Factors That Affect Patient Attrition in Buprenorphine Treatment for Opioid Use Disorder: A Retrospective Real-World Study Using Electronic Health Records

Abstract

To describe attrition patterns of opioid use disorder (OUD) patients treated with buprenorphine (BUP) and to assess how clinical, sociodemographic, or BUP medication dosing features are associated with attrition. Patients and Methods: Electronic health records of adults (16+ year-olds) with OUD treated with BUP from 23 different substance use or mental health care programs across 11 US states were examined for one year following BUP initiation in inpatient (IP), intensive outpatient (IOP), or outpatient (OP) settings. Treatment attrition was declared at >37 days following the last recorded visit. Survival analyses and predictive modelling were used. Results: Retention was consistently 2-3 times higher following BUP initiation in OP (n = 2409) than in IP/IOP (n = 2749) settings after 2 (50% vs 25%), 6 (27% vs 9%) and 12 months (14% vs 4%). Retention was higher for females, whites (vs blacks), and those with less severe OUD, better global function, or not using non-psychotropic medications. Comorbid substance use, other psychiatric disorders, and the number of psychotropic medications were variously related to retention depending on the setting in which BUP was initiated. Predictive modelling revealed that a higher global assessment of functioning and a smaller OUD severity based on the Clinical Global Impression -Severity led to longer retentions, a higher initial BUP dose led to higher retention in a few cases, an OP setting of BUP initiation led to longer retentions, and a lower total number of psychotropic and nonpsychotropic medications led to longer retentions. These were the most important parameters in the model, which identified 75.2% of patients who left BUP treatment within three months post-initiation, with a precision of 90.5%. Conclusion: Of all the OUD patients who began BUP, 50-75% left treatment within three months, and most could be accurately identified. This could facilitate patient-centered management to better retain OUD patients in BUP treatment.

Estimated Clinical Outcomes and Cost-effectiveness Associated With Provision of Addiction Treatment in US Primary Care Clinics

“…We estimated that individuals treated with buprenorphine would be 4 times less likely than those not receiving buprenorphine to unlink from care. 75 Treatment retention did not differ among the strategies.…”

“…For the BUP and BUP plus HR strategies, we assumed 100% of PCPs would offer buprenorphine at their visits, but patients had a 30% probability of accepting it. We estimated that individuals treated with buprenorphine would be 4 times less likely than those not receiving buprenorphine to unlink from care . Treatment retention did not differ among the strategies.…”

Review on Spatial Memory, Psychosis and Cognitive Dysfunction Screening Methods in Rat models

“…This theory is reinforced by the fact that dissociative NMDA receptor antagonists such as ketamine, PCP and dextromethorphan/ dextrorphan (at large overdoses) induce a psychotic state more rapidly than dopaminergic stimulants, even at recreational doses. [10] TREATMENT: Treatment includes a combination of medication and counselling. Drugs that are effective in reducing the symptoms are Aripiprazole, Asenapine, Brexpiprazole, Clozapine, Iloperidone, Lurasidone, Cariprazine, Olanzapine, Paliperidone and its palmitate, Quetiapine.…”

Accelerating Opioid Use Disorders Research by Integrating Multiple Data Modalities

“…Rentsch et al [54] showed that rapid escalation dose trajectories lead to greater risk for OUD compared to those that escalated at lower rates. OUD treatment medications (e.g., buprenorphine) are useful for examining prescription patterns associated with treatment attrition [55]. Other data modalities are readily available for use.…”