Pengyue Zhang1, Krystel Tossone2, Robert Ashmead3, Tina Bickert4, Emelie Bailey3, Nathan J Doogan3, Aimee Mack3, Schuyler Schmidt5, Andrea E Bonny6. 1. Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, United States of America. 2. Center on Trauma and Adversity, Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America. 3. Ohio Colleges of Medicine Government Resource Center, The Ohio State University Wexner Medical Center, United States of America. 4. Ohio Colleges of Medicine Government Resource Center, The Ohio State University Wexner Medical Center, United States of America. Electronic address: tina.bickert@osumc.edu. 5. Ohio Department of Medicaid, United States of America. 6. Division of Adolescent Medicine, Nationwide Children's Hospital, United States of America; Department of Pediatrics, College of Medicine, The Ohio State University, United States of America.
Abstract
BACKGROUND: Medications for opioid use disorder (MOUDs), including methadone, buprenorphine and naltrexone, are associated with lower death rates and improved quality of life for people in recovery from opioid use disorder (OUD). Less is known about each MOUD modality's association with treatment retention and the contribution of behavioral health therapy (BHT). The objectives of the current study were to estimate the association between MOUD type and treatment retention and determine whether BHT was associated with length of time retained. METHODS: We investigated the time from initiation to discontinuation from MOUD by medication type and exposure to BHT using statewide Medicaid Claims data (N = 81,752). We estimated covariate adjusted hazard ratios (AHR) using a Cox proportional hazards model. RESULTS: Compared to methadone, buprenorphine was associated with a higher risk of discontinuation at the time of initiation (AHR = 2.41, 95% CI = 2.28-2.55), however that difference decreased over one year of maintained retention (AHR = 1.44, 95% CI = 1.37-1.50). Compared to methadone and buprenorphine, naltrexone was associated with a higher risk of discontinuation at the time of initiation (naltrexone vs. methadone AHR = 2.49, 95% CI = 2.30-2.65; naltrexone vs. buprenorphine AHR 1.03, 95% CI = 1.00-1.07), and that relative risk increased over the course of one year of retention (naltrexone vs. methadone AHR = 3.85, 95% CI = 3.63-4.09; naltrexone vs. buprenorphine AHR = 2.67, 95% CI = 2.54-2.81). In general, independent of MOUD type, exposure to BHT during MOUD treatment was associated with a lower risk of discontinuation (AHR = 0.94, 95% CI = 0.92-0.96). However, BHT during the treatment episode was not associated with retention in the adolescent/young adult and pregnant women subpopulations. DISCUSSION: From the standpoint of early success, methadone was associated with the lowest risk of treatment discontinuation. While buprenorphine and naltrexone were associated with similar risks at the beginning of treatment, the relative discontinuation risk for buprenorphine was less than half that of naltrexone at one year of retention. In general, BHT with MOUD was associated with a lower risk of treatment discontinuation.
BACKGROUND: Medications for opioid use disorder (MOUDs), including methadone, buprenorphine and naltrexone, are associated with lower death rates and improved quality of life for people in recovery from opioid use disorder (OUD). Less is known about each MOUD modality's association with treatment retention and the contribution of behavioral health therapy (BHT). The objectives of the current study were to estimate the association between MOUD type and treatment retention and determine whether BHT was associated with length of time retained. METHODS: We investigated the time from initiation to discontinuation from MOUD by medication type and exposure to BHT using statewide Medicaid Claims data (N = 81,752). We estimated covariate adjusted hazard ratios (AHR) using a Cox proportional hazards model. RESULTS: Compared to methadone, buprenorphine was associated with a higher risk of discontinuation at the time of initiation (AHR = 2.41, 95% CI = 2.28-2.55), however that difference decreased over one year of maintained retention (AHR = 1.44, 95% CI = 1.37-1.50). Compared to methadone and buprenorphine, naltrexone was associated with a higher risk of discontinuation at the time of initiation (naltrexone vs. methadone AHR = 2.49, 95% CI = 2.30-2.65; naltrexone vs. buprenorphine AHR 1.03, 95% CI = 1.00-1.07), and that relative risk increased over the course of one year of retention (naltrexone vs. methadone AHR = 3.85, 95% CI = 3.63-4.09; naltrexone vs. buprenorphine AHR = 2.67, 95% CI = 2.54-2.81). In general, independent of MOUD type, exposure to BHT during MOUD treatment was associated with a lower risk of discontinuation (AHR = 0.94, 95% CI = 0.92-0.96). However, BHT during the treatment episode was not associated with retention in the adolescent/young adult and pregnant women subpopulations. DISCUSSION: From the standpoint of early success, methadone was associated with the lowest risk of treatment discontinuation. While buprenorphine and naltrexone were associated with similar risks at the beginning of treatment, the relative discontinuation risk for buprenorphine was less than half that of naltrexone at one year of retention. In general, BHT with MOUD was associated with a lower risk of treatment discontinuation.
Authors: Ann Tarja Karlsson; John-Kåre Vederhus; Thomas Clausen; Bente Weimand; Kristin Klemmetsby Solli; Lars Tanum Journal: Int J Environ Res Public Health Date: 2022-09-11 Impact factor: 4.614