A Naturalistic Study of Predictors of Retention in Treatment Among Emerging Adults Entering First Buprenorphine Maintenance Treatment for Opioid Use Disorders

Introduction: Emerging adulthood (between the ages 18-25years) has been conceptualized as a specific developmental stage based on unique psychosocial characteristics. Opioids are commonly used drugs in this population. Few studies have reported predictors of retention in buprenorphine maintenance treatment among opioid-dependent emerging adults, particularly from India. Moreover, no study has examined outcomes with opioid maintenance treatment among emerging adults in non-clinical trial, naturalistic settings. The current study aimed to assess retention in buprenorphine maintenance treatment among emerging adults in a naturalistic setting. Also, it aimed to assess the factors associated with retention in treatment among these individuals.

Methods: The current study was a retrospective cohort study conducted at a substance use disorder treatment centre in northern part of India. The patients who received buprenorphine maintenance treatment between 1st January 2012 and 31st December 2014 were eligible for inclusion in the current study. The follow-up data of these subjects were assessed up to and including 31st March 2015. Information was retrieved on socio-demographic variables. The information related to substance use included type of substance, duration of use, age of onset, motive of use, route of administration and source of procurement. Additionally, details of buprenorphine dose, dispensing pattern, induction settings were recorded. Cox regression analysis was carried out to assess the predictors of retention in buprenorphine maintenance treatment.

Results: Of 68 emerging adults, 33.8% were retained in treatment at 90days, 19.1% at 6months and 11.7% at one year. After controlling for various covariates in adjusted Cox regression analysis, substance use in first degree relatives (AHR: 2.40, 95% CI 1.33-4.31), lower daily buprenorphine dose (AHR: 0.86, 95% CI 0.78-0.94) and past month injection drug use (AHR: 0.30, 95% CI 0.14-0.66) were found to be the significant predictors of treatment dropout.

Conclusions: The findings of the current study help understand the predictors of retention in buprenorphine maintenance treatment among emerging adults in a real-world situation. These findings will help guide formulation of responsive and relevant buprenorphine maintenance treatment program for the emerging adults.