Psychological and physiological stress negatively impacts early engagement and retention of opioid-dependent individuals on methadone maintenance

Abstract

The present study investigated whether psychological and/or physiological measures of stress would impede induction onto methadone maintenance and predict early (<6 months) discontinuation. Compared with controls, opioid-dependent subjects displayed increased distress on the perceived stress scale (PSS) and post-traumatic stress disorder checklist (PCLC); 60% exhibited abnormal cortisol. Addiction severity index (ASI), drug-use, and stress indices explained between 17–37% of the variance in engagement including attendance, opioid abstinence, and methadone stabilization. Participants who discontinued treatment displayed poor engagement, abnormal cortisol, elevated withdrawal symptoms, higher distress, and increased ongoing opioid use versus compliant individuals. Discontinuation was initially related to drug-use severity; however, by 6 months, retention depended primarily upon cortisol abnormalities, which increased an individual’s discontinuation risk by 7.7-fold. These findings support admission screening with the ASI/cortisol for drop out, and stress/drug-use indices for engagement that together may enable clinically-relevant early recognition and interventions for prevention of stress-induced relapse in opioid-dependent populations.

Long‐term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi‐site trial

“…These findings are consistent with those reported by prior studies [3,5]. We speculate that to improve treatment retention in these two medication conditions, efforts should target factors (at both the patient and contextual level) that contribute to medication discontinuation, such as patients' lack of medication knowledge [18], concurrent use of cocaine or other substances [11,19], inadequate medication dosage [11], co-occurring psychological conditions or stress [19,20] and involuntary medication discontinuation due to strict clinical requirements [21] or incarceration [22]. Because participants did not always stay in the randomized treatment condition, we included both randomization condition and treatment in the model as separate factors and found similar positive treatment effects of BUP and MET (relative to no treatment) in reduced opioid use.…”

“…These findings are consistent with those reported by prior studies. 3,5 We speculate that to improve treatment retention in these two medication conditions, efforts should target factors (at both the patient and contextual level) that contribute to medication discontinuation such as patients’ lack of medication knowledge, 18 concurrent use of cocaine or other substances, 11,19 inadequate medication dosage, 11 co-occurring psychological conditions or stress, 19,20 and involuntary medication discontinuation due to strict clinical requirements 21 or incarceration. 22 …”

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

“…Given that depressive symptoms are now part of a core symptom cluster for PTSD in the DSM-5, and that dysphoria is a common emotional state in recovery, we were interested that participants with PTSD were more likely to enter OBOT. This aligns with findings from prior studies 38,49 where opioid dependent individuals with emotional issues were receptive to buprenorphine treatment. The linkage model may provide needed structure to people who have experienced traumatic situations to access care.…”

“…These findings are of interest because of the high prevalence of PTSD among opioid users compared to other drug classes 1,38 . It is also known that poor mental health is co-morbid with opioid use dependence 47 , with depression most commonly studied.…”

“…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 . Similarly, poor mental health may worsen retention in buprenorphine treatment in some studies 38 , while other studies have suggested a link between depressive symptomatology and retention 47,48 . Because being hospitalized is the unique defining aspect of the linkage treatment model, days of hospitalization was included as a predictor as well.…”