Identifying Factors Associated with Stopping Treatment for Opioid Dependence.

People with opioid use disorder who are treated with buprenorphine, a commonly prescribed drug to treat addiction, are more likely to disengage from treatment programs if they are black or Hispanic, unemployed, or have hepatitis C, according to a study co-authored by School of Public Health researchers.

Like other chronic medical conditions, such as hypertension or diabetes, opioid use disorder requires long-term engagement in therapy for its success. According to experts, many individuals who participate in Office Based Addiction Treatment (OBAT) with buprenorphine, or Suboxone, discontinue treatment less than one year after initiation.

Buprenorphine—when formulated with another drug, naloxone—is an effective treatment for opioid dependence. Treatment has been shown to lead to reduced rates of heroin and prescription opioid use, as well as a reduction in “risky behaviors” that are associated with development of significant co-morbidities, such as HIV or viral hepatitis infection.

To better understand the reasons for disengagement from buprenorphine treatment, researchers from the School of Medicine and SPH examined patients treated at Boston Medical Center’s OBAT program between 2002 and 2014. The observational study followed more than 1,200 patients over 12 years, with the goal of identifying patient-specific factors associated with retention in the treatment program for longer than one year.

The study, published online in the Journal of Substance Abuse Treatment, found that older age, female gender, and co-morbid psychiatric diagnoses were associated with greater odds of treatment retention beyond one year. Meanwhile, patients who were black or Hispanic, unemployed, and had evidence of hepatitis C viral infection had decreased odds of treatment retention beyond one year.

“This study highlights some important disparities in treatment outcomes, especially racial/ethnic disparities in outcomes, which reflect a larger issue in medical care in general, as well as in society at large,” said lead author Zoe Weinstein, assistant professor of medicine and director of the Addiction Consult Service at BMC. She pointed out that identifying risk factors for disengagement is especially important given the increased focus in expanding access to treatment with opioid agonists, such as buprenorphine.

The authors argue that the results highlight new avenues of exploration to improve current strategies of treating addiction. For instance, they suggest that employment assistance programs may help retain patients in recovery programs by engaging them in work.

SPH co-authors on the study included: Debbie Cheng, professor of biostatics; Mari-Lynn Drainoni, associate professor of health law, policy, and management; Sara Bachman, research associate professor of health law, policy, and management; Jeffrey Samet, professor of community health sciences and of medicine; and Emily Quinn of the Data Coordinating Center.

Funding for the study was provided by the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, and the National Center For Advancing Translational Sciences.