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Randomized Controlled Trial
. 2012 Sep;37(9):1046-53.
doi: 10.1016/j.addbeh.2012.04.011. Epub 2012 May 8.

Predictors of attrition with buprenorphine/naloxone treatment in opioid dependent youth

Diane Warden  1 , Geetha A Subramaniam, Thomas Carmody, George E Woody, Abu Minhajuddin, Sabrina A Poole, Jennifer Potter, Marc Fishman, Michael Bogenschutz, Ashwin Patkar, Madhukar H Trivedi
Affiliations
Randomized Controlled Trial

Predictors of attrition with buprenorphine/naloxone treatment in opioid dependent youth

Diane Warden et al. Addict Behav. 2012 Sep.

Abstract

Background: In opioid dependent youth there is substantial attrition from medication-assisted treatment. If youth at risk for attrition can be identified at treatment entry or early in treatment, they can be targeted for interventions to help retain them in treatment.

Methods: Opioid dependent adolescents and young adults (n=152), aged 15-21, were randomized to 12 weeks (BUP, n=74) or 2 weeks of detoxification (DETOX, n=78) with buprenorphine/naloxone (Bup/Nal), both in combination with 12 weeks of psychosocial treatment. Baseline and early treatment related predictors of treatment attrition were identified in each group using bivariate and multivariate logistic regression.

Results: In the DETOX group 36% left between weeks 2 and 4, at the end of the dose taper, while in the BUP group only 8% left by week 4. In the BUP group, early adherence to Bup/Nal, early opioid negative urines, use of any medications in the month prior to treatment entry, and lifetime non-heroin opioid use were associated with retention while prior 30-day hallucinogen use was associated with attrition. In the DETOX group, only use of sleep medications was associated with retention although not an independent predictor. A broad range of other pre-treatment characteristics was unrelated to attrition.

Conclusions: Prompt attention to those with early non-adherence to medication or an early opioid positive urine, markers available in the first 2 weeks of treatment, may improve treatment retention. Extended Bup/Nal treatment appeared effective in improving treatment retention for youth with opioid dependence across a wide range of demographics, and pre-treatment clinical characteristics.

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Conflict of interest statement

Conflict of interest

Dr. Warden previously held stock in Pfizer and Bristol-Myers Squibb. She has received funding from the National Alliance for Research on Schizophrenia and Depression. Dr. Woody has served on the advisory board of the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) System. Dr. Fishman is the medical director of Mountain Manor Treatment Center (MMTC), one of multiple research sites in this study. He is a beneficiary of the trust that owns MMTC and serves on the governing board of the trust and the board of directors of MMTC. The terms of Dr. Fishman's potential conflict of interest in research are managed by Johns Hopkins University in accordance with its conflicts of interest policies. Dr. Patkar has received research support from NIH (NIDA/NIAAA), Duke Endowment, AstraZeneca, Forest Pharmaceuticals, Cephalon, Janssen, Jazz, McNeil, Organon, Orphan, Merck, Lundbeck, Pfizer, Titan, Shire, Sunovion; has been a consultant/Advisory Board member of Forest Pharmaceuticals, Gilead, Dey Pharmaceuticals, Titan, Reckitt Benckiser, and on Speakers Bureau of Alkermes, Bristol-Myers Squibb, Dey Pharmaceuticals, and Sunovion. Dr. Trivedi is a consultant to or on speaker bureaus for Alkermes, AstraZeneca, Axon Advisors, Bristol-Myers Squibb Company, Cephalon, Inc., Eli Lilly & Company, Evotec, Forest Pharmaceuticals, GlaxoSmithKline, Johnson & Johnson PRD, Lundbeck, MedAvante, Neuronetics, Otsuka Pharmaceuticals, Pamlab, Pfizer Inc., PGxHealth, Rexahn Pharmaceuticals, SHIRE Development, Takeda, Tal Medical/Purtech Venture, Targacept, and Transcept. He receives research support from the Agency for Healthcare Research and Quality (AHRQ), National Institute of Mental Health, National Institute on Drug Abuse, Naurex, Targacept, and Valient. Drs. Subramaniam, Carmody, Minhajuddin, and Potter, and Ms. Poole report no biomedical financial interests or potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Timing of attrition.
See this image and copyright information in PMC

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