Arthur Robin Williams1, Christine M Mauro2, Tianshu Feng3, Amanda Wilson4, Angelo Cruz5, Mark Olfson6, Stephen Crystal7, Hillary Samples7, Lisa Chiodo8. 1. Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States of America. Electronic address: aw2879@cumc.columbia.edu. 2. Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168th St., New York, NY 10032, United States of America. 3. Research Foundation for Mental Hygiene, 1051 Riverside Dr., New York, NY 10032, United States of America. 4. Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America; North-Star Care, Inc., 4810 Point Fosdick Dr. Suite #92, Gig Harbor, WA 98335, United States of America. 5. Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America. 6. Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr., New York, NY 10032, United States of America. 7. Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson St., New Brunswick, NJ 08901, United States of America. 8. Addiction Research and Education Foundation, 46 Sovereign Way, Florence, MA, 01062, United States of America; North-Star Care, Inc., 4810 Point Fosdick Dr. Suite #92, Gig Harbor, WA 98335, United States of America; University of Massachusetts Amherst, School of Nursing, 651 N Pleasant St, Amherst, MA 01003, United States of America.
Abstract
OBJECTIVE: Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non-prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. METHODS: The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1000 newly admitted patients with OUD for buprenorphine maintenance (2015-2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding. Outcomes included hazards of treatment discontinuation and rates of opioid use. RESULTS: Compared to patients testing negative for buprenorphine at intake, those testing positive (59.6%) had lower hazards of treatment discontinuation (HR = 0.52, 95% CI: 0.44, 0.60, p < 0.01). Results were little changed following adjustment for baseline opioid use and other patient characteristics (aHR: 0.60, 95% CI: 0.51, 0.70, p < 0.01). Risk of discontinuation did not significantly differ between patients by buprenorphine source: prescribed v. NPB (reference) at admission (HR = 1.15, 95% CI: 0.90, 1.46). Opioid use was lower in the buprenorphine positive group at admission (25.0% vs. 53.1%, p < 0.0001) and throughout early months of treatment but converged after 7 months for those remaining in care (17.1% vs. 16.5%, p = 0.89). CONCLUSION: NPB preceding treatment intake was associated with decreased hazards of treatment discontinuation and lower opioid use. These findings suggest use of NPB may be a marker of treatment readiness and that buprenorphine testing at intake may have predictive value for clinical assessments regarding risk of early treatment discontinuation.
OBJECTIVE: Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non-prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. METHODS: The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1000 newly admitted patients with OUD for buprenorphine maintenance (2015-2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding. Outcomes included hazards of treatment discontinuation and rates of opioid use. RESULTS: Compared to patients testing negative for buprenorphine at intake, those testing positive (59.6%) had lower hazards of treatment discontinuation (HR = 0.52, 95% CI: 0.44, 0.60, p < 0.01). Results were little changed following adjustment for baseline opioid use and other patient characteristics (aHR: 0.60, 95% CI: 0.51, 0.70, p < 0.01). Risk of discontinuation did not significantly differ between patients by buprenorphine source: prescribed v. NPB (reference) at admission (HR = 1.15, 95% CI: 0.90, 1.46). Opioid use was lower in the buprenorphine positive group at admission (25.0% vs. 53.1%, p < 0.0001) and throughout early months of treatment but converged after 7 months for those remaining in care (17.1% vs. 16.5%, p = 0.89). CONCLUSION: NPB preceding treatment intake was associated with decreased hazards of treatment discontinuation and lower opioid use. These findings suggest use of NPB may be a marker of treatment readiness and that buprenorphine testing at intake may have predictive value for clinical assessments regarding risk of early treatment discontinuation.
Authors: Lewei Allison Lin; Michelle R Lofwall; Sharon L Walsh; Adam J Gordon; Hannah K Knudsen Journal: Drug Alcohol Depend Date: 2018-03-10 Impact factor: 4.492
Authors: Marc R Larochelle; Jane M Liebschutz; Fang Zhang; Dennis Ross-Degnan; J Frank Wharam Journal: Ann Intern Med Date: 2015-12-29 Impact factor: 25.391
Authors: Noa Krawczyk; Ramin Mojtabai; Elizabeth A Stuart; Michael Fingerhood; Deborah Agus; B Casey Lyons; Jonathan P Weiner; Brendan Saloner Journal: Addiction Date: 2020-02-24 Impact factor: 6.526
Authors: Chinazo O Cunningham; Robert J Roose; Joanna L Starrels; Angela Giovanniello; Nancy L Sohler Journal: J Addict Med Date: 2013 Jul-Aug Impact factor: 3.702