The impact of psychiatric comorbidity on treatment discontinuation among individuals receiving medications for opioid use disorder

Abstract

Background: Psychiatric illness complicates the clinical course of opioid use disorder (OUD) including treatment using medication for OUD (MOUD). The purpose of this study was to assess the relationship between psychiatric comorbidity and MOUD discontinuation, stratified by whether the client dropped out of treatment or whether MOUD was terminated by the addiction facility.

Methods: The study population consisted of individuals with OUD receiving MOUD. Data was derived from the 2015-2017 Treatment Episodes Dataset - Discharges (TEDS-D), which includes discharge records from addiction treatment centers across the United States. The association between psychiatric comorbidity and MOUD discontinuation (including client dropout and facility termination) was assessed using multivariable logistic regression models that included clinically relevant covariates (age, sex, race, education, employment status, living arrangement, prior addiction treatment, intravenous opioid use, primary opioid used at admission, polysubstance use, previous arrests, length of stay, and referral source).

Results: Psychiatric comorbidity decreased the odds of client dropout (adjusted odds ratio (aOR): 0.88, 95 % confidence interval (CI): 0.86 - 0.89) but increased the odds of MOUD being terminated by the treatment facility (aOR: 1.59, 95 % CI: 1.56-1.63). The association between psychiatric comorbidity and MOUD discontinuation varied considerably between states.

Conclusions: Individuals with psychiatric illness are slightly less likely to drop out of MOUD treatment but are more likely to have their treatment prematurely terminated by the treatment facility. This emphasizes the importance of considering psychiatric illness when providing OUD treatment and suggests that measures to improve MOUD retention for individuals with psychiatric illness are required.

Keywords: Medication for opioid use disorder; Mental health; Opioid use disorder; Psychiatry; Treatment discontinuation.