Treatment Persistence Among Insured Patients Newly Starting Buprenorphine/Naloxone for Opioid Use Disorder

Shcherbakova, Natalia; Tereso, Gary; Spain, Jacqueline; Roose, Robert J.

doi:10.1177/1060028017751913

Cited by 30 publications

(28 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, we would like to point out that opioid medications are associated with increased discontinuation risk of buprenorphine, although not statistically significant using naltrexone as a comparison drug (table 3). In our analysis, many of the patients on MOUD are prescribed with codeine, fentanyl, hydrocodone, morphine, oxycodone and tramadol; and similar statistics are observed by Shcherbakova et al (2018). Overprescribing of opioid medications is believed to be a major cause for the current opioid epidemic (Manchikanti et al, 2012).…”

Section: Discussionsupporting

confidence: 71%

“…Subsequently, risk factors for discontinuation of buprenorphine are investigated. These studies include Lopian, Chebolu, Kulak, Kahn, & Blondell (2019), Manhapra, Agbese, Leslie, & Rosenheck (2018), Morgan et al (2018), Saloner et al (2017), Samples et al (2018), and Shcherbakova et al (2018) etc. Risk factors in these studies include demographic variables, administrative factors (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…For instance, medications are only measured in the baseline period before initiation of buprenorphine in Samples et al (2018). Shcherbakova et al (2018) examines concomitant medications regardless of the concomitant medications' initiation times. In other words, concomitant medications are treated as binary variables.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder

Zhang

Chiang

Quinney

et al. 2020

Preprint

View full text Add to dashboard Cite

Introduction: Retention in buprenorphine treatment for opioid use disorder (OUD) yields better opioid abstinence and reduces all-cause mortality for patients with OUD. Despite significant efforts have been made to expand the availability and use of buprenorphine in the United States, its retention rates remain on a low level. The current study examines discontinuation of buprenorphine with respect to concurrent initiation of other medications using real-world evidence. Methods: Case-crossover study was conducted to examine discontinuation of buprenorphine using a large-scale longitudinal health dataset including 148,306 commercially-insured individuals initiated on medications for opioid use disorder (MOUD). Odds ratios and Bonferroni adjusted p-values were calculated for medications and therapeutic classes of medications. Results: Clonidine was associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone (OR = 1.583 and adjusted p-value < 0.05) and using naltrexone as a comparison drug (OR = 2.706 and adjusted p-value < 0.05). Opioid medications (oxycodone, morphine and fentanyl) and methocarbamol were associated with increased discontinuation risk of buprenorphine using the buprenorphine dataset alone (adjusted p-value < 0.05), but not significant using naltrexone as a comparison drug. 6 drug therapeutic classes were associated with increased discontinuation risk of buprenorphine both using the buprenorphine dataset alone and using naltrexone as a comparison drug (adjusted p-value < 0.05). Conclusion: Concurrent initiation of medications is associated with increased discontinuation risk of buprenorphine. Opioid medications are prescribed among patients on MOUD and associated with increased discontinuation risk of buprenorphine. Analgesics is associated with increased discontinuation risk of buprenorphine for patients without previous exposure of pain medications.

show abstract

Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder

Zhang

Chiang

Quinney

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Opiate substitution treatment was consistently associated with a lower frequency of ED presentation and hospital admission than comparison groups of untreated opiate users. Among substitution patients, consistent medication was associated with a lower rate of ED utilization . Some studies looked at different types of treatment.…”

Section: Resultsmentioning

confidence: 99%

Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis

Lewer

Freer

King³

et al. 2020

Addiction

122

View full text Add to dashboard Cite

Aims To summarize evidence on the frequency and predictors of health-care utilization among people who use illicit drugs. Design Systematic search of MEDLINE, EMBASE and PsychINFO for observational studies reporting healthcare utilization published between 1 January 2000 and 3 December 2018. We conducted narrative synthesis and meta-analysis following a registered protocol (identifier: CRD42017076525). Setting and participants People who use heroin, powder cocaine, crack cocaine, methamphetamine, amphetamine, ecstasy/3,4-methylenedioxymethamphetamine (MDMA), cannabis, hallucinogens or novel psychoactive substances; have a diagnosis of 'substance use disorder'; or use drug treatment services. Measurements Primary outcomes were the cumulative incidence (risk) and rate of care episodes in three settings: primary care, hospital admissions (in-patient) and emergency department (ED).Findings Ninety-two studies were included, 84% from North America and Australia. Most studies focused on people using heroin, methamphetamine or crack cocaine, or who had a diagnosis of drug dependence. We were able to conduct a meta-analysis of rates across 25 studies reporting ED episodes and 25 reporting hospital admissions, finding pooled rates of 151 [95% confidence interval (CI) = 114-201] and 41 (95% CI = 30-57) per 100 person-years, respectively; on average 4.8 and 7.1 times more often than the general population. Heterogeneity was very high and was not explained by drugs used, country of study, recruitment setting or demographic characteristics. Predictors of health-care utilization were consistent across studies and included unstable housing, drug injection and mental health problems. Opioid substitution therapy was consistently associated with reduced ED presentation and hospital admission. There was minimal research on health-care utilization by people using ecstasy/MDMA, powder cocaine, hallucinogens or novel psychoactive substances.Conclusions People who use illicit drugs are admitted to emergency department or hospital several times more often than the general population.

show abstract

“…While the treatment of OUD with OST improves outcomes compared to no treatment, there is a wide range of the overall success of OST, depending on what time period is being reported. Two recent reports indicated that~40% of patients treated with buprenorphine were retained in OST treatment for 1 year [12,13]. There are some known demographic, socioeconomic, and psychosocial contributors to the retention of individuals in MAT, based mostly on research in methadone-based OST.…”

Section: Improving Successful Opioid Substitution Therapymentioning

confidence: 99%

The importance of buprenorphine research in the opioid crisis

Pendergrass

Crist

Jones³

et al. 2019

Mol Psychiatry

View full text Add to dashboard Cite

With the urgency to treat patients more effectively for opioid use disorder in the midst of the opioid epidemic, a key area for precision medicine is to improve individualized medication-assisted treatment for opioid use disorder. The expansion of medication-assisted treatment is a key to reducing illicit opioid use, preventing opioid overdose deaths, and reducing the comorbidities and societal impacts of opioid use disorder. The most common medication for opioid use disorder will soon be buprenorphine. Research to date shows the successful impact of buprenorphine treatment, including the pharmacogenomics of buprenorphine response and treatment efficacy. Buprenorphine is also a promising treatment for depression and anxiety, and neonatal opioid withdrawal syndrome (NOWS). However, the rates of success with medication-assisted treatment for opioid use disorder, particularly at the beginning of treatment, still show many individuals relapsing to illicit opioid use. With the scope of the opioid crisis, there is an urgent need for expansion of buprenorphine treatment research to provide critical information for improving outcomes of opioid use disorder. Implementing the best strategies for opioid use disorder treatment is of dire urgency and will save lives.

show abstract

Treatment Persistence Among Insured Patients Newly Starting Buprenorphine/Naloxone for Opioid Use Disorder

Abstract: Several health care delivery and use variables were significantly associated with nonpersistence. Concomitant use of prescription opioids is the most easily modifiable risk factor that health care providers and policy makers may act on to improve treatment continuation.

Cited by 30 publications

References 34 publications

The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder

The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder

Frequency of health‐care utilization by adults who use illicit drugs: a systematic review and meta‐analysis

The importance of buprenorphine research in the opioid crisis

Contact Info

Product

Resources

About