Methadone Maintenance Treatment Discontinuation Among Young People who use Opioids in Vancouver, Canada

Abstract

Objective Retaining adolescents and young adults (AYA) in medications for opioid use disorder (MOUD), like methadone maintenance treatment (MMT), is critical to reducing toxic drug fatalities. This analysis sought to identify factors associated with MMT discontinuation among AYA. Method Data were derived from the At-Risk Youth Study, a prospective cohort study of street-involved AYA in Vancouver, Canada, between December 2005 and June 2018. Multivariable extended Cox regression identified factors associated with time to MMT discontinuation among AYA who recently initiated MMT. In subanalysis, multivariable extended Cox regression analysis identified factors associated with time to “actionable” MMT discontinuation, which could be addressed through policy changes. Results A total of 308 participants reported recent MMT during the study period. Participants were excluded if they reported MMT in the past 6 months at baseline and were retained in MMT ( n = 94, 30.5%); were missing MMT status data ( n = 43, 14.0%); or completed an MMT taper ( n = 11, 3.6%). Of the remaining 160 participants who initiated MMT over the study period, 102 (63.8%) discontinued MMT accounting for 119 unique discontinuation events. In multivariable extended Cox regression, MMT discontinuation was positively associated with recent weekly crystal methamphetamine use (adjusted hazard ratio [AHR] = 1.67, 95% confidence interval [CI]: 1.19 to 2.35), but negatively associated with age of first “hard” drug use (per year older) (AHR = 0.95, 95% CI: 0.90 to 1.00) and female sex (AHR = 0.66, 95% CI: 0.44 to 0.99). In subanalysis, recent weekly crystal methamphetamine use (AHR = 4.61, 95% CI: 1.78 to 11.9) and weekly heroin or fentanyl use (AHR = 3.37, 95% CI: 1.21 to 9.38) were positively associated with “actionable” MMT discontinuation, while older age (AHR = 0.87, 95% CI: 0.76 to 0.99) was negatively associated. Conclusions Efforts to revise MMT programming; provide access to a range of MOUD, harm reduction, and treatments; and explore coprescribing stimulants to AYA with concurrent stimulant use may improve treatment retention and reduce toxic drug fatalities.

The impact of methamphetamine use on medications for opioid use disorder (MOUD) treatment retention: a scoping review

“…Pilarinos et al [ 36 ] examined factors associated with time to methadone discontinuation among a sample of youth (aged 14–26) engaged in methadone in Vancouver, Canada. Discontinuation was defined as individuals who indicated they had received MMT in the last 6 months but were not currently on MMT during data collection.…”

“They make it too hard and too many hoops to jump”: system and organizational barriers to drug treatment during epidemic rates of opioid overdose

“…Participants’ experiences with drug treatment offer insight into the low retention rates for medications to treat opioid use disorder observed in numerous studies. Many studies have examined individual level factors that are associated with poor retention in MOUD and other drug treatment programs including polysubstance use, more severe opioid use disorder and homelessness [ 18 , 29 , 31 , 32 , 52 ]. The implication from these studies seems to be that polysubstance users are unable to adhere to MOUD and that they require additional services, including treatment options, such as contingency management, to address their other substance use and psychosocial needs.…”

“…The implication from these studies seems to be that polysubstance users are unable to adhere to MOUD and that they require additional services, including treatment options, such as contingency management, to address their other substance use and psychosocial needs. However, many of these barriers may very well be at the organizational level with polydrug users more likely to fail urine drug screens and be discontinued in treatment [ 31 ]. Many times, these additional drugs did not decrease the safety of MOUD, and it was not clear that programs were offering services to address other substance use problems.…”

“…While there are currently no recommended treatment durations for MOUD, longer duration of treatment is associated with better treatment outcomes and lower risk of opioid overdose [ 30 ]. Research suggests many program-related policies that may lead to discontinuation of MOUD, including discharge from clinics for missing an appointment or using other substances [ 31 ]. Some MOUD clinics require abstinence from all substances and patients who fail to achieve this are discharged from care [ 32 ].…”

Investigating the effect of Zinc supplementation on the metabolic profile and expression of Nrf2, PPARγ and IL-10 genes in patients undergoing Methadone Maintenance Treatment: A Randomized, Double-Blind, Placebo- Controlled Trial

“…Methadone is used to prevent opiate withdrawal. Methadone is a synthetic opioid analgesic, similar to morphine, but with a longer duration of action and less abuse potential (15). Iyengar et al showed that, the relationship between zinc and the immune system, and reported that drug addicts are susceptible to various infections such as hepatitis and acquired immunode ciency syndrome, as well as concern about the excessive urinary loss of zinc in this group (16).…”