Very Early Disengagement and Subsequent Re-engagement in Primary Care Office Based Opioid Treatment (OBOT) with Buprenorphine

Overview

Journal J Subst Abuse Treat

Specialty Psychiatry

Date 2017 Jul 5

PMID 28673522

Citations 16

Authors

David Hui

Zoe M Weinstein

Debbie M Cheng

Emily Quinn

Hyunjoong Kim

Colleen LaBelle

Jeffrey H Samet

Affiliations

Soon will be listed here.

Abstract

Introduction: Patients with opioid use disorder often require multiple treatment attempts before achieving stable recovery. Rates of disengagement from buprenorphine are highest in the first month of treatment and termination of buprenorphine therapy results in return to use rates as high as 90%. To better characterize these at-risk patients, this study aims to describe: 1) the frequency and characteristics of patients with very early disengagement (≤1month) from Office Based Opioid Treatment (OBOT) with buprenorphine and 2) the frequency and characteristics of patients who re-engage in care at this same OBOT clinic within 2years, among the subset of very early disengagers.

Methods: This is a retrospective cohort study of adult patients enrolled in a large urban OBOT program. Descriptive statistics were used to characterize the sample and the proportion of patients with very early (≤1month) disengagement and their re-engagement. Multivariable logistic regression models were used to identify patient characteristics associated with the outcomes of very early disengagement and re-engagement. Potential predictors included: sex, age, race/ethnicity, education, employment, opioid use history, prior substance use treatments, urine drug testing, and psychiatric diagnoses.

Results: Overall, very early disengagement was unusual, with only 8.4% (104/1234) of patients disengaging within the first month. Among the subset of very early disengagers with 2years of follow-up, the proportion who re-engaged with this OBOT program in the subsequent 2years was 11.9% (10/84). Urine drug test positive for opiates within the first month (AOR: 2.01, 95% CI: 1.02-3.93) was associated with increased odds of very early disengagement. Transferring from another buprenorphine prescriber (AOR: 0.09, 95% CI: 0.01-0.70) was associated with decreased odds of very early disengagement. No characteristics were significantly associated with re-engagement.

Conclusions: Early disengagement is uncommon; however, continued opioid use appeared to be associated with higher odds of treatment disengagement and these patients may warrant additional support. Re-engagement was uncommon, suggesting the need for a more formal explicit system to encourage and facilitate re-engagement among patients who disengage.

Citing Articles

Organization of primary care and early MOUD discontinuation.

Harris R, Kearney M, Keddem S, Calderbank T, Tomczuk L, Clapp J Addict Sci Clin Pract. 2024; 19(1):96.

PMID: 39702538 PMC: 11658460. DOI: 10.1186/s13722-024-00527-w.

Impact of Alternative Ways to Operationalize Buprenorphine Treatment Duration on Understanding Continuity of Care for Opioid Use Disorder.

Dong H, Stringfellow E, Russell W, Bearnot B, Jalali M Int J Ment Health Addict. 2024; 22(4):2285-2290.

PMID: 39629044 PMC: 11614103. DOI: 10.1007/s11469-022-00985-w.

Are gaps in rates of retention on buprenorphine for treatment of opioid use disorder closing among veterans across different races and ethnicities? A retrospective cohort study.

Hayes C, Raciborski R, Martin B, Gordon A, Hudson T, Brown C J Subst Use Addict Treat. 2024; 166:209461.

PMID: 39067770 PMC: 11392633. DOI: 10.1016/j.josat.2024.209461.

Low-dose buprenorphine initiation and treatment continuation among hospitalized patients with opioid dependence: A retrospective cohort study.

Hayes B, Li P, Nienaltow T, Torres-Lockhart K, Khalid L, Fox A J Subst Use Addict Treat. 2023; 158:209261.

PMID: 38103838 PMC: 10947892. DOI: 10.1016/j.josat.2023.209261.

Buprenorphine use and courses of care for opioid use disorder treatment within the Veterans Health Administration.

Gordon A, Saxon A, Kertesz S, Wyse J, Manhapra A, Lin L Drug Alcohol Depend. 2023; 248:109902.

PMID: 37196572 PMC: 10875624. DOI: 10.1016/j.drugalcdep.2023.109902.

