Long‐Term Retention in an Outpatient Behavioral Health Clinic With Buprenorphine

Montalvo, Cristina; Stankiewicz, Brad; Brochier, Annelise; Henderson, David C.; Borba, Christina P.C.

doi:10.1111/ajad.12896

Cited by 17 publications

(35 citation statements)

References 27 publications

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“…Consistent with this was the lack of evidence for any abuse of stimulants or benzodiazepines in patients who were prescribed these medications. Despite concerns about this that have been raised, 19 use of benzodiazepines in the current study did not appear to put these patients at risk for overdose, which is consistent with the findings of others 3,20 . Stimulant prescription for ADHD in this population also has been found previously to be safe 21 …”

Section: Discussionsupporting

confidence: 89%

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: Discussionsupporting

confidence: 89%

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

Feder

2020

American J Addict

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“…Age was the most frequently studied risk factor; of the 31 MMT studies examining age, 18 studies found increasing age to be associated with increased retention [37, 39, 50, 54, 59, 63, 74-76, 80, 81, 83, 89, 92, 94, 95, 97]. Similar patterns were observed for studies of buprenorphine, with eight of 12 included studies reporting increased retention with age [56,58,69,70,72,82,86,93], and mixed OST with four of the six included studies reporting consistent effects for age [43,44,53,87]. While gender was widely studied (n = 40), more than half the studies reported a non-significant association between gender and retention.…”

Section: Plos Onementioning

confidence: 72%

“…While gender was widely studied (n = 40), more than half the studies reported a non-significant association between gender and retention. However, where an association was observed, most studies (12/14) identified men as having significantly lower retention [39,44,50,53,58,63,72,73,90,92,93,97]. Two studies reported opposite effects, one in relation to MMT [66] and Native American (n = 3) [39,50] groups.…”

Section: Plos Onementioning

confidence: 99%

“…There was a large range of treatment settings, with OST clinics accounting for the largest proportion of treatment settings at 53.7% (n = 36) [31, 33-39, 42, 45, 46, 48-51, 53, 55, 57, 60, 62, 64, 66, 67, 75-81, 83, 92, 94-97]. 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].…”

Section: Study Characteristicsmentioning

confidence: 99%

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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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“…For people with OUDs who do initiate treatment, continued adherence and retention in care are needed to optimize outcomes. Longitudinal studies have consistently found that longterm retention in buprenorphine treatment is poor, with only one-third retained in care at 2 years [145][146][147]. No studies have directly linked stigma to retention in care for opioid agonist treatment, but among persons with other stigmatized conditions like HIV, stigma has been found to be a consistently strong correlate of treatment adherence, retention in care, and treatment outcomes [148,149].…”

Section: Internalized and Anticipated Stigmamentioning

confidence: 99%

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

et al. 2019

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• The current United States opioid overdose crisis is a complex, multifaceted, public health emergency that urgently requires the implementation of evidence-based primary, secondary, and tertiary preventive interventions. We develop a typology of the stigma related to opioid use, showing how multiple dimensions of stigma continue to fundamentally hinder the response to the crisis. • Public stigma is driven by stereotypes about people with opioid use disorders, such as their perceived dangerousness or perceived moral failings, which translate into negative attitudes toward people with opioid use disorders. • Enacted stigma describes the behavioral manifestations of public stigma, including discrimination and social distancing. Public and enacted stigma, in turn, lead to delivery of suboptimal care and undermine access to treatment and harm reduction services. • Public stigma and enacted stigma can become structural stigma when they become encoded in cultural norms, laws, and institutional policies. Collectively, these forms of stigma run at cross purposes to-and reduce public support for-public health-oriented policies to address the opioid overdose crisis.

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Long‐Term Retention in an Outpatient Behavioral Health Clinic With Buprenorphine

Cited by 17 publications

References 27 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

Stigma as a fundamental hindrance to the United States opioid overdose crisis response

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