicit opioid abstinence rates confirmed by urine toxicology increased by 53% during MySafeRx but fell 43% within 3 weeks post-intervention.ConclusionThe MySafeRx medication adherence and remote coaching mobile platform is acceptable and can be feasibly implemented in real-world opioid use disorder treatment settings during high-risk periods (i.e., initial stabilization, after illicit opioid lapse), resulting in reduced illicit opioid use; however, the effect did not last after intervention completion, suggesting longer duration or extended taper of program may be needed.ClinicalTrials.Gov NCT02942199 10/24/16 https://clinicaltrials.gov/ct2/show/NCT02942199Electronic supplementary materialThe online version of this article (10.1186/s13722-018-0122-4) contains supplementary material, which is available to authorized users.

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A naturalistic study of predictors of retention in treatment among emerging adults entering first buprenorphine maintenance treatment for opioid use disorders

Cited by 29 publications

References 29 publications

Retention of patients in opioid substitution treatment: A systematic review

Retention of patients in opioid substitution treatment: A systematic review

Buprenorphine/naloxone maintenance for “poppy husk” dependence: A retrospective study

MySafeRx: a mobile technology platform integrating motivational coaching, adherence monitoring, and electronic pill dispensing for enhancing buprenorphine/naloxone adherence during opioid use disorder treatment: a pilot study

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