Opioid use disorder (OUD) affects millions of individuals each year in the United States. Patient retention in medications for opioid use disorder (MOUD) treatment is suboptimal. This study examines and quantifies the associations between each additional month of buprenorphine or methadone use and nonprescribed opioid use.
Methods:
Data were obtained from an 18-month longitudinal, observational cohort study of patients (age ≥ 18 years) treated for OUD. Patients completed a baseline self-reported questionnaire between March 2018 and December 2019 and were asked to complete follow-up questionnaires at approximately 3-, 6-, 12-, and 18-months post-baseline until May 2021. Patients treated with buprenorphine or methadone, without taking other MOUD at least 12 months prior to baseline, were included. Outcomes included past 30-day use of prescription opioids nonmedically, heroin, or illegally made fentanyl. A multivariable, multilevel regression model with a binomial distribution and a logit link was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
Results:
This study included 353 patients taking buprenorphine (mean [standard deviation, SD] age 39 [11] years; 226 [64%] female), and 785 patients taking methadone (mean [SD] age 42 [12] years; 392 [50%] female). Each additional month of MOUD treatment was associated with a 25% decrease in the odds of past 30-day nonprescribed opioid use for patients taking buprenorphine (aOR [95% CI] = 0.75 [0.68-0.83]), and a 17% decrease for patients taking methadone (aOR = 0.83 [0.79-0.87]). The COVID-19 pandemic (aOR = 9.29 [2.96-29.17]; aOR = 3.19 [1.74-5.86]) and MOUD adverse reaction experiences (aOR = 3.07 [1.11-8.48]; aOR = 2.51 [1.01-6.22]) were significantly associated with higher odds of nonprescribed opioid use among buprenorphine and methadone groups.
Conclusion:
Among patients treated with buprenorphine or methadone, with each additional treatment month since baseline, those who continued with treatment appeared to be more likely to report 17% to 25% decreased odds of past 30-day nonprescribed opioid use. Our findings can be used by clinicians in the shared decision-making process with patients, emphasizing the value of sustained retention in MOUD.
Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2022. HHS Publication No. PEP22-07-01-005, NSDUH Series H-57. Accessed January 12, 2023. https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report
2.
SpencerMRMiniñoAMWarnerM. Drug overdose deaths in the United States, 2001–2021. Hyattsville, MD: National Center for Health Statistics; 2022. NCHS Data Brief, No. 457. https://dx.doi.org/10.15620/cdc:122556
CantorJPowellDKofnerASteinBD.Population-based estimates of geographic accessibility of medication for opioid use disorder by substance use disorder treatment facilities from 2014 to 2020. Drug Alcohol Depend. 2021;229:109107.
5.
Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63 Publication No. PEP21-02-01-002. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021. Accessed January 12, 2023. https://store.samhsa.gov/sites/default/files/pep21-02-01-002.pdf
6.
BurnsMTangLChangCCH, et al. Duration of medication treatment for opioid-use disorder and risk of overdose among Medicaid enrollees in 11 states: a retrospective cohort study. Addiction. 2022;117(12):3079–3088.
The Medicaid Outcomes Distributed Research Network (MODRN). Use of medications for treatment of opioid use disorder among US medicaid enrollees in 11 states, 2014–2018. JAMA. 2021;326(2):154–164. doi:10.1001/jama.2021.7374
9.
Lo-CiganicWHGelladWFGordonAJ, et al. Association between trajectories of buprenorphine treatment and emergency department and in-patient utilization. Addiction. 2016;111(5):892–902.
10.
MaJBaoY-PWangR-J, et al. Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis. Mol Psychiatry. 2019;24(12):1868–1883.
11.
SamplesHWilliamsARCrystalSOlfsonM.Impact of long-term buprenorphine treatment on adverse health care outcomes in medicaid: the impact of longer treatment on health care outcomes for opioid use disorder within a key population of Medicaid enrollees. Health Affairs. 2020;39(5):747–755.
12.
HserYISaxonAJHuangD, et al. Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction. 2014;109(1):79–87.
13.
WilliamsARSamplesHCrystalSOlfsonM.Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder. Am J Psychiatry. 2020;177(2):117–124.
14.
WakemanSELarochelleMRAmeliO, et al. Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Netw Open. 2020;3(2):e1920622.
15.
ChingJHOwensDKTraftonJAGoldhaber-FiebertJDSalomonJA.Impact of treatment duration on mortality among veterans with opioid use disorder in the United States Veterans Health Administration. Addiction. 2021;116(12):3494–3503.
16.
LarochelleMRBernsonDLandT, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3):137–145.
17.
DegenhardtLClarkBMacphersonG, et al. Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies. Lancet Psychiatry. 2023;10(6):P386–P402.
18.
KatzmarzykPTJakicicJM.Physical activity for health—every minute counts. JAMA. 2023;330(3):213–214.
19.
LaudetABStanickV.Predictors of motivation for abstinence at the end of outpatient substance abuse treatment. J Subst Abuse Treat. 2010;38(4):317–327.
DeverJAHertzMFDunlapLJ, et al. The medications for opioid use disorder study: methods and initial outcomes from an 18-month study of patients in treatment for opioid use disorder. Public Health Rep. 2024:333549231222479.
22.
