Elizabeth A Evans1, Caroline Yoo2, David Huang3, Andrew J Saxon4, Yih-Ing Hser5. 1. Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 312 Arnold House, 715 North Pleasant St. Amherst, MA 01003, USA. Electronic address: eaevans@umass.edu. 2. UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd. Ste 200, Los Angeles, CA 90024. USA. Electronic address: cyoo5@ucla.edu. 3. UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd. Ste 200, Los Angeles, CA 90024. USA. Electronic address: yhuang@ucla.edu. 4. Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA. Electronic address: Andrew.Saxon@va.gov. 5. UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd. Ste 200, Los Angeles, CA 90024. USA. Electronic address: yhser@ucla.edu.
Abstract
BACKGROUND: Nationwide efforts seek to address the opioid epidemic by increasing access to medications for opioid use disorder (OUD), particularly with buprenorphine. A poorly understood challenge is that among individuals with OUD who do receive buprenorphine, many do not adhere to the pharmacotherapy long enough to achieve sustained benefits. We aimed to identify factors associated with buprenorphine treatment utilization over time. METHODS: We used random-intercept modeling to identify factors associated with buprenorphine treatment utilizationover 2 years after first follow-up by 789 individuals with OUD who had participated in a multi-site randomized clinical trial ofbuprenorphine compared to methadone. Key predictors were participants' reports of buprenorphine treatment accessibility and acceptability (assessed at first follow-up) and their interaction effects, controlling for baseline randomization status, sociodemographics, and other covariates. RESULTS: Approximately 9.3-11.2% of participants utilized buprenorphine treatment over the 2 years of follow-up. Interaction effects indicated that individuals who perceived buprenorphine to be both accessible and acceptable were most likely to use buprenorphine during follow-up, controlling for other factors. In contrast, individuals who perceived buprenorphine to be unacceptable were least likely to use buprenorphine, regardless the level of perceived access to the medication. Buprenorphine treatment utilization was also negatively associated with Hispanic ethnicity, West coast context, and cumulative months receiving methadone treatment and incarceration during follow-up. CONCLUSIONS: To engage more individuals with OUD in long-term treatment with buprenorphine, interventions should target buprenorphine treatment acceptability, in addition to increasing buprenorphine access, and tailor efforts to meet the needs of vulnerable populations. TRIAL REGISTRATION: The START Follow-up Study on ClinicalTrials.gov (NCT01592461). Published by Elsevier Inc.
RCT Entities:
BACKGROUND: Nationwide efforts seek to address the opioid epidemic by increasing access to medications for opioid use disorder (OUD), particularly with buprenorphine. A poorly understood challenge is that among individuals with OUD who do receive buprenorphine, many do not adhere to the pharmacotherapy long enough to achieve sustained benefits. We aimed to identify factors associated with buprenorphine treatment utilization over time. METHODS: We used random-intercept modeling to identify factors associated with buprenorphine treatment utilization over 2 years after first follow-up by 789 individuals with OUD who had participated in a multi-site randomized clinical trial of buprenorphine compared to methadone. Key predictors were participants' reports of buprenorphine treatment accessibility and acceptability (assessed at first follow-up) and their interaction effects, controlling for baseline randomization status, sociodemographics, and other covariates. RESULTS: Approximately 9.3-11.2% of participants utilized buprenorphine treatment over the 2 years of follow-up. Interaction effects indicated that individuals who perceived buprenorphine to be both accessible and acceptable were most likely to use buprenorphine during follow-up, controlling for other factors. In contrast, individuals who perceived buprenorphine to be unacceptable were least likely to use buprenorphine, regardless the level of perceived access to the medication. Buprenorphine treatment utilization was also negatively associated with Hispanic ethnicity, West coast context, and cumulative months receiving methadone treatment and incarceration during follow-up. CONCLUSIONS: To engage more individuals with OUD in long-term treatment with buprenorphine, interventions should target buprenorphine treatment acceptability, in addition to increasing buprenorphine access, and tailor efforts to meet the needs of vulnerable populations. TRIAL REGISTRATION: The START Follow-up Study on ClinicalTrials.gov (NCT01592461). Published by Elsevier Inc.
Entities:
Keywords:
Buprenorphine; Longitudinal; Opioid use disorder; Pharmacotherapy; Treatment acceptability, access, and utilization
Authors: M Connock; A Juarez-Garcia; S Jowett; E Frew; Z Liu; R J Taylor; A Fry-Smith; E Day; N Lintzeris; T Roberts; A Burls; R S Taylor Journal: Health Technol Assess Date: 2007-03 Impact factor: 4.014
Authors: Alexander Y Walley; Julie K Alperen; Debbie M Cheng; Michael Botticelli; Carolyn Castro-Donlan; Jeffrey H Samet; Daniel P Alford Journal: J Gen Intern Med Date: 2008-09 Impact factor: 5.128
Authors: Julie Netherland; Michael Botsko; James E Egan; Andrew J Saxon; Chinazo O Cunningham; Ruth Finkelstein; Mark N Gourevitch; John A Renner; Nancy Sohler; Lynn E Sullivan; Linda Weiss; David A Fiellin Journal: J Subst Abuse Treat Date: 2008-08-20
Authors: Andrea K Finlay; Alex H S Harris; Christine Timko; Mengfei Yu; David Smelson; Matthew Stimmel; Ingrid A Binswanger Journal: J Addict Med Date: 2021-04-01 Impact factor: 4.647
Authors: Andrew A Herring; Aidan A Vosooghi; Joshua Luftig; Erik S Anderson; Xiwen Zhao; James Dziura; Kathryn F Hawk; Ryan P McCormack; Andrew Saxon; Gail D'Onofrio Journal: JAMA Netw Open Date: 2021-07-01