Psychoactive medications and disengagement from office based opioid treatment (obot) with buprenorphine

Abstract

Background The prevalence of psychoactive medications (PAMs) use in patients enrolled in Office Based Opioid Treatment (OBOT) and its association with engagement in this care is largely unknown. Objective To describe the use of PAMs, including those medications with emerging evidence of misuse (“emerging PAMs” - gabapentin, clonidine and promethazine) among patients on buprenorphine, and its association with disengagement from OBOT. Methods This is a retrospective cohort study of adults on buprenorphine from January, 2002 to February, 2014. The association between use of PAMs and 6-month disengagement from OBOT was examined using multivariable logistic regression models. A secondary analysis exploring time-to-disengagement was conducted using Cox regression models. Results At OBOT entry, 43% of patients (562/1308) were prescribed any PAM; including 17% (223/1308) on an emerging PAM. In separate adjusted analyses, neither the presence of any PAM (adjusted odds ratio [AOR] 1.07, 95% CI [0.78, 1.46]) nor an emerging PAM (AOR 1.28 [0.95, 1.74]) was significantly associated with 6-month disengagement. The results were similar for the Cox model (any PAM (adjusted hazard ratio [AHR] 1.16, 95% CI [1.00, 1.36]), emerging PAM (AHR 1.18 [0.98, 1.41])). Exploratory analyses suggested gabapentin (AHR 1.30 [1.05 – 1.62]) and clonidine (AHR 1.33 [1.01 – 1.73]) specifically, may be associated with an overall shorter time to disengagement. Conclusions Psychoactive medication use is common among patients in buprenorphine treatment. No significant association was found between the presence of any psychoactive medications, including medications with emerging evidence of misuse, and 6-month disengagement from buprenorphine treatment.

Associations between prescribed benzodiazepines, overdose death and buprenorphine discontinuation among people receiving buprenorphine

“…People with cooccurring mental disorders and drug use disorders are more likely to seek treatment than those with a single disorder alone [43,44]. Furthermore, psychiatric diagnosis among those receiving buprenorphine has been associated with improved treatment retention [45,46]. Thus, people who receive benzodiazepines may have a more severe underlying mental disorder, and it may be the underlying mental disorder that leads them to seek and remain in buprenorphine treatment rather than receiving the benzodiazepine prescription.…”

Discontinuing Methadone and Buprenorphine: A Review and Clinical Challenges

“…Although discontinuing therapy with methadone or buprenorphine/naloxone may be a personal goal for many patients, family members, and addiction treatment staff, there are discouraging odds of completing a taper and remaining abstinent from illicit opioids. Weinstein et al 28 conclude that, though many patients want to discontinue, few are successful, and the medical community “should direct its efforts to overcome the barriers to long-term maintenance.” Robert Newman went further, challenging the significance of attempting to build interventions to make patients medication-free when they are already doing well on a maintenance medication. Newman asked, “to what end?” (p.1429) 29 .…”

A Research Agenda for Advancing Strategies to Improve Opioid Safety: Findings from a VHA State of the Art Conference

“…Discontinuation of treatment can occur for a variety of reasons related to patient (e.g., relapse), provider (e.g., quality of care), and system factors (e.g., arbitrary limits of duration of care). [21][22][23][24][25][26] Research priorities include understanding how to implement chronic disease management for MOUD, understanding factors leading to MOUD discontinuation, and re-engaging patients who discontinue care. 27 Finally, studying interventions to link patients who have a non-fatal overdose to MOUD treatment was deemed a high priority.…”