Predictors of Family Medicine Patient Retention in Opioid Medication-Assisted Treatment

Justesen, Kathryn; Hooker, Stephanie Ann; Sherman, Michelle D.; Lonergan-Cullum, Mary; Nissly, Tanner; Levy, Robert J.

doi:10.3122/jabfm.2020.06.200086

Cited by 11 publications

(21 citation statements)

References 30 publications

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“…Despite low statistical power, results suggest that MOUD provision by providers who also offer comprehensive medical care may further increase MOUD retention. These findings add support 6 for rural PCPs to offer MOUD as part of their routine comprehensive primary care to combat the opioid crisis. [10][11][12] As MOUD requires regular visits, the improved retention seen among patients receiving MOUD from their PCP may be related to the stabilizing role of longitudinal interactions with a provider.…”

Section: Discussionmentioning

confidence: 58%

Retention With Medication for Opioid Use Disorder: The Role of the Primary Care Relationship

Munger

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2022

J Addict Med

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Objectives: Primary care providers (PCPs) prescribe medication for opioid use disorder (MOUD), but patients may receive MOUD from a provider who only prescribes MOUD, and who does not provide routine medical care that would be expected from a PCP. The importance of receiving MOUD from one's own PCP versus another provider on patient MOUD retention is not known. Methods: All patients receiving MOUD from December 2016 through November 2019 within a rural, Federally Qualified Health Center were included. Patient sociodemographic, PCP-MOUD concordance, and retention time in MOUD were extracted from the electronic health record. Travel-time from patients' home to the clinic where MOUD was provided was calculated. The risk of premature discontinuation was estimated with Kaplan-Meier curves and with hazard ratios (HR) with 95% confidence intervals (CI). All analyses were performed using R version 3.4.4. Results: Among (n = 353) patients receiving MOUD from 2016 to 2019, n = 77 (21.8%) patients receivedMOUD from their PCP (PCP-MOUD concordance). PCP-MOUD concordance was associated with reduced risk of premature discontinuation (HR = 0.41, 95% CI = 0.18-0.95), however, after multivariable adjustment, PCP-MOUD concordance was not significant (HR = 0.45, 95% CI = 0.19-1.05). Conclusions: In this rural Federally Qualified Health Center, MOUD provision by a patient's own PCP, as compared to a separate provider, did not reach statistical significance for an association with improved retention in treatment. These findings are likely due to a small sample size, and support expanding buprenorphine access as part of comprehensive primary care to combat the opioid crisis, especially in rural areas.

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Section: Discussionmentioning

confidence: 58%

Retention With Medication for Opioid Use Disorder: The Role of the Primary Care Relationship

Munger

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2022

J Addict Med

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“…This scoping review identified 18 studies (Figure 1) evaluating important health outcomes among patients with OUD and ADHD within addiction treatment programs. 6,9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The sample size of the included studies ranged from 12 to 81 752 patients. 6,9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The follow-up period of longitudinal studies ranged from 12 weeks to 30 years.…”

Section: Resultsmentioning

confidence: 99%

“…6,9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The sample size of the included studies ranged from 12 to 81 752 patients. 6,9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The follow-up period of longitudinal studies ranged from 12 weeks to 30 years. [24][25][26][27][28][29][30][31][32][33][34]38,39 Included in this review were 1 placebo-controlled trial, 24 5 prospective observational studies, 25,…”

Section: Resultsmentioning

confidence: 99%

Gaps in Evidence-based Treatment of Concurrent Attention Deficit Hyperactivity Disorder and Opioid Use Disorder: A Scoping Review

