‘I just thought that was the best thing for me to do at this point’: Exploring patient experiences with depot buprenorphine and their motivations to discontinue

Clay, Simon; Treloar, Carla; Degenhardt, Louisa; Grebely, Jason; Christmass, Michael; Gough, C. M.; Hayllar, Jeremy; McDonough, Mike; Henderson, C. R.; Crawford, Sione; Farrell, Michael; Marshall, Alison D.

doi:10.1016/j.drugpo.2023.104002

Cited by 8 publications

(5 citation statements)

References 43 publications

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“…Patient decision making could be multicausal, reflective of patient complexity or medication ambivalence, as well as provider or system-level barriers. Our results align with prior qualitative work in this area, in pointing to the role of health system issues, medication concerns, and patient motivations as explanations, 24,25 and identified additional reasons for discontinuation, including the role of rules and policies, medication adverse effects (some of which may have been spurious), and lack of efficacy in treating chronic pain. This study also reveals the interplay between system and patient factors that may underlie discontinuation decisions.…”

Section: Discussionsupporting

confidence: 86%

“…Recent qualitative studies point to health system issues, medication concerns, and patient motivations as explanations. 24,25 One study, investigating perceptions of buprenorphine among 42 patients engaged in treatment, probed interactions with clinicians that may have influenced discontinuation decisions in prior treatment episodes. Some participants described limited follow-up as they began to miss appointments and lack of care coordination after residential treatment as contributing factors.…”

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confidence: 99%

“…24 Another study, examining the experiences of patients receiving (n = 21) or recently discontinued/discontinuing (n = 19) monthly depot buprenorphine injections, described dissatisfaction with adverse effects, perceptions of inefficacy (eg, did not curb cravings), and lack of desire to maintain treatment, whether due to desire to use opioids or belief that they had recovered and no longer needed it, as motivations. 25 Finally, 2 studies investigated patient explanations for discontinuing buprenorphine within the context of a clinical trial. In 1 study, patients attributed discontinuation primarily to health system issues, including involuntary discharge, program inflexibility, and conflicts with staff.…”

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confidence: 99%

“…Recent qualitative studies point to health system issues, medication concerns, and patient motivations as explanations 24,25 . One study, investigating perceptions of buprenorphine among 42 patients engaged in treatment, probed interactions with clinicians that may have influenced discontinuation decisions in prior treatment episodes.…”

mentioning

confidence: 99%

“…Some participants described limited follow-up as they began to miss appointments and lack of care coordination after residential treatment as contributing factors 24 . Another study, examining the experiences of patients receiving (n = 21) or recently discontinued/discontinuing (n = 19) monthly depot buprenorphine injections, described dissatisfaction with adverse effects, perceptions of inefficacy (eg, did not curb cravings), and lack of desire to maintain treatment, whether due to desire to use opioids or belief that they had recovered and no longer needed it, as motivations 25 . Finally, 2 studies investigated patient explanations for discontinuing buprenorphine within the context of a clinical trial.…”

mentioning

confidence: 99%

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Patients' Perspectives on Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder

Wyse,

Eckhardt,

Waller

et al. 2024

J Addict Med

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Objectives Buprenorphine and other medications for opioid use disorder (OUD) are recommended as standard of care in the treatment of OUD and are associated with positive health and addiction-related outcomes. Despite benefits, discontinuation is common, with half of patients discontinuing in the first year of treatment. Addressing OUD is a major clinical priority, yet little is known about the causes of medication discontinuation from the patient perspective. Methods From March 2021 to April 2022, we conducted qualitative interviews with patients who had discontinued buprenorphine for the treatment of OUD within the past 12 months. Eligible participants were selected from 2 Veterans Health Administration Health Care Systems in Oregon. Coding and analysis were guided by conventional qualitative content analysis. Results Twenty participants completed an interview; 90% were White and 90% were male, and the mean age was 54.2 years. Before discontinuation, participants had received buprenorphine for 8.3 months on average (range, 1–40 months); 80% had received buprenorphine for less than 12 months. Qualitative analysis identified the following themes relating to discontinuation: health system barriers (eg, logistical hurdles, rules and policy violations), medication effects (adverse effects; attributed adverse effects, lack of efficacy in treating chronic pain) and desire for opioid use. Patient description of decisions to discontinue buprenorphine could be multicausal, reflecting provider or system-level barriers in interaction with patient complexity or medication ambivalence. Conclusions Study results identify several actionable ways OUD treatment could be modified to enhance patient retention.

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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