Ajay Manhapra1,2,3,4,5, Elina Stefanovics1,2, Robert Rosenheck1,2. 1. VA New England Mental Illness Research and Education Center, West Haven, Connecticut, USA. 2. Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA. 3. Advanced PACT Pain Clinic, VA Hampton Medical Center, Hampton, Virginia, USA. 4. Department of Physical Medicine and Rehabilitation, Eastern Virginia Medical School, Norfolk, Virginia, USA. 5. Department of Psychiatry, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Abstract
Background: Despite substantial benefits associated with opioid agonist treatment (OAT) with buprenorphine and methadone for opioid use disorder (OUD), only a small proportion of patients with OUD initiate OAT. There is a lack of studies addressing the correlates of OAT initiation among patients with OUD. Methods: Using Veterans Health Administration (VHA) national administrative data, we identified veterans with OUD who started OAT with either buprenorphine or methadone maintenance treatment (MMT) in fiscal year (FY) 2012 (first prescription of buprenorphine or first methadone clinic visit after the first 60 days of FY) and those who received no OAT that year. Multivariate logistic regression models including sociodemographic characteristics, diagnoses, and service and psychotropic drug use variables were used to identify independent predictors of OAT initiation. Results: Greater age (10-year increments; odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.0.9-0.97) and black race (OR: 0.46, 95% CI: 0.38-0.55) were associated with lower odds of being started on buprenorphine compared with no OAT, but not with MMT initiation. Veterans with cocaine and anxiolytic-sedative hypnotic use disorders had higher odds of being started on both buprenorphine and methadone compared with no OAT. Receipt of any mental health inpatient treatment was associated with higher odds of being started on buprenorphine but not methadone. Overall, we were unable to identify a robust set of patient characteristics associated with initiation of OAT. Conclusion: This study points out the stark reality that in the middle of an opioid crisis, we have very little insight into which patients with OUD initiate OAT.
Background: Despite substantial benefits associated with opioid agonist treatment (OAT) with buprenorphine and methadone for opioid use disorder (OUD), only a small proportion of patients with OUD initiate OAT. There is a lack of studies addressing the correlates of OAT initiation among patients with OUD. Methods: Using Veterans Health Administration (VHA) national administrative data, we identified veterans with OUD who started OAT with either buprenorphine or methadone maintenance treatment (MMT) in fiscal year (FY) 2012 (first prescription of buprenorphine or first methadone clinic visit after the first 60 days of FY) and those who received no OAT that year. Multivariate logistic regression models including sociodemographic characteristics, diagnoses, and service and psychotropic drug use variables were used to identify independent predictors of OAT initiation. Results: Greater age (10-year increments; odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.0.9-0.97) and black race (OR: 0.46, 95% CI: 0.38-0.55) were associated with lower odds of being started on buprenorphine compared with no OAT, but not with MMT initiation. Veterans with cocaine and anxiolytic-sedative hypnotic use disorders had higher odds of being started on both buprenorphine and methadone compared with no OAT. Receipt of any mental health inpatient treatment was associated with higher odds of being started on buprenorphine but not methadone. Overall, we were unable to identify a robust set of patient characteristics associated with initiation of OAT. Conclusion: This study points out the stark reality that in the middle of an opioid crisis, we have very little insight into which patients with OUD initiate OAT.
Authors: Madeline C Frost; Julie E Richards; John R Blosnich; Eric J Hawkins; Judith I Tsui; E Jennifer Edelman; Emily C Williams Journal: Drug Alcohol Depend Date: 2022-06-03 Impact factor: 4.852
Authors: Alex S Bennett; Honoria Guarino; Peter C Britton; Dan O'Brien-Mazza; Stephanie H Cook; Franklin Taveras; Juan Cortez; Luther Elliott Journal: Ann Med Date: 2022-12 Impact factor: 5.348
Authors: Elizabeth J Austin; Elsa S Briggs; Lori Ferro; Paul Barry; Ashley Heald; Geoffrey M Curran; Andrew J Saxon; John Fortney; Anna D Ratzliff; Emily C Williams Journal: J Gen Intern Med Date: 2022-05-25 Impact factor: 6.473
Authors: Denise M Boudreau; Gwen Lapham; Eric A Johnson; Jennifer F Bobb; Abigail G Matthews; Jennifer McCormack; David Liu; Cynthia I Campbell; Rebecca C Rossom; Ingrid A Binswanger; Bobbi Jo Yarborough; Julia H Arnsten; Chinazo O Cunningham; Joseph E Glass; Mark T Murphy; Mohammad Zare; Rulin C Hechter; Brian Ahmedani; Jordan M Braciszewski; Viviana E Horigian; José Szapocznik; Jeffrey H Samet; Andrew J Saxon; Robert P Schwartz; Katharine A Bradley Journal: J Subst Abuse Treat Date: 2020-03
Authors: Katherine Mackey; Stephanie Veazie; Johanna Anderson; Donald Bourne; Kim Peterson Journal: J Gen Intern Med Date: 2020-11-03 Impact factor: 5.128
Authors: Alexandria Macmadu; Kimberly Paull; Rouba Youssef; Sivakumar Batthala; Kevin H Wilson; Elizabeth A Samuels; Jesse L Yedinak; Brandon D L Marshall Journal: Drug Alcohol Depend Date: 2020-11-23 Impact factor: 4.492
Authors: Benjamin A Howell; Erica A Abel; Dongchan Park; Sara N Edmond; Leah J Leisch; William C Becker Journal: J Gen Intern Med Date: 2020-11-11 Impact factor: 5.128