Long-term retention in Office Based Opioid Treatment with buprenorphine

Abstract

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.

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

“…To improve retention, consideration can also be given to inclusion of employment assistance, as some authors have suggested. [25] Acknowledgements. We acknowledge help from Tonya Esterhuizen (Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University) with data analysis and the staff at the SBTC for assistance during data collection.…”

Very early disengagement and subsequent re-engagement in primary care Office Based Opioid Treatment (OBOT) with buprenorphine

“…A manual review of clinic notes was performed to identify patient-reported reasons for disengagement as part of a separate study. (Weinstein et al, 2017) Descriptive statistics were used to characterize the reasons for disengagement among the very early disengagers, which included broad categories such as health contraindications, insurance problems, clinic problems, and legal issues.…”

“…We selected race for use in the final model because previous studies have implicated racial disparities as a factor predicting substance use treatment outcomes. (Mennis & Stahler, 2015; Weinstein et al, 2017; Wells, Klap, Koike, & Sherbourne, 2001)…”

“…(Weinstein et al, 2017) It will assess the following: 1) the proportion and characteristics of patients in an urban safety net hospital OBOT program who leave care in less than 1 month (i.e., very early disengagement); and 2) the proportion and characteristics of those who re-engage in care with the same clinic within 2 years among those with very early disengagement.…”

Commentary: Providing technical assistance for the state targeted response for opioid use disorders: Time is of the essence

“…Meanwhile, longitudinal studies have demonstrated that individuals treated with pharmacologic agonist interventions such as methadone and buprenorphine effectively reduce opioid craving and use. 7,8 Detoxification without maintenance on one of these life-saving medications greatly increases the risk of overdose and death. 9,10 More recently, several studies have found that extended-release naltrexone (vivitrol) is equally effective as agonist treatments in reducing the risk of relapse once an individual is successfully inducted onto extended-release naltrexone.…”