Predictors of patient retention in methadone maintenance treatment.

Abstract

This study sought to determine whether select pretreatment demographic and in-treatment clinical variables predict premature treatment discharge at 6 and 12 months among patients receiving methadone maintenance treatment (MMT). Data were abstracted from electronic medical records for 1,644 patients with an average age of 34.7 years (SD = 11.06) admitted to 26 MMT programs located throughout the United States from 2009 to 2011. Patients were studied through retrospective chart review for 12 months or until treatment discharge. Premature discharge at 6- and 12-month intervals were the dependent variables, analyzed in logistic regressions. Clinical predictor variables included average methadone dosage (mg/d) and urinalysis drug screen (UDS) findings for opioids and various nonopioid substances at intake and 6 months. Pretreatment demographic variables included gender, race/ethnicity, employment status, marital status, payment method, and age at admission. UDS findings positive (UDS+) for cocaine at intake and 6 months were found to be independent predictors of premature discharge at 12 months. UDS+ for opioids at 6 months was also an independent predictor of premature discharge at 12 months. Higher average daily methadone dosages were found to predict retention at both 6 and 12 months. Significant demographic predictors of premature discharge at 6 months included Hispanic ethnicity, unemployment, and marital status. At 12 months, male gender, younger age, and self-pay were found to predict premature discharge. Select demographic characteristics may be less important as predictors of outcome after patients have been in treatment beyond a minimum period of time, while others may become more important later on in treatment.

The impact of comorbid psychiatric disorders on methadone maintenance treatment in opioid use disorder: a prospective cohort study

“…In keeping with previous evidence,12,58,59 our study showed that cocaine use is also associated with continued opioid use while on MMT. Conversely, decreased cocaine use has been associated with cessation of illicit opioid use 60.…”

The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment

“…The finding that responding to OAT dosing, which is clinically indicated for increased craving or polysubstance use, was inflexible and oftentimes misguided by prescribers further supports guideline-based OAT prescribing. There is now considerable evidence that documents higher retention when patients are prescribed methadone rather than buprenorphine and higher methadone doses that exceed 80mg to 100mg per day (Bao et al, 2009; Booth, Corsi, & Mikulich-Gilbertson, 2004; Farre, Mas, Torrens, Moreno, & Cami, 2002; Hser et al, 2014; Maxwell & Shinderman, 1999; Peles et al, 2006; Proctor et al, 2015; Simoens, Matheson, Bond, Inkster, & Ludbrook, 2005; Strain, Bigelow, Liebson, & Stitzer, 1999; Wickersham, Zahari, Azar, Kamarulzaman, & Altice, 2013). Instead, Ukrainian clients report that either inadequate or compete lack of response by Ukrainian OAT prescribers interfered (consciously or unconsciously) with the success of a client's treatment plan.…”

“…Demographic characteristics such as younger age, male gender, and unemployment have been found to negatively impact OAT retention (Che et al, 2010; Jiang et al, 2014; Proctor et al, 2015; Strike et al, 2005) while unmarried patients or those without a supportive network were more likely to experience a poor outcome with respect to OAT retention (Che et al, 2010; Yang, 2013). Clinical factors, including addiction severity and medication dosing and type of medication received (methadone vs buprenorphine/naloxone) were found to be predictors of OAT retention (Bao et al, 2009; Che et al, 2010; Peles, Schreiber, & Adelson, 2006; Proctor et al, 2015). Structural issues such as distance to and accessibility of clinic site have also been shown to predict discontinuation of OAT (Che et al, 2010).…”

Hospitalized opioid‐dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge

“…Older age may be a predictor of treatment retention because older patients have had more treatment episodes, which cumulatively increase the likelihood of treatment retention 51 . Younger patients, who have not experienced as many substance-related negative consequences relative to older patients 32 , are more likely to drop out early from methadone maintenance and opiate agonist treatment 13,15,16,27,49,52 . Racial/ethnic minorities are more likely to drop out of treatment early 29,52 , suggesting the need for further research to improve treatment retention.…”

“…Non-white racial/ethnic group membership predicts early drop out 1,15 . Gender has not consistently predicted entry or retention 1,29–31 , although there is some evidence to suggest that men are more likely to be retained 28,32 . While some studies have found treatment readiness for cessation of drug use to be an important influence on retention 11 in different treatment modalities (e.g., long term residential, outpatient, methadone) 20,25,33,34 , others have not found this relationship 35,36 , particularly among samples of African-American patients 35,37 .…”