Emerging adult age status predicts poor buprenorphine treatment retention

Abstract

Emerging adults (18–25 years old) are often poorly retained in substance use disorder treatment. Office-based buprenorphine often enhances treatment retention among people with opioid dependence. In this study, we examined the records of a collaborative care buprenorphine treatment program to compare the treatment retention rates of emerging adults versus older adults. Subjects were 294 adults, 71 (24%) aged 18–25, followed in treatment with buprenorphine, nurse care management, and an intensive outpatient program followed by weekly psychosocial treatment. Compared to older adults, emerging adults remained in treatment at a significantly lower rate at 3 months (56% versus 78%) and 12 months (17% versus 45%), and were significantly more likely to test positive for illicit opioids, relapse, or drop out of treatment. Further research into factors associated with buprenorphine treatment retention among emerging adults is needed to improve treatment and long-term outcomes in this group.

Is residential treatment effective for opioid use disorders? A longitudinal comparison of treatment outcomes among opioid dependent, opioid misusing, and non-opioid using emerging adults with substance use disorder

“…First, complete abstinence rates for emerging adults with opioid dependence were substantially higher at 12 month follow-up (29%) than was expected given results from a prior study of emerging adults with opioid dependence enrolled in outpatient B/N maintenance treatment, which had only 17% 12-month retention (Schuman-Olivier et al, 2014). Even though self-reported “abstinence” and treatment “retention” can differ, within opioid maintenance treatment programs, non-retention is strongly associated with dropout and relapse to illicit opioid use (Schuman-Olivier et al, 2014; Zhang et al, 2003). Notably, 6-month complete abstinence rates after this residential treatment (42.5%) were similar to 6-month retention rates in buprenorphine maintenance treatment (38%; Schuman-Olivier et al, 2014).…”

“…In order to compare with rates reported in a prior study of emerging adults with opioid dependence receiving buprenorphine maintenance (Schuman-Olivier et al, 2014), we also used chi-squared tests to examine between-group differences in complete abstinence during follow-ups measured at 6-month as past 90 days abstinence, and at 12-month as past 180 days complete abstinence. In order to be conservative, missing a follow-up assessment was assumed to represent non-abstinent/relapsed status.…”

“…Opioid replacement therapy (e.g., buprenorphine/naloxone [B/N]) improves outcomes for many people with opioid dependence and this has emerged as a first-line treatment; however, emerging adults with opioid dependence draw less long-term benefit than older adults from office-based B/N treatment (Schuman-Olivier et al, 2014). Extended treatment with B/N has been demonstrated to be more effective for opioid dependence than detoxification or placebo (Fudala et al, 2003; Weiss et al, 2011).…”

“…The wide-spread introduction of office-based B/N maintenance treatment for opioid dependence, has been largely successful with more than 14,000 prescribers nationwide (SAMHSA, 2013) and 9.3 million prescriptions were dispensed in 2012 alone (DEA Fax 2013 from IMS Health™ National Prescription Audit Plus). Yet, younger age and emerging adulthood in particular, is associated with higher rates of illicit drug use and much greater attrition during B/N treatment (Dreifuss et al, 2013; Hillhouse et al, 2013; Marsch et al, 2005; Schuman-Olivier et al, 2014; Soeffing et al, 2009), which, in turn, is associated with relapse (Zhang et al, 2003) and increased overdose risk (Clausen et al, 2008; Davoli et al, 2007). While short-term extended B/N treatment for youth has been shown to be more effective than rapid detoxification (Woody et al, 2008), a long-term study of B/N treatment comparing older adults to emerging adults demonstrated a substantially lower proportion of emerging adults remaining in treatment at 12 months (17% versus 45%) and emerging adults were significantly more likely to test positive for illicit opioids, relapse, or drop out of treatment (Schuman-Olivier et al, 2014).…”

Testing a Matching Hypothesis for Emerging Adults in Project MATCH: During-Treatment and One-Year Outcomes

“…Prior research has shown that emerging adults may have worse psychosocial and SUD treatment outcomes than older adults, including a lower likelihood of completing treatment (McHugh et al, 2013;Mertens & Weisner, 2000;SchumanOlivier et al, 2014;Vuoristo-Myllys et al, 2013) and greater substance use or less abstinence during or following treatment exposure (Dennis et al, 2009;Hoeppner et al, 2014;Schuman-Olivier et al, 2014;Sinha et al, 2003).…”