Linking patients with buprenorphine treatment in primary care: Predictors of engagement.

BACKGROUND: Office-based buprenorphine treatment promises to expand effective treatment for opioid use disorder. Unfortunately, patients may be lost during engagement, before induction with medication. Few data are available regarding rates and predictors of successfully reaching induction.
METHODS: The sample included 100 consecutive patients seeking treatment in 2016 at an office-based buprenorphine treatment program in an urban, academic primary care clinic. Patients completed phone intake, nurse visit and physician visit prior to induction. We reviewed electronic medical records to describe the time to complete each step and used multivariable logistic regression to identify predictors of reaching induction.
RESULTS: Sixty percent of the sample dropped out prior to induction, with the majority dropping out prior to the nurse visit. For patients who successfully completed induction, median time between screening and induction was 18days (interquartile range 13-30days). After adjustment for other factors, completing induction was significantly less likely in patients with recent polysubstance use (OR=0.15, 95% CI=0.04-0.53), prior methadone treatment (OR=0.05, 95% CI=0.01-0.36), prior buprenorphine treatment (OR=0.60, 95% CI=0.01-0.47), or other prior treatment (OR=0.19, 95% CI=0.04-0.98). Sociodemographic characteristics, such as younger age, minority race/ethnicity, homelessness, unemployment, history of incarceration and relationship status were not significant predictors.
CONCLUSIONS: Over half of patients beginning primary care buprenorphine treatment were not successful in starting medication. Those with polysubstance use or previous substance use treatment were least likely to be successful. Programs should carefully consider barriers that might prevent treatment-seeking patients from starting medications. Some patients might need enhanced support to successfully start treatment with buprenorphine.