Associations of retention on buprenorphine for opioid use disorder with patient characteristics and models of care in the primary care setting

Bailey, Steffani R.; Lucas, Jennifer; Angier, Heather; Cantone, Rebecca E.; Fleishman, Joan; Garvey, Brian; Cohen, Deborah J.; Rdesinski, Rebecca E.; Gordon, Leah

doi:10.1016/j.jsat.2021.108548

Cited by 9 publications

(6 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the present sample, 43% of patients were retained for 1 year, which is comparable to prior data, but emphasizes the importance of optimizing buprenorphine treatment retention through identification of patients at high risk for attrition 4,5 . The association of cocaine positive urinalysis results with treatment drop‐out provides additional weight to prior observations of cocaine use as a risk factor for treatment drop‐out, where some studies had observed null findings for cocaine, perhaps due to smaller sample sizes relative to the present analysis or use of self‐report data rather than toxicology to characterize cocaine use 6,7 .…”

Section: Discussionsupporting

confidence: 75%

“…2 Prior research favors integrating treatment with primary care over segregated addiction treatment models, with evidence to support greater satisfaction, lower associated medical costs, and higher retention among patients seen in comprehensive primary care. [2][3][4] Even so, less than half of patients prescribed buprenorphine remain in treatment for a year or more, 4,5 which suggests the treatment could be further optimized and emphasizes the importance of identifying risk factors for attrition.…”

Section: Introductionmentioning

confidence: 99%

“…Providing buprenorphine in primary care provides an ideal opportunity to optimize the overall health of OUD patients with comprehensive care that simultaneously addresses OUD and other health comorbidities such as hypertension, human immunodeficiency virus (HIV), hepatitis C virus (HCV), and diabetes 2 . Prior research favors integrating treatment with primary care over segregated addiction treatment models, with evidence to support greater satisfaction, lower associated medical costs, and higher retention among patients seen in comprehensive primary care 2–4 . Even so, less than half of patients prescribed buprenorphine remain in treatment for a year or more, 4,5 which suggests the treatment could be further optimized and emphasizes the importance of identifying risk factors for attrition.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Buprenorphine treatment retention and comorbidities among patients with opioid use disorder in a primary care setting

et al. 2022

View full text Add to dashboard Cite

Background and Objectives More information is needed about comorbidities among patients receiving buprenorphine maintenance treatment and their relationship with retention. Methods Retrospective electronic health record data over a 5‐year period from primary care patients receiving buprenorphine for the treatment of opioid use disorder were examined (N = 899). The present analysis determined the prevalence of comorbidities and examined associations with treatment retention as defined by cumulative duration of buprenorphine prescription. Results Tobacco use and comorbidities including hypertension were prevalent but did not predict retention according to survival analyses controlling for demographic characteristics. Retention was poorer among patients testing positive for cocaine (HR = 1.38, 95% CI: 1.09–1.74, p = .007) and patients with hepatitis C virus (HR = 1.17, 95% CI: 1.01–1.37, p = .04). Conclusion and Scientific Significance This study provides new knowledge of previously unexamined associations between comorbidities (e.g., hypertension) and buprenorphine treatment retention. The robust association between cocaine use and poorer buprenorphine retention serves to resolve prior conflicting data in the literature.

show abstract

Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Buprenorphine treatment retention and comorbidities among patients with opioid use disorder in a primary care setting

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Studies in this setting have yielded less consistent findings for race, sex, and SUD and medical comorbidity. [16][17][18][19][20][21] Identifying disparities in health care receipt and retention is essential to understanding their mechanisms and informing strategies to address them. As the SCOUTT initiative is ongoing, disparities identified from this evaluation can be used to tailor and inform the spread of this VHA initiative.…”

mentioning

confidence: 99%

“…Although several studies have examined retention on buprenorphine for treatment of OUD in primary care, few findings have been replicated. Of the factors studied, drug use and younger age have been associated with lower buprenorphine retention 16,17,19,20 and psychiatric comorbidity 20,21 with higher buprenorphine retention among primary care patients. Studies in this setting have yielded less consistent findings for race, sex, and SUD and medical comorbidity 16-21 …”

mentioning

confidence: 99%

Buprenorphine Receipt and Retention for Opioid Use Disorder following an Initiative to Increase Access in Primary Care

