Trends in Abstinence and Retention Associated with a Medication-Assisted Treatment Program for People with Opioid Use Disorders

Abstract

Background: Medication-assisted treatment (MAT) is an evidence-based program for patients with opioid use disorders. Yet, within the state of Utah, MAT had not been widely available, promoted, or adopted within the public sector. Recognizing the potential benefit, a collective impact approach was used to promote social change and increase the use of MAT in the community for treatment of opioid use disorders.Objective: Conduct a retrospective, observational case series study to measure the effect of a community-based, collective impact approach implementing the MAT program to improve the rate of abstinence and retention among individuals identified with an opioid use disorder in three Utah counties. Methods:The study was designed and implemented by the Utah Opioid Community Collaborative (OCC) using a collective impact approach, which included broad sector coordination (public-private collaboration), a common agenda, participation in mutually reinforcing activities, continuous communication, consistent measurement of results, and identification of a backbone organization. The MAT intervention program includes use of medications approved by the U.S. Food and Drug Administration in combination with counseling and behavioral therapies delivered within two community sites. Analysis was performed over time to describe the rate of abstinence and retention associated with participation in the MAT program during 2015 through 2017.Results: Of the 339 identified with risk of an opioid use disorders, 228 enrolled in the MAT Program. At MAT enrollment, average age was 32.6 ± 8.2 years old and 58.0% were female. At 365 days after MAT enrollment, 84% of participants were abstinent from opioid substances and 62% from all illicit substances.Conclusions: Use of a collective impact approach provides a successful mobilization framework in Utah for increasing community engagement and expanding patient access to underresourced MAT programs while suggesting a high rate of abstinence from illicit substances at 12 months.

Long-acting injectable buprenorphine for opioid use disorder: A systematic review of impact of use on social determinants of health

“…This systematic review found that when compared to the literature on treatment as usual (TAU) MAT, LAIB treatment had comparable rates of employment (44-51%) (Rosic, Worster, Thabane, Marsh, & Samaan, 2020;Zippel-Schultz et al, 2016), retention (50-73%) (O'Connor et al, 2020), and abstinence (35-82%) (Brunisholz et al, 2020;Carew & Comiskey, 2018;Teesson et al, 2008). Specific identified benefits of LAIB compared to TAU MAT were: (1) the reduced risk of intentional or accidental diversion of buprenorphine to others including children in the community; (2) the dosing flexibility with regard to unanticipated treatment interruptions, including incarceration; and (3) reduction in time lost and stigma associated with frequent medication collection.…”

Lessening the Impact of Opioid Misuse at a Federally Qualified Health Center in New York: Outcomes of an Integrated Workforce Training Program

“…management. 8,9 Addressing this need involves increasing the capacity of primary care and health care centers to deliver integrated care and includes the need for overdose prevention and harm reduction strategies in the context of telehealth services. Systemwide changes involving the use of teambased brief interventions and collaborative care management models to increase practice integration are needed.…”

“…These outcomes are consistent with or better than outcomes listed in the broad body of research on MAT to date, which typically shows 50% retention in care. [9][10][11] Limited research is focused on the efficacy of low-threshold MAT programs, with few studies describing their features. 3,25 Our findings illustrate the effectiveness of delivering MAT for OUD using a team-based harm reduction approach for patients with complex health care needs through an interprofessional integrated care model.…”

“…[20][21][22] (3) Deliver an enhanced, patient-centered, integrated care coordination model that boosts physical and mental health outcomes and increases retention and engagement in MAT. 9,11 (4) Respond to the pandemic by using a low-threshold MAT model and adopting a more flexible approach to MAT services to individuals with OUD, transitioning to a telehealth model of care in combination with in-person appointments.…”

Life unites us: A novel approach to addressing opioid use disorder stigma

“…The collective impact model has shown promise in addressing and preventing drug dependency (Bonfine et al, 2018; Brunisholz et al, 2020; Knighton et al, 2018). Bonefine, et al used sequential intercept mapping (identifying a community’s cross-sector resources and approaches) to encourage treatment adherence and prevent criminal justice involvement, while Brunisholz et al and Knighton et al created a broad coalition whose partnership supported an increase in access to treatment resources.…”