Patient Perspectives Associated with Intended Duration of Buprenorphine Maintenance Therapy

Abstract

Patients with opioid use disorders frequently discontinue opioid maintenance therapy (OMT) prematurely, reducing retention and possibly limiting the efficacy of OMT. The current study is a cross-sectional survey of patients (N = 69) enrolled in buprenorphine maintenance therapy (BMT). We examined patient demographics, BMT characteristics (e.g., dose, time in BMT), and patient perspectives regarding intended duration of BMT. In addition, patients’ reasons for continuing or discontinuing BMT were investigated. Results revealed that the majority (82%) of participants reported wanting to continue BMT for at least 12 months. Age at first drug use, time in BMT, concern about pain, and concern about relapse were all positively associated with intended duration of BMT. The following were negatively associated with intended duration of BMT: recent discussion with a treatment provider about BMT discontinuation, prior attempt to discontinue BMT, concern about withdrawal symptoms, experiencing pleasurable effects from taking buprenorphine, and perceived conflicts of BMT with life, work, or school obligations. The most common reasons for wanting to continue BMT included concerns about withdrawal symptoms, relapse, and pain. Although preliminary, the findings highlight key issues with regard to patients’ perspectives of BMT. The results of this study provide information that may be useful in improving OMT programs and treatment outcomes.

Patients' Beliefs About Medications are Associated with Stated Preference for Methadone, Buprenorphine, Naltrexone, or no Medication-Assisted Therapy Following Inpatient Opioid Detoxification

“…Thus, particularly for BUP and XR-NTX, beliefs about the medications (rather than structural barriers or previous experience) may be very influential in patient medication preference. The importance of the perception of efficacy for patients’ stated preferences is consistent with literature on correlates of retention in MMT (Kayman et al, 2006) and patient preferences for how long to continue MMT (Bentzley et al, 2015; Winstock et al, 2011). …”

“…The scales we created to measure beliefs about MATs had satisfactory internal consistency, face validity, and were consistent with stated MAT preference, supporting the utility of the Health Belief Model and these scales in this population. Second, previous studies on patient beliefs about MATs either examined how beliefs predicted a preference for (or actual choice of) MMT vs. BUP (Gryczynski et al, 2013; Pinto et al, 2010; Ridge et al, 2009) or examined retention in (Kayman et al, 2006) or intended duration of (Bentzley et al, 2015; Winstock et al, 2011) maintenance treatment with either MMT or BUP. Another study contrasted attitudes toward BUP or MMT amongst patients enrolling in MMT or people not in treatment (Schwartz et al, 2008).…”

“…This was true even when controlling for other predictors of treatment engagement, including homelessness, being on parole, and long-term drug use (Millery et al, 2002). Further, a belief that treatment is efficacious – or the converse, that one will relapse without it – is associated with a desire to stay in treatment longer for patients already in BUP or MMT maintenance treatment (Bentzley, Barth, Back, Aronson, & Book, 2015; Winstock, Lintzeris, & Lea, 2011), as well as with actual retention in MMT (Kayman, Goldstein, Deren, & Rosenblum, 2006). …”

Neuroinflammation—a co-occurring phenomenon linking chronic pain and opioid dependence

“…One, therefore, cannot rule out the possibility that reported opioid misuse in the chronic pain population may be due, in part, to pain patients taking opioids to relieve the negative affect associated with chronic pain that may be exacerbated by opioid withdrawal, and where the relief of dysphoric states becomes an important driver of opioid seeking behavior. In support of this theory, clinical studies investigating subjective reporting in electronic diaries obtained from heroin addicts identified feeling sad as a driver of opioid craving [30], whereas subjects on buprenorphine or methadone maintenance continued therapy because they want to feel ‘normal’ [31,32]. We have recently argued that the opioid abstinence syndrome and the anxiogenic and negative affective states that evolve following abstinence [25,33] are likely salient factors for learning that opioids relieve negative affect, which drives subsequent addictive behaviors [34 • ].…”

Withdrawal severity and early response to treatment in the outpatient transition from opioid use to extended release naltrexone

“…Prolonged medication exposure and behavioral incentives can help improve adherence and effectiveness, yet problems of withdrawal management during detoxification and naltrexone induction persist . Fear of discontinuing opioid agonist medications and anticipation of severe withdrawal discomfort may variably influence treatment choice and outcome . Additional concerns rise from reports of untimely or inappropriate use of naltrexone triggering heightened withdrawal to encompass delirium, agitation, and confusion during detoxification .…”