Hawkins,

Malte,

Hagedorn

et al. 2024

J Addict Med

View full text Add to dashboard Cite

Objectives Buprenorphine, a medication for opioid use disorder (OUD), is underutilized in general medical settings. Further, it is inequitably received by racialized groups and persons with comorbidities. The Veterans Health Administration launched an initiative to increase buprenorphine receipt in primary care. The project's objective was to identify patient-related factors associated with buprenorphine receipt and retention in primary care clinics (n = 18) participating in the initiative. Methods Retrospective cohort quality improvement evaluation of patients 18 years or older with 2 or more primary care visits in a 1-year period and an OUD diagnosis in the year before the first primary care visit (index date). Buprenorphine receipt was the proportion of patients with OUD who received 1 or more buprenorphine prescriptions from primary care providers during the post–index year and retention the proportion who received buprenorphine for 180 days or longer. Results Of 2880 patients with OUD seen in primary care, 11.7% (95% confidence interval [CI], 10.6%–12.9%) received buprenorphine in primary care, 58.2% (95% CI, 52.8%–63.3%) of whom were retained on buprenorphine for 180 days or longer. Patients with alcohol use disorder (adjusted odds ratio [AOR], 0.39; 95% CI, 0.27–0.57), nonopioid drug use disorder (AOR, 0.64; 95% CI, 0.45–0.93), and serious mental illness (AOR, 0.60; 95% CI, 0.37–0.97) had lower buprenorphine receipt. Those with an anxiety disorder had higher buprenorphine receipt (AOR, 1.42; 95% CI, 1.04–1.95). Buprenorphine receipt (AOR, 0.55; 95% CI, 0.35–0.87) and 180-day retention (AOR, 0.40; 95% CI, 0.19–0.84) were less likely among non-Hispanic Black patients. Conclusions Further integration of addiction services in primary care may be needed to enhance buprenorphine receipt for patients with comorbid substance use disorders, and interventions are needed to address disparities in receipt and retention among non-Hispanic Black patients.

show abstract

Pain, Substance Use Disorders, Mental Health, and Buprenorphine Treatment among Patients With and Without HIV

Miller,

McGinnis,

Edelman

et al. 2024

AIDS Behav

View full text Add to dashboard Cite

Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. The Veterans Aging Cohort Study contained 7,875 patients (2,702 PWH and 5,173 without HIV) with new OUD clinical encounters (2008–2017). Buprenorphine initiation and retention were derived from prescription data. We identified patterns of co-occurring diagnoses (via ICD codes) and assessed the effects of class membership on both outcomes using latent class analysis and regression analyses. The mean age of patients was 55, 98% were male, 58% Black, 8% Hispanic, and only 8% initiated buprenorphine within 12 months of OUD diagnosis. Four classes of co-occurring diagnoses were identified: “Few Co-occurring Diagnoses” (42.3%); “Multiple Pain Conditions” (21.3%); “Pain + SUD” (18.4%) and “Pain + SUD + Mental Health” (18.0%). Patients in the “Pain + SUD” class and “Pain + SUD + Mental Health” class were significantly less likely to initiate buprenorphine and had 59% and 45% lower odds, respectively, of initiating buprenorphine compared with patients in the “Few Co-occurring Diagnoses” class; this effect did not vary by HIV status. Buprenorphine retention was not significantly associated with HIV status or class membership. However, Black Veterans were less likely to initiate or be retained in buprenorphine treatment. Higher comorbidity burden was negatively associated with buprenorphine initiation but not with retention. More research is warranted to determine other factors that may influence treatment retention.

show abstract

Associations of retention on buprenorphine for opioid use disorder with patient characteristics and models of care in the primary care setting

Cited by 9 publications

References 41 publications

Buprenorphine treatment retention and comorbidities among patients with opioid use disorder in a primary care setting

Buprenorphine treatment retention and comorbidities among patients with opioid use disorder in a primary care setting

Buprenorphine Receipt and Retention for Opioid Use Disorder following an Initiative to Increase Access in Primary Care

Pain, Substance Use Disorders, Mental Health, and Buprenorphine Treatment among Patients With and Without HIV

Contact Info

Product

Resources

About