Predictors of early dropout in outpatient buprenorphine/naloxone treatment

Abstract

Background and Objectives Identifying predictors of early drop out from outpatient treatment of opioid use disorder (OUD) with buprenorphine/naloxone (BN) may improve care for subgroups requiring more intensive engagement to achieve stabilization. However, previous research on predictors of dropout among this population has yielded mixed results. The aim of the present study was to elucidate these mixed findings by simultaneously evaluating a range of putative risk factors that may predict dropout in BN maintenance treatment. Methods Outpatient medical records and weekly supervised urine toxicology results were retrospectively reviewed for patients at two community psychiatric clinics (n=202): a private hospital clinic (n=84) and a federally qualified health center (n=118). A forward stepwise logistic regression was utilized to investigate the association between early dropout (i.e., discontinuing treatment or buprenorphine non-adherence within the first three months of clinic entry) and extracted sociodemographic, clinical, substance use, and treatment history variables. Results Overall, 56 of 202 participants (27.7%) dropped out of treatment. The multivariable analysis indicated that age under 25 (B=1.47, SEB=.52, p <.01) and opioid use in month 1 (B=1.50, SEB=.41, p<.001) were significantly associated with early dropout; those with a history of suicide attempt were significantly less likely to drop out (B=−1.44, SEB = .67, p<.05). Conclusions and Scientific Significance Consistent with previous research, younger age and use of opioids during the first month of treatment predicted early dropout. Having a history of prior suicide attempt was associated with 3-month BN treatment retention, which has not been previously reported.

Hospitalized opioid‐dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge

“…Given that depressive symptoms are now part of a core symptom cluster for PTSD in the DSM-5, and that dysphoria is a common emotional state in recovery, we were interested that participants with PTSD were more likely to enter OBOT. This aligns with findings from prior studies 38,49 where opioid dependent individuals with emotional issues were receptive to buprenorphine treatment. The linkage model may provide needed structure to people who have experienced traumatic situations to access care.…”

“…We found that prior history of buprenorphine/methadone treatment 13,27,28 , (older) age 49 , and non-minority status, predicted improved treatment retention. Because addiction is a chronic relapsing condition, multiple treatment attempts may be necessary to achieve abstinence.…”

“…Of note, some studies have reported that patients with elevated depression are more likely to remain in buprenorphine treatment 47,48 . Relatedly, individuals with a history of suicide attempts were less likely to drop out of buprenorphine treatment 49 . Yet, a prospective randomized trial found that reductions in depressive symptoms among heroin users who were given escitalopram, did not predict improved retention compared to those who did not receive escitalopram 18 .…”

“…Older age may be a predictor of treatment retention because older patients have had more treatment episodes, which cumulatively increase the likelihood of treatment retention 51 . Younger patients, who have not experienced as many substance-related negative consequences relative to older patients 32 , are more likely to drop out early from methadone maintenance and opiate agonist treatment 13,15,16,27,49,52 . Racial/ethnic minorities are more likely to drop out of treatment early 29,52 , suggesting the need for further research to improve treatment retention.…”

“…We were limited to variables used in the parent trial, so were unable to include all variables identified in prior studies. We did not collect urine drug toxicologies at baseline, an indicator of treatment severity 49 , but nearly all (51/52) participants were injection drug users, another indicator of drug use severity which precluded testing injection use as a predictor. While many buprenorphine providers require abstinence from alcohol and benzodiazepines given dangerous interactions with opioid use, the exclusion criteria in the parent study (alcohol/benzodiazepine dependence, chronic pain, and cocaine dependence) may limit generalizability.…”