Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

Abstract

Background Patients and clinicians have begun to recognize the advantages and disadvantages of buprenorphine relative to methadone, but factors that influence choices between these two medications remain unclear. For example, we know little about how patients’ preferences and previous experiences influence treatment decisions. Understanding these issues may enhance treatment engagement and retention. Methods Adults with opioid dependence (n = 283) were recruited from two integrated health systems to participate in interviews focused on prior experiences with treatment for opioid dependence, knowledge of medication options, preferences for treatment, and experiences with treatment for chronic pain in the context of problems with opioids. Interviews were audio-recorded, transcribed verbatim, and coded using Atlas.ti. Results Our analysis revealed seven areas of consideration for opioid agonist treatment decision-making: 1) awareness of treatment options; 2) expectations and goals for duration of treatment and abstinence; 3) prior experience with buprenorphine or methadone; 4) need for accountability and structured support; 5) preference to avoid methadone clinics or associated stigma; 6) fear of continued addiction and perceived difficulty of withdrawal; and 7) pain control. Conclusion The availability of medication options increases the need for clear communication between clinicians and patients, for additional patient education about these medications, and for collaboration and patient influence over choices in treatment decision-making. Our results suggest that access to both methadone and buprenorphine will increase treatment options and patient choice and may enhance treatment adherence and outcomes.

Blocking microglial pannexin-1 channels alleviates morphine withdrawal in rodents

“…To alleviate or avoid the aversive symptoms of withdrawal, many of these individuals continue to use opiates [1][2][3][4] . Withdrawal is therefore a key determinant of opiate use in dependent individuals, yet its underlying mechanisms are poorly understood and effective therapies are lacking.…”

Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement

“…Mean age was 39 years (SD=13). Individuals had past 12 month problems with prescription opioids (n=87; 72%), heroin (n=21; 17%) or both (n=10; 8%); the remainder did not report past year problems with opioids but may have reported other problematic drug use (see Yarborough et al, 2016). Lifetime experiences with prescription opioids, heroin, or both, were significantly higher.…”

“…Both health systems provide inpatient and outpatient medical, mental health and addiction medicine care. Goals of the study included understanding patient experiences with, and preferences for, opioid use disorder treatment (Yarborough et al, 2016) and health care provider beliefs about buprenorphine treatment for OUD (Green et al, 2014). Data was derived from the EMR (health care utilization, diagnoses, comorbidities), and structured questionnaire and semi-structured interviews with patients with opioid use disorders.…”

“…Our prior work has described health system use (McCarty et al, 2010) and costs associated with opioid treatment (Lynch et al, 2014), health care provider experiences with adopting buprenorphine as an OUD treatment option (Green et al, 2014), and patient-reported opioid agonist treatment preferences (Yarborough et al, 2016). The aim of the current paper is to document individuals’ explanatory models for how they developed an OUD—and, for some, how these models affected treatment engagement.…”

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

“…While methadone is a full mu‐opioid agonist, buprenorphine is a partial mu‐opioid agonist, providing a ‘ceiling effect’ for respiratory depression and potentially limiting the effect of additional heroin use 29, 30. Qualitative studies in the United States suggest that patient preference for buprenorphine and methadone varies, and is influenced by peer attitudes, prior treatment experience and clinic dispensing practices 31, 32, 33. Internationally, there is no consensus about which medication to use.…”