Does Medication Improve Retention in Treatment for Patients with an Opioid Use Disorder?

Background: More than 65,000 Americans died from a drug overdose in 2016, an increase of 17.7% from the prior year. Drug overdose is now the leading cause of death for Americans under 50 and the leading cause of accidental death for all Americans. A strong scientific consensus supports research regarding utilization of maintenance medical treatment as the first-line treatment of opioid use disorder (OUD) and a crucial support for recovery efforts. Compared to psychosocial treatment alone, methadone and buprenorphine,the most commonly used medications approved by the FDA for long-term treatment of OUD, increase retention and reduce illicit opioid use. We address conflicting assumptions within the substance use disorder (SUD) treatment field that pharmacotherapy efforts are barriers to recovery.

Methods: Medicaid claims data were utilized for years 2008 to mid-2016 from the Missouri Department of Social Services on all health services received by eligible members with a SUD diagnosis code during this time period. Claims included eligibility status, enrollment dates, and basic demographics (age, sex, race/ethnicity, and county). Before any additional sample selection criteria were applied, the data included 202,748 individuals and 324,062 eligibility episodes (continuous enrollment periods of 45 days or longer). We defined two types of treatment episodes: SUD facility treatment episodes with and without adjunctive buprenorphine (SUD and SUD+B), and buprenorphine episodes with or without adjunctive SUD facility treatment (BUP and BUP+F). Retention in SUD facility treatment was defined by the presence of a psychosocial service at least 31 days from the start of an episode. Retention in buprenorphine treatment was similarly defined by the presence of more than 30 days of total buprenorphine supply in a treatment episode. For all statistical tests, we used a modified version of multivariate logistic regression to adjust for repeated measures.

Results: After controlling for demographic and comorbidity characteristics, SUD+B consumers were 2.28 times more likely than SUD consumers to be retained in SUD facility treatment for more than 30 days. Female consumers were more likely than male consumers to be retained in treatment. Our results demonstrate that buprenorphine treatment is associated with SUD facility retention and engagement. Additionally, results show that SUD facility treatment is associated with shorter periods of buprenorphine treatment. Overall, buprenorphine treatment appeared significantly more effective in protecting against medical instability, represented by ED visits and hospitalizations, even after controlling for psychiatric, SUD, and physical comorbidities.

Discussion: The current study supports several conclusions relevant to debate whether medications result in barriers to recovery. Buprenorphine treatment enhances retention and engagement in psychosocial treatment. Compared to SUD facility treatment, buprenorphine is more effective in stabilizing patients—reducing both ED visits and hospitalizations.

These conclusions lend support for low-threshold models of OUD treatment that prioritize access to maintenance medical treatment and promote consumers’ voluntary engagement in psychosocial services. These models emphasize the importance of reducing barriers to medical treatment for OUD even when those barriers include the other traditional components of SUD treatment.