(Withdrawn) Understanding the Moderators of Quality of Life for People Who Initiate Methadone: A Comparison between Initiation in Jail and in the Community

Opioid use disorder (OUD) is a highly prevalent substance use disorder (SUD) in the United States (US), and is highly prevalent among those involved in the criminal justice system. Currently, measuring quality of life (QoL) as an outcome of OUD treatment is rarely explored in research, especially in the US. QoL offers insight regarding how patients are faring outside of typical metrics around abstinence and treatment attendance. Drawing upon data from two randomized controlled trials (RCTs), this paper seeks to compare demographic and treatment characteristics of participants who initiated methadone treatment in jail and community settings, and examine potential moderators in the relationship between initiation setting and QoL at baseline.

This paper is a secondary analysis and compares baseline characteristics of adult study participants with OUD who were recruited to two separate RCTs in Baltimore, MD; one from a jail setting and one from a community setting. The World Health Organization’s QoL measure (WHOQoL-BREF) was used as the QoL outcome measure with four domains of QoL: physical, psychological, social, and environmental. The two study samples were first compared on baseline characteristics obtained from the Addiction Severity Index (ASI) using bivariate statistics (e.g., t tests, x²). For variables that were statistically significantly different between initiation settings, we also conducted linear regression with each QoL domain as the dependent variable. The linear regression models utilized a Bonferroni correction due to the exploratory nature of these analyses.

The full sample consisted of 520 unique individuals, 225 participants who participated in the jail study and 295 who participated in the community study. Most participants were Black (59.8%), but the proportion of Black participants was greater in the jail study (62%) than the community setting (58%). There were significant differences between study settings on 18 of the 24 demographic and participant characteristics of interest. Out of the four QoL domains only physical QoL was moderated. Physical QoL was moderated by age and initiation setting (p < .001) where those who were younger and initiated in the community had a higher QoL compared to older community participants, and younger jail participants had a lower QoL than older jail participants. Physical QoL was also moderated by days of opioid use and initiation setting (p < .001), where community members who used opioids for less days had a higher QoL than community members who used opioids for more days, but jail participants who used opioids for less days experienced a lower QoL than those who used opioids for more days. All moderated relationships persisted in multivariable linear regression. No significant moderators were found for psychological, social or environmental QoL.

Age and days of opioid use were found to moderate physical QoL by initiation setting. Somewhat surprisingly, community-initiated participants had lower QoL on physical QoL at treatment entry, potentially lending to structural issues in the community that do not support people who are in treatment for OUD. Understanding QoL can help researchers to understand systemic issues contributing to QoL and clinicians to better form treatment plans around patients’ needs.