Three-year retention in buprenorphine treatment for opioid use disorder nationally in the Veterans Health Administration

Manhapra, Ajay; Petrakis, Ismene L.; Rosenheck, Robert A.

doi:10.1111/ajad.12553

Cited by 67 publications

(70 citation statements)

References 36 publications

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“…Treatment retention and compliance (as measured by percentage of negative urines) in this study was significantly higher than in previous studies 1,3‐5,7,25 . This may be related to patient selection factors (most were employed full‐time or taking care of their children full‐time) and the strong physician‐patient relationship developed in this setting.…”

Section: Discussioncontrasting

confidence: 68%

“…Buprenorphine has been shown to be one of the most successful treatments for opioid use disorder. Most of the published data on the use of buprenorphine has come from clinics associated with academic centers 1‐9 . Patient populations in these studies have often been from lower socioeconomic levels, predominantly male, have had relatively low retention rates, and have been difficult to track in any long‐term follow‐up.…”

Section: Introductionmentioning

confidence: 99%

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Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice

Feder

2020

American J Addict

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Background and Objectives There have been few reports of buprenorphine treatment of opioid use disorder in private psychiatric practice. This report describes such a patient population and the outcomes obtained. Methods Chart reviews were performed on 285 patients seen over a 10‐year period in the author’s solo private psychiatric practice. Quantitative and qualitative data were reviewed and analyzed. Results Comorbidity of psychiatric disorders was high (75%), while comorbidity of substance use disorders was low (5%, alcohol only). Fourteen percent of patients completed treatment (tapered off of buprenorphine and remained opioid‐free for up to 7 years). Forty‐eight percent of the sample had good outcomes (remaining on buprenorphine and abstinent of other opioids), 28% had poor outcomes, and 10% dropped out of prolonged successful treatment with unknown final outcomes. The group achieved a relatively high rate of smoking cessation during the study (22%). There were high rates of language disorder (21.6%) and autism spectrum disorder (8.6%) in children of mothers in the study. Discussion and Conclusion Outcomes were excellent compared with those reported in other treatment settings. Rates of smoking cessation were also notable. The treatment of comorbid psychiatric conditions, the setting to develop a strong physician‐patient relationship, patients choosing whether to taper off of buprenorphine, and the slow rate of taper all likely contributed to successful outcomes. Further investigation is needed regarding possible increased rates of developmental disorders in children of mothers treated with buprenorphine. Scientific Significance Private psychiatric practice is a highly successful domain for the treatment of opioid use disorder. (Am J Addict 2020;29:508–514)

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Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice

Feder

2020

American J Addict

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“…Other treatment settings included office based or primary care OST (n = 9) [32,40,47,58,82,84,87,88,93], hospital setting (n = 5) [61,63,65,85,91], outpatient treatment programmes (n = 4) [54,56,71,72] and mixed treatment settings (n = 3) [41,44,73]. The remaining studies reported on national or regional registries, including health insurance databases (n = 10) [43,52,59,69,74,86,89,90] or Veteran Health Administration records in the US [68,70]. Two-thirds of the included studies focused on methadone maintenance treatment (MMT) (n = 45) [31-39, 42, 45, 46, 48, 50, 54, 55, 57, 59-67, 73-81, 83, 85, 89-92, 94-97], with 21% focusing on Buprenorphine (n = 14) [40, 47, 49, 56, 58, 68-72, 82, 84, 88, 93].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The most frequently used measure of dropout was time to discontinuation of OST (n = 32), with varying thresholds applied to identify date of dropout. Almost half the studies reporting on time to discontinuation did not specify a threshold for identifying dropout (n = 13) [37,40,42,43,45,56,62,65,68,69,85,91,94]; seven studies indicated that a patient was identified as having dropped out of OST if they missed more than 30 consecutive days of treatment [53,57,60,67,74,80,92]; six studies applied a threshold of seven days [44,46,49,78,96,97], and the remaining studies applied a threshold of five days [83], ten days [51], 14 days [58,66,95], 21 days [63]and two months [59]. The other six studies reporting on dropout used a binary measure, which identified patients as having dropped out of treatment after a specific period of follow-up [38,48,55,61,79,88].…”

Section: Study Characteristicsmentioning

confidence: 99%

Retention of patients in opioid substitution treatment: A systematic review

et al. 2020

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Background Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout. Methods A systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided. Results 67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST. Conclusions Younger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies.

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“…Some of these have had an observational [8,[14][15][16][17][18][19][20] and others have had an interventional design [21,22]. Taking into account the chronicity of this relapsing disorder, however, readmission is as important as retention.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Opioid Agonist Treatment Participation after First Treatment Entry is Similar across 4 European Regions but Lower in Non-Nationals

et al. 2018

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Heroin users in opioid agonist treatment (OAT) show markedly reduced heroin consumption, less crime and a lower mortality rate. However, the extent of long-term OAT participation over subsequent treatment episodes remains unclear. We analysed the annual proportion of patients in treatment (at least 1 day) since the start of first OAT in 4 European regions: Barcelona (BA) 1996–2012: 8,602 patients; Czech Republic (CZ) 2000–2014: 4,377 patients; Netherlands (NL) 1994–2014: 33,235 patients, Zurich (ZU) 1992–2015: 11,795. We estimated the long-term decline of treatment need due to mortality or abstinence and also a “nuisance” short-term decline until the equilibrium level of cycling in and out of OAT is reached to obtain the adjusted treatment participation value. The adjusted treatment participation was around 50% (BA: 47.4–51.4%; CZ: 49.8–53.9%; NL: 52.3–54.0%; ZU: 46.4–49.3%), and the annual decline of treatment need was close to 4%. Non-nationals (NL patients with a migrant background) showed substantial lower adjusted treatment participation (rate ratio BA: 0.059–0.343; NL: 0.710–0.751; ZU: 0.681–0.797; CZ: n.a.). Our method may provide a policy-relevant indicator of long-term provision, quality and access to OAT following first treatment.

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Three-year retention in buprenorphine treatment for opioid use disorder nationally in the Veterans Health Administration

Abstract: Future research focused on identifying further correlates of treatment retention is required to help devise interventions to improve treatment continuation. (Am J Addict 2017;26:572-580).

Cited by 67 publications

References 36 publications

Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice

Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice

Retention of patients in opioid substitution treatment: A systematic review

Long-Term Opioid Agonist Treatment Participation after First Treatment Entry is Similar across 4 European Regions but Lower in Non-Nationals

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