TY - JOUR
T1 - Who stays in medication treatment for opioid use disorder? A national study of outpatient specialty treatment settings
AU - Krawczyk, Noa
AU - Williams, Arthur Robin
AU - Saloner, Brendan
AU - Cerdá, Magdalena
N1 - Funding Information:
Dr. Williams and Dr. Saloner were supported by grants from the National Institute of Drug Abuse (NIDA K23 DA044342 (Williams); K01DA042139 (Saloner).
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/7
Y1 - 2021/7
N2 - 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.
AB - 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.
KW - Discontinuation
KW - Medication treatment
KW - Opioid use disorder
KW - Overdose
KW - Retention
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U2 - 10.1016/j.jsat.2021.108329
DO - 10.1016/j.jsat.2021.108329
M3 - Article
C2 - 34116820
AN - SCOPUS:85101410428
SN - 0740-5472
VL - 126
JO - Journal of Substance Abuse Treatment
JF - Journal of Substance Abuse Treatment
M1 - 108329
ER -