References

Davoli M, Bargagli A, Perucci C, Schifano P, Belleudi V, Hickman M . Risk of fatal overdose during and after specialist drug treatment: the VEdeTTE study, a national multi-site prospective cohort study. Addiction. 2007; 102(12):1954-9. DOI: 10.1111/j.1360-0443.2007.02025.x. View

White J, Irvine R . Mechanisms of fatal opioid overdose. Addiction. 2000; 94(7):961-72. View

Whitley S, Sohler N, Kunins H, Giovanniello A, Li X, Sacajiu G . Factors associated with complicated buprenorphine inductions. J Subst Abuse Treat. 2010; 39(1):51-7. PMC: 4755478. DOI: 10.1016/j.jsat.2010.04.001. View

Sordo L, Barrio G, Bravo M, Indave B, Degenhardt L, Wiessing L . Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017; 357:j1550. PMC: 5421454. DOI: 10.1136/bmj.j1550. View

Marcovitz D, McHugh R, Volpe J, Votaw V, Connery H . Predictors of early dropout in outpatient buprenorphine/naloxone treatment. Am J Addict. 2016; 25(6):472-7. PMC: 5014362. DOI: 10.1111/ajad.12414. View

Thomas C, Garnick D, Horgan C, Miller K, Harris A, Rosen M . Establishing the feasibility of measuring performance in use of addiction pharmacotherapy. J Subst Abuse Treat. 2013; 45(1):11-8. PMC: 3954716. DOI: 10.1016/j.jsat.2013.01.004. View

Campbell M, Kolodner G, Spencer R, Dupont R . Drug test results as a predictor of retention among patients using buprenorphine in a comprehensive outpatient treatment program. J Addict Dis. 2016; 35(4):315-324. DOI: 10.1080/10550887.2016.1139427. View

Breen C, Harris S, Lintzeris N, Mattick R, Hawken L, Bell J . Cessation of methadone maintenance treatment using buprenorphine: transfer from methadone to buprenorphine and subsequent buprenorphine reductions. Drug Alcohol Depend. 2003; 71(1):49-55. DOI: 10.1016/s0376-8716(03)00071-1. View

Soeffing J, Martin L, Fingerhood M, Jasinski D, Rastegar D . Buprenorphine maintenance treatment in a primary care setting: outcomes at 1 year. J Subst Abuse Treat. 2009; 37(4):426-30. DOI: 10.1016/j.jsat.2009.05.003. View

10.

Takayanagi Y, Spira A, Roth K, Gallo J, Eaton W, Mojtabai R . Accuracy of reports of lifetime mental and physical disorders: results from the Baltimore Epidemiological Catchment Area study. JAMA Psychiatry. 2014; 71(3):273-80. PMC: 4135054. DOI: 10.1001/jamapsychiatry.2013.3579. View

11.

Cunningham C, Roose R, Starrels J, Giovanniello A, Sohler N . Prior buprenorphine experience is associated with office-based buprenorphine treatment outcomes. J Addict Med. 2013; 7(4):287-93. PMC: 3737355. DOI: 10.1097/ADM.0b013e31829727b2. View

12.

Wells K, Klap R, Koike A, Sherbourne C . Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. Am J Psychiatry. 2001; 158(12):2027-32. DOI: 10.1176/appi.ajp.158.12.2027. View

13.

van der Wees P, Zaslavsky A, Ayanian J . Improvements in health status after Massachusetts health care reform. Milbank Q. 2013; 91(4):663-89. PMC: 3876186. DOI: 10.1111/1468-0009.12029. View

14.

Bell J, Trinh L, Butler B, Randall D, Rubin G . Comparing retention in treatment and mortality in people after initial entry to methadone and buprenorphine treatment. Addiction. 2009; 104(7):1193-200. DOI: 10.1111/j.1360-0443.2009.02627.x. View

15.

Mattick R, Ali R, White J, OBrien S, Wolk S, Danz C . Buprenorphine versus methadone maintenance therapy: a randomized double-blind trial with 405 opioid-dependent patients. Addiction. 2003; 98(4):441-52. DOI: 10.1046/j.1360-0443.2003.00335.x. View

16.

Chen L, Hedegaard H, Warner M . Drug-poisoning Deaths Involving Opioid Analgesics: United States, 1999-2011. NCHS Data Brief. 2014; (166):1-8. View

17.

Proctor S, Wainwright J, Herschman P, Kopak A . AiRCare: A naturalistic evaluation of the effectiveness of a protracted telephone-based recovery assistance program on continuing care outcomes. J Subst Abuse Treat. 2016; 73:9-15. DOI: 10.1016/j.jsat.2016.10.003. View

18.

Cornish R, Macleod J, Strang J, Vickerman P, Hickman M . Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ. 2010; 341:c5475. PMC: 2965139. DOI: 10.1136/bmj.c5475. View

19.

Schuman-Olivier Z, Weiss R, Hoeppner B, Borodovsky J, Albanese M . Emerging adult age status predicts poor buprenorphine treatment retention. J Subst Abuse Treat. 2014; 47(3):202-12. PMC: 4180514. DOI: 10.1016/j.jsat.2014.04.006. View

20.

Gryczynski J, Mitchell S, Jaffe J, OGrady K, Olsen Y, Schwartz R . Leaving buprenorphine treatment: patients' reasons for cessation of care. J Subst Abuse Treat. 2013; 46(3):356-61. PMC: 3947058. DOI: 10.1016/j.jsat.2013.10.004. View