Cumulative barriers to retention in methadone treatment among adults from rural and small urban communities

Abstract

Background Though methadone has been shown to effectively treat opioid use disorder, many barriers prevent individuals from accessing and maintaining treatment. Barriers are prevalent in less populated areas where treatment options are limited. This study examines barriers to retention in methadone treatment in a small Midwest community and identifies factors associated with greater endorsement of barriers. Methods Patients at an opioid treatment program (N = 267) were recruited to complete a computer-based survey onsite. Surveys assessed demographics, opioid misuse, depression and anxiety symptoms, trauma history and symptoms, social support, and barriers to retention in treatment (e.g., childcare, work, housing, transportation, legal obligations, cost, health). Descriptive statistics were used to examine individual barriers and multiple regression was calculated to identify demographic and psychosocial factors associated with greater cumulative barriers. Results Most participants reported at least one barrier to retention in treatment and more than half reported multiple barriers. Travel hardships and work conflicts were the most highly endorsed barriers. Past year return to use (B = 2.31, p = 0.004) and more severe mental health symptomology (B = 0.20, p = 0.038) were associated with greater cumulative barriers. Greater levels of social support were associated with fewer barriers (B = − 0.23, p < 0.001). Conclusion This study adds to the limited research on barriers to retention in methadone treatment among patients in rural and small urban communities. Findings suggest flexible regulations for dispensing methadone, co-location or care coordination, and family or peer support programs may further reduce opioid use and related harms in small communities. Individuals with past year return to use reported a greater number of barriers, highlighting the time following return to use as critical for wraparound services and support. Those with co-occurring mental health issues may be vulnerable to poor treatment outcomes, as evidenced by greater endorsement of barriers. As social support emerged as a protective factor, efforts to strengthen informal support networks should be explored as adjunctive services to methadone treatment.

Nor-LAAM loaded PLGA Microparticles for Treating Opioid Use Disorder

“…Buprenorphine and naltrexone, acting as partial agonists and antagonists to MOR, respectively, have played roles in reducing opioid craving, mitigating withdrawal symptoms, and preventing relapse [6][7][8]. Despite the effectiveness of Medications for OUD (MOUDs) [9,10], challenges persist, including poor patient retention, increased overdose risks, low efficacy [6,11], and undesired side effects [12,13]. Due to lower patient compliance with current treatments, sustained-release formulations of buprenorphine and naltrexone have been developed, which addressed some of these challenges [7,8].…”

Utilization of Medications for Opioid Use Disorder Among West Virginia Medicaid Enrollees Following Medicaid Coverage of Methadone

“…It is also unknown whether Medicaid coverage of OTP services would have different impacts for those already recognized as needing treatment (e.g., enrolled with an OUD diagnosis) compared to those without. Additionally, while expanding Medicaid coverage of OTP services removed the cost barrier, prior studies have identified that distance from an OTP reduces methadone use and treatment duration, [8][9][10][11][12][13][14] and there are wide disparities in access to OTPs across the United States, particularly in nonmetropolitan areas. 10,15,16 To that end, we also examine whether these known barriers (i.e., travel distance and residing in a nonmetropolitan area) impacted methadone initiation and treatment duration following Medicaid coverage of methadone treatment.…”

Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone Program

“… 14 Unfortunately, factors associated with decreased retention in MTD are often those associated with more severe illness such as concurrent use of non-opioid substances (eg, stimulants), 15 comorbid psychiatric illness, 16 and inadequate social support. 17 Many factors can impact abstinence and retention in MTD and these 2 outcomes are closely related. 18 - 20 One intervening (mediating/moderating) variable in effective MTD is dose because under-dosing is associated with increased likelihood of continued illicit opioid use, and this ongoing opioid use often results in discharge from care.…”