Factors Affecting Noncompliance With Buprenorphine Maintenance Treatment

Fareed, Ayman; Eilender, Pamela; Ketchen, Bethany; Buchanan-Cummings, Ann Marie; Scheinberg, Kelly; Crampton, Kelli; Nash, Abigail I.; Shongo-Hiango, Hilaire; Drexler, Karen

doi:10.1097/adm.0000000000000057

Cited by 42 publications

(33 citation statements)

References 21 publications

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“…(Fareed et al, 2014; Ferri, Finlayson, Wang, & Martin, 2014; Hser et al, 2014) Illicit buprenorphine use at OBOT enrollment is associated with increased short-term retention in buprenorphine treatment. (Alford et al, 2011; Cunningham, Roose, Starrels, Giovanniello, & Sohler, 2013) Once enrolled in OBOT, illicit benzodiazepine(Ferri et al, 2014) and illicit opioid (Fiellin et al, 2008; Stein, Patricia Cioe, & Friedmann, 2005) use early in treatment are both predictive of short-term disengagement.…”

Section: 0 Introductionmentioning

confidence: 99%

Long-term retention in Office Based Opioid Treatment with buprenorphine

Weinstein

Kim

Cheng

et al. 2017

Journal of Substance Abuse Treatment

162

138

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Background Guidelines recommend long-term treatment for opioid use disorder with buprenorphine; however, little is known about patients in long-term treatment. The aim of this study is to examine the prevalence and patient characteristics of long-term treatment retention (≥1 year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine. Methods This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014 in a large urban safety-net primary care OBOT program. The primary outcome was retention in OBOT for at least one continuous year. Potential predictors included age, race, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1 year OBOT retention were identified using generalized estimating equation logistic regression models. Patients who re-enrolled in the program contributed repeated observations. Results There were 1605 OBOT treatment periods among 1237 patients in this study. Almost half, 45% (717/1605), of all treatment periods were ≥1 year and a majority, 53.7% (664/1237), of patients had at least one ≥1 year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10 year increase [1.05, 1.34]) were associated with greater odds of ≥1 year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]) were associated with lower odds of ≥1 year retention. Conclusions Over half of patients who presented to Office Based Opioid Treatment with buprenorphine were ultimately successfully retained for ≥1 year. However, significant disparities in one-year treatment retention were observed, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C.

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Section: 0 Introductionmentioning

confidence: 99%

Long-term retention in Office Based Opioid Treatment with buprenorphine

Weinstein

Kim

Cheng

et al. 2017

Journal of Substance Abuse Treatment

162

138

View full text Add to dashboard Cite

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“…MAT patients with co-occurring disorders have more severe psychiatric, medical, and legal problems at intake 8–10 and post-treatment, and are at higher risk for relapse and treatment noncompliance. 8,10–12 Though MAT patients with co-occurring disorders are more severe at intake 8,9 and have more severe psychiatric problems after release, 9,11 some studies have found these patients to have equivalent or better substance use outcomes, 9 including longer treatment retention 13,14 and lower relapse rates. 10 Researchers have hypothesized that increased psychiatric severity may motivate patients to seek and remain in treatment.…”

Section: Introductionmentioning

confidence: 99%

The impact of addiction medications on treatment outcomes for persons with co-occurring PTSD and opioid use disorders

et al. 2015

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Background and Objectives Previous research has been inconclusive about whether adding psychosocial treatment to medication assisted treatment (MAT) improves outcomes for patients with co-occurring psychiatric and opioid use disorders. This study evaluated the impact of MAT and psychosocial therapies on treatment outcomes for patients with co-occurring opioid use disorders and PTSD. Methods Patients meeting criteria for PTSD and substance use disorders were randomly assigned to one of three treatment conditions: Standard Care (SC) alone, Integrated Cognitive Behavioral Therapy (ICBT) plus SC, or Individual Addiction Counseling (IAC) plus SC. Substance use and psychiatric symptoms were assessed at baseline and 6 months. Only patients with opioid use disorders were included in the present analyses (n = 126). Two-way ANOVAS and logistic regression analyses were used to examine associations between treatment conditions and MAT, for substance use and psychiatric outcomes. Results MAT patients receiving ICBT had significantly decreased odds of a positive urine drug screen, compared to non-MAT patients receiving SC alone (OR = .07, 95% CI = .01, .81, p = .03). For PTSD symptoms, a significant MAT by psychosocial treatment condition interaction demonstrated that MAT patients had comparable declines in PTSD symptoms regardless of psychosocial treatment type (F(2, 88) = 4.74, p = .011). Non-MAT patients in ICBT had significantly larger reductions in PTSD. Conclusions and Scientific Significance For patients with co-occurring opioid use disorders and PTSD, MAT plus ICBT is associated with more significant improvement in substance use. For non-MAT patients, ICBT is most beneficial for PTSD symptoms.

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“…The lead author (J.B.) sketched together a set of variables that were important in determining the severity of need, loosely based on the Addiction Severity Index (ASI; McLellan et al, 2006). Further refinements based on clinical expertise and reviews of the scientific literature (eg, Sullivan et al, 2010; Bukten and Skurtveit, 2014; Fareed et al, 2014; Perrault et al, 2015) led to a brief 21-item screener. It assesses areas of psychosocial functioning (eg, legal, drug and alcohol use, transportation, chronic pain, social support) with individual items summed for a possible maximum score possible of 26 (Fig.…”

Section: Methodsmentioning

confidence: 99%

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact

Brooklyn

Sigmon

2017

Journal of Addiction Medicine

173

149

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Background Opioid use disorders (OUDs) are reaching epidemic proportions in the United States, and many geographic areas struggle with a persistent shortage in availability of opioid agonist treatment. Over the past 5 years, Vermont addiction medicine physicians and public health leaders have responded to these challenges by developing an integrated hub-and-spoke opioid treatment network. Methods In the present report, we review the development, implementation, and impact of this novel hub-and-spoke model for expanding OUD treatment in Vermont. Results Vermont’s hub-and-spoke system has been implemented state-wide and well-received by providers and patients alike. Adoption of this model has been associated with substantial increases in the state’s OUD treatment capacity, with Vermont now having the highest capacity for treating OUD in the United States with 10.56 people in treatment per 1000. There has been a 64% increase in physicians waivered to prescribe buprenorphine, a 50% increase in patients served per waivered physician, and a robust bidirectional transfer of patients between hubs and spokes based upon clinical need. Challenges to system implementation and important future directions are discussed. Conclusions Development and implementation of a hub-and-spoke system of care has contributed substantially to improvements in opioid agonist treatment capacity in Vermont. This system may serve as a model for other states grappling with the current opioid use epidemic.

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Factors Affecting Noncompliance With Buprenorphine Maintenance Treatment

Cited by 42 publications

References 21 publications

Long-term retention in Office Based Opioid Treatment with buprenorphine

Long-term retention in Office Based Opioid Treatment with buprenorphine

The impact of addiction medications on treatment outcomes for persons with co-occurring PTSD and opioid use disorders

Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact

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