2022

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Objectives: To describe the effectiveness of medications for the treatment of opioid use disorder (OUD) and attention deficit/hyperactivity disorder (ADHD). Data Sources: Literature search of PubMed, Embase, Web of Science, CINAHL, Medline, PsycINFO, and Google Scholar was performed for studies published from inception to October 25, 2022. Study Selection and Data Extraction: Studies were included if patients were diagnosed with OUD and ADHD and had pharmacotherapy for either condition. Abstracts, commentaries, reviews, case reports, case series, non-English articles, and animal studies were omitted. Data Synthesis: This review found 18 studies. Treatment of ADHD was evaluated for impact on ADHD and OUD outcomes, while treatment of OUD was evaluated for OUD-related outcomes. Outcomes assessed included markers for symptom intensity, adherence, and treatment failure. While results were mixed, treatment of ADHD was largely associated with improvements in ADHD severity and retention in OUD treatment programs. ADHD severity was associated with higher rates of illicit substance abuse and worse OUD-related outcomes. It could not be determined which medications for treatment of OUD should be prioritized. Relevance to Patient Care and Clinical Practice: This review summarized key findings from studies that treated ADHD or OUD among dually diagnosed patients and highlighted methodological considerations for future research. Conclusions: Treatment of ADHD is warranted among patients with OUD and ADHD to improve retention in OUD treatment programs and reduce illicit substance abuse. Pharmacotherapy for the treatment of ADHD or OUD should continue to be determined based on patients' characteristics and the capabilities of the treatment program.

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“…MOUD is the gold standard treatment for OUD and is consistently associated with better OUD treatment outcomes including higher treatment retention rates and reduced substance use recurrence compared to non-pharmacological therapies for OUD [26,27], yet treatment outcomes vary widely by race, age, sex and gender, treatment setting, and polysubstance use [28,29]. Although predictors of MOUD treatment outcomes have been identified broadly [23,28,[30][31][32][33], little is known about within-group differences in Black adults receiving MOUD, especially for MOUD with buprenorphine. The few studies examining predictors of MOUD outcomes (i.e., substance use and treatment retention) among Black individuals have focused on methadone treatment samples [34,35].…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes Among Black Adults Receiving Medication for Opioid Use Disorder

Parlier-Ahmad

Pugh

Martin

2021

J. Racial and Ethnic Health Disparities

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Largely due to structural racism, Black people with substance use disorder have worse outcomes than their White counterparts. The opioid epidemic has amplified these racial disparities. Little is known about strengths that buffer against the systemic issues that disproportionately impact Black adults with opioid use disorder (OUD), particularly those receiving buprenorphine for OUD. The objectives of this study are to (1) assess psychosocial and clinical predictors of OUD outcomes and (2) explore differences in OUD outcomes by gender among a sample of Black adults receiving buprenorphine. This is a secondary data analysis of a cross-sectional survey and medical record review with a convenience sample recruited from an addiction medicine clinic. Analyses included Black participants who provided at least one urine drug test during the study period (n = 98). Prospective 6-month OUD outcomes (treatment retention, substance use recurrence, and buprenorphine continuation) were abstracted from the medical record. Univariate analyses explored differences by gender. Multivariate regressions assessed predictors of OUD outcomes. Participants were 53% women and middle-aged (47 ± 12 years). The majority (59%) had been in treatment for at least 1 year at study enrollment. Substance use recurrence was common, but many individuals remained in treatment. OUD outcomes did not differ by gender. Older age and absence of injection opioid use history were significant predictors of treatment retention and buprenorphine continuation. When provided access to high-quality treatment, Black adults with OUD demonstrate positive outcomes. Addressing structural racism and developing culturally informed treatment interventions are necessary to improve access to high-quality care for this community.Keywords Black adults . Opioid use disorder (OUD) . Medication for opioid use disorder (MOUD) . Buprenorphine . Social determinants of health

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Predictors of Family Medicine Patient Retention in Opioid Medication-Assisted Treatment

Cited by 11 publications

References 30 publications

Retention With Medication for Opioid Use Disorder: The Role of the Primary Care Relationship

Retention With Medication for Opioid Use Disorder: The Role of the Primary Care Relationship

Gaps in Evidence-based Treatment of Concurrent Attention Deficit Hyperactivity Disorder and Opioid Use Disorder: A Scoping Review

Treatment Outcomes Among Black Adults Receiving Medication for Opioid Use Disorder

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