Noa Krawczyk1, Arthur Robin Williams2, Brendan Saloner3, Magdalena Cerdá4. 1. Department of Population Health, NYU Grossman School of Medicine, United States of America. Electronic address: Noa.krawczyk@nyulangone.org. 2. Columbia University Department of Psychiatry, New York State Psychiatric Institute, United States of America. 3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States of America. 4. Department of Population Health, NYU Grossman School of Medicine, United States of America.
Abstract
BACKGROUND: Maintenance treatments with medications for opioid use disorder (MOUD) are highly effective at reducing overdose risk while patients remain in care. However, few patients initiate medication and retention remains a critical challenge across settings. Much remains to be learned about individual and structural factors that influence successful retention, especially among populations dispensed MOUD in outpatient settings. METHODS: We examined individual and structural characteristics associated with MOUD treatment retention among a national sample of adults seeking MOUD treatment in outpatient substance use treatment settings using the 2017 Treatment Episode Dataset-Discharges (TEDS-D). The study assessed predictors of retention in MOUD using multivariate logistic regression and accelerated time failure models. RESULTS: Of 130,300 episodes of MOUD treatment in outpatient settings, 36% involved a duration of care greater than six months. The strongest risk factors for treatment discontinuation by six months included being of younger age, ages 18-29 ((OR):0.52 [95%CI:0.50-0.54]) or 30-39 (OR:0.57 [95%CI:0.55-0.59); experiencing homelessness (OR: 0.70 [95%CI:0.66-0.73]); co-using methamphetamine (OR:0.48 [95%CI:0.45-0.51]); and being referred to treatment by a criminal justice source (OR:0.55 [95%CI:0.52-0.59) or by a school, employer, or community source (OR:0.71 [95%CI:0.66-0.76). CONCLUSIONS: Improving retention in treatment is a pivotal stage in the OUD cascade of care and is critical to reducing overdose deaths. Efforts should prioritize interventions to improve retention among patients who are both prescribed and dispended MOUD, especially youth, people experiencing homelessness, polysubstance users, and people referred to care by the justice system who have especially short stays in care.
BACKGROUND: Maintenance treatments with medications for opioid use disorder (MOUD) are highly effective at reducing overdose risk while patients remain in care. However, few patients initiate medication and retention remains a critical challenge across settings. Much remains to be learned about individual and structural factors that influence successful retention, especially among populations dispensed MOUD in outpatient settings. METHODS: We examined individual and structural characteristics associated with MOUD treatment retention among a national sample of adults seeking MOUD treatment in outpatient substance use treatment settings using the 2017 Treatment Episode Dataset-Discharges (TEDS-D). The study assessed predictors of retention in MOUD using multivariate logistic regression and accelerated time failure models. RESULTS: Of 130,300 episodes of MOUD treatment in outpatient settings, 36% involved a duration of care greater than six months. The strongest risk factors for treatment discontinuation by six months included being of younger age, ages 18-29 ((OR):0.52 [95%CI:0.50-0.54]) or 30-39 (OR:0.57 [95%CI:0.55-0.59); experiencing homelessness (OR: 0.70 [95%CI:0.66-0.73]); co-using methamphetamine (OR:0.48 [95%CI:0.45-0.51]); and being referred to treatment by a criminal justice source (OR:0.55 [95%CI:0.52-0.59) or by a school, employer, or community source (OR:0.71 [95%CI:0.66-0.76). CONCLUSIONS: Improving retention in treatment is a pivotal stage in the OUD cascade of care and is critical to reducing overdose deaths. Efforts should prioritize interventions to improve retention among patients who are both prescribed and dispended MOUD, especially youth, people experiencing homelessness, polysubstance users, and people referred to care by the justice system who have especially short stays in care.
Authors: Arthur Robin Williams; Edward V Nunes; Adam Bisaga; Frances R Levin; Mark Olfson Journal: Am J Drug Alcohol Abuse Date: 2019-01-24 Impact factor: 3.829
Authors: Andrew Rosenblum; Charles M Cleland; Chunki Fong; Deborah J Kayman; Barbara Tempalski; Mark Parrino Journal: J Environ Public Health Date: 2011-07-06
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: Anthony J Eller; Elizabeth E DiDomizio; Lynn M Madden; Jennifer D Oliva; Frederick L Altice; Kimberly A Johnson Journal: Ann Med Date: 2022-07-01 Impact factor: 5.348
Authors: Antoine Chaillon; Chrianna Bharat; Jack Stone; Nicola Jones; Louisa Degenhardt; Sarah Larney; Michael Farrell; Peter Vickerman; Matthew Hickman; Natasha K Martin; Annick Bórquez Journal: Addiction Date: 2021-12-04 Impact factor: 7.256