KellySMO’GradyKESchwartzRPPetersonJAWilsonMEBrownBS.The relationship of social support to treatment entry and engagement: The Community Assessment Inventory. Subst Abuse. 2010;31(1):43–52.
JiangXGuyGPJrDunphyCPickensCMJonesCM.Characteristics of adults reporting illicitly manufactured fentanyl or heroin use or prescription opioid misuse in the United States, 2019. Drug Alcohol Depend. 2021;229:109160.
25.
VolkowND. Collision of the COVID-19 and Addiction Epidemics. vol. 173. American College of Physicians; 2020:61–62.
26.
Centers for Disease Control and Prevention. Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2019
27.
Rabe-HeskethSSkrondalA.Multilevel and Longitudinal Modeling Using Stata. STATA Press; 2008.
28.
AllisonPD.Handling missing data by maximum likelihood. SAS Global Forum. 2012; 2012(312):1–21.
29.
CarpenterJRSmukM.Missing data: a statistical framework for practice. Biom J. 2021;63(5):915–947.
30.
MukherjeeKGunsoyNBKristyRM, et al. Handling missing data in Health Economics and Outcomes Research (HEOR): a systematic review and practical recommendations. PharmacoEconomics. 2023;41(12):1589–1601.
31.
IbrahimJGMolenberghsG.Missing data methods in longitudinal studies: a review. Test. 2009;18(1):1–43.
32.
BaraldiANEndersCK.An introduction to modern missing data analyses. J School Psychol. 2010;48(1):5–37.
33.
O’brienRM.A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41(5):673–690.
34.
DuchesneauEDShmuelSFaurotKR, et al. Missing data approaches in longitudinal studies of aging: a case example using the National Health and Aging Trends Study. PLoS One. 2023;18(6):e0286984.
35.
FingerhoodMIKingVLBroonerRKRastegarDA.A comparison of characteristics and outcomes of opioid-dependent patients initiating office-based buprenorphine or methadone maintenance treatment. Subst Abuse. 2014;35(2):122–126.
36.
HserYIEvansEHuangD, et al. Long-term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi-site trial. Addiction. 2016;111(4):695–705.
37.
Substance Abuse and Mental Health Services Administration. Medicaid coverage of medication-assisted treatment for alcohol and opioid use disorders and of medication for the reversal of opioid overdose. HHS Publication No. SMA-18-5093. Substance Abuse and Mental Health Services Administration; 2018.
38.
OlfsonMZhangVSchoenbaumMKingM.Buprenorphine treatment by primary care providers, psychiatrists, addiction specialists, and others: trends in buprenorphine treatment by prescriber specialty-primary care providers, psychiatrists, and addiction medicine specialists. Health Affairs. 2020;39(6):984–992.
39.
ZhangPTossoneKAshmeadR, et al. Examining differences in retention on medication for opioid use disorder: an analysis of Ohio Medicaid data. J Subst Abuse Treat. 2022;136:108686.
40.
DunphyCPetersonCZhangKJonesCM.Do out-of-pocket costs influence retention and adherence to medications for opioid use disorder?Drug Alcohol Depend. 2021;225:108784.
41.
VillamilVIUnderwoodNCremerLJRooks-PeckCRJiangXGuyGP.Barriers to retention in medications for opioid use disorder treatment in real-world practice. J Subst Use Addict Treat. 2024;160:209310.
42.
BrackettCDDuncanMWagnerJFFinebergLKraftS.Multidisciplinary treatment of opioid use disorder in primary care using the collaborative care model. Subst Abuse. 2022;43(1):240–244.
43.
ZhangKJonesCMComptonWM, et al. Association between receipt of antidepressants and retention in buprenorphine treatment for opioid use disorder: a population-based retrospective cohort study. J Clin Psychiatry. 2022;83(3):40692.
44.
ChanBGeanEArkhipova-JenkinsI, et al. Retention strategies for medications for opioid use disorder in adults: a rapid evidence review. J Addict Med. 2021;15(1):74–84.
45.
VoelkerR.App aids treatment retention for opioid use disorder. JAMA. 2019;321(5):444.
46.
JonesCMShoffCHodgesK, et al. Receipt of telehealth services, receipt and retention of medications for opioid use disorder, and medically treated overdose among Medicare beneficiaries before and during the COVID-19 pandemic. JAMA Psychiatry. 2022;79(10):981–992.
47.
PintoHMaskreyVSwiftLRumballDWagleAHollandR.The SUMMIT trial: a field comparison of buprenorphine versus methadone maintenance treatment. J Subst Abuse Treat. 2010;39(4):340–352.
CunninghamCEdlundMJFishmanM, et al. The ASAM national practice guideline for the treatment of opioid use disorder: 2020 focused update. J Addict Med. 2020;14(Suppl. 1):1–91.
50.
KrawczykNFawoleAYangJTofighiB.Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review. Addict Sci Clin Pract. 2021;16(1):1–15.
51.
AlexanderGCStollerKBHaffajeeRLSalonerB. An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19. vol. 173. American College of Physicians; 2020:57–58.
52.
CzeislerMÉLaneRIPetroskyE, et al. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049.
DavisCSSamuelsEA.Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19. Int J Drug Policy. 2021;93:102905.
56.
JohnsonTPWislarJS.Response rates and nonresponse errors in surveys. JAMA. 2012;307(17):1805–1806.
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