Leaving buprenorphine treatment: Patients' reasons for cessation of care

Abstract

Many opioid-dependent patients leave treatment prematurely. This study is a planned secondary analysis from a randomized trial of counseling for African Americans (N=297) entering buprenorphine treatment at one of two outpatient programs. This study examines: (1) whether patients’ initial treatment duration intentions prospectively predict retention; and (2) patients’ reasons for leaving treatment. Participants were queried about their treatment duration intentions at treatment entry, and their reasons for leaving treatment at 6-month follow-up. At baseline, 28.0% reported wanting to stay in buprenorphine treatment less than 6 months, while 42.1% actually left buprenorphine treatment within 6 months. However, participants intending short-term buprenorphine at the outset were not at elevated risk of early treatment discontinuation (OR=1.15; p=.65). Participants attributed treatment cessation predominantly to conflicts with staff, involuntary discharge, and perceived inflexibility of the program. Future research should examine patient-centered models of buprenorphine treatment that could improve retention.

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

“…Retention rates in treatment reported in the literature vary widely, but it is generally estimated that >50% of patients leave or are withdrawn in the first 3 weeks of treatment. [12][13][14] After 6 months of treatment, one study reported retention of 79%, [15] but others noted much lower rates of 58%, [16] 46% [17] and 27%. [18] In another study, an average of only 44% of buprenorphine clients spent at least 3 weeks in an Australian treatment facility.…”

Patient Perspectives Associated with Intended Duration of Buprenorphine Maintenance Therapy

“…Patients who perceive they have a low risk for opioid relapse demonstrate less interest in engaging in OMT (Bailey, Herman, & Stein, 2013) and express a shorter intended duration of treatment (Winstock, Lintzeris, & Lea, 2011). For those patients who do engage in OMT, dissatisfaction with program rules drives much of OMT discontinuation (Gryczynski et al, 2013; Reisinger et al, 2009) despite high levels of patient satisfaction with the OMT treatment itself (Barry et al, 2007; Ling, Hillhouse, Ang, Jenkins, & Fahey, 2013). Patient perspectives, such as these, may contribute to suboptimal treatment outcomes.…”

“…To date, only two reports have specifically addressed how patient perspectives of buprenorphine maintenance therapy (BMT) are associated with treatment duration (Gryczynski et al, 2013; Winstock et al, 2011). One report revealed that intended treatment duration was longer in patients who had been enrolled in BMT for a longer period of time and who were more concerned about relapse (Winstock et al, 2011).…”

“…One report revealed that intended treatment duration was longer in patients who had been enrolled in BMT for a longer period of time and who were more concerned about relapse (Winstock et al, 2011). Another report showed that perceived conflict of BMT with life, work, or school obligations was a major reason for treatment discontinuation (Gryczynski et al, 2013). However, these studies were limited by focusing on perspectives of patients naïve to BMT (Gryczynski et al, 2013), restricting the time course of treatment to 6 months (Gryczynski et al, 2013), and by including patients maintained on both methadone as well as buprenorphine (Winstock et al, 2011).…”

“…Another report showed that perceived conflict of BMT with life, work, or school obligations was a major reason for treatment discontinuation (Gryczynski et al, 2013). However, these studies were limited by focusing on perspectives of patients naïve to BMT (Gryczynski et al, 2013), restricting the time course of treatment to 6 months (Gryczynski et al, 2013), and by including patients maintained on both methadone as well as buprenorphine (Winstock et al, 2011). In the current study, we investigated patients maintained exclusively on buprenorphine in a naturalistic sample in order to identify patient perspectives that may affect intended treatment duration in clinical practice.…”