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Observational Study
. 2021 Sep 1:226:108886.
doi: 10.1016/j.drugalcdep.2021.108886. Epub 2021 Jun 25.

An examination between treatment type and treatment retention in persons with opioid and co-occurring alcohol use disorders

Carrie M Mintz  1 , Ned J Presnall  2 , Kevin Y Xu  3 , Sarah M Hartz  3 , John M Sahrmann  4 , Laura J Bierut  3 , Richard A Grucza  5
Affiliations
Observational Study

An examination between treatment type and treatment retention in persons with opioid and co-occurring alcohol use disorders

Carrie M Mintz et al. Drug Alcohol Depend. .

Abstract

Background and aims: Persons with opioid use disorder (OUD) and co-occurring alcohol use disorder (AUD) are understudied. We identified whether co-occurring AUD was associated with OUD treatment type, compared associations between treatment type and six-month treatment retention and determined whether co-occurring AUD moderated these relationships.

Methods: We used an observational cohort study design to analyze insurance claims data from 2011 to 2016 from persons aged 12-64 with an opioid abuse or opioid dependence diagnosis and OUD treatment claim. Our unit of analysis was the treatment episode; we used logistic regression for analyses.

Results: Of 211,047 treatment episodes analyzed, 14 % had co-occurring alcohol abuse or dependence diagnoses. Among persons with opioid dependence, persons with co-occurring alcohol dependence were 25 % less likely to receive medication treatment relative to those without AUD. Further, alcohol dependence was associated with decreased likelihood of treatment with buprenorphine (AOR 0.47, 95 % CI 0.44-0.49) or methadone (AOR 0.31, 95 % CI 0.28-0.35) and increased likelihood of treatment with extended-release (AOR 1.36, 95 % CI 1.21-1.54) or oral (AOR 1.73, 95 % CI 1.57-1.90) naltrexone relative to psychosocial treatment. Buprenorphine and methadone were associated with highest retention prevalence regardless of OUD or AUD severity. Co-occurring alcohol abuse or dependence did not meaningfully change retention prevalence associated with buprenorphine or methadone. Co-occurring AUD was not associated with improved retention among persons receiving either formulation of naltrexone.

Conclusions: Buprenorphine and methadone are associated with relatively high likelihood of treatment retention among persons opioid and alcohol dependence, but are disproportionately under-prescribed.

Keywords: Alcohol use disorder; Buprenorphine; Methadone; Naltrexone; Opioid use disorder; Treatment retention.

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Conflict of interest statement

Conflict of Interest

Dr. Bierut is listed as an inventor on Issued U.S. Patent 8,080,371, “Markers for Addiction” covering the use of certain SNPs in determining the diagnosis, prognosis, and treatment of addiction; Dr. Bierut is a Speaker Bureau member for Imedex. The other authors have indicated they have no potential conflicts of interest to disclose.

Figures

Figure 1a.
Figure 1a.
Predicted prevalence of six-month treatment retention by among persons with opioid abuse by treatment type and co-occurring alcohol use disorder severity. Model adjusted for alcohol use disorder disease severity, opioid use disorder treatment type, disease severity*treatment type, sex, age, insurance-year cohort, previous opioid use disorder diagnosis, comorbid sedative, cocaine, stimulant, cannabis and other substance use disorder(s), comorbid mood, anxiety, psychotic and personality disorder(s), and medical comorbidities. *p<.05, ***p<.001, ****p<.0001.
Figure 1b.
Figure 1b.
Predicted prevalence of six-month treatment retention by among persons with opioid dependence by treatment type and co-occurring alcohol use disorder severity. Model adjusted for alcohol use disorder disease severity, opioid use disorder treatment type, disease severity*treatment type, sex, age, insurance-year cohort, previous opioid use disorder diagnosis, comorbid sedative, cocaine, stimulant, cannabis and other substance use disorder(s), comorbid mood, anxiety, psychotic and personality disorder(s), and medical comorbidities. **p<.01, ***p<.001, ****p<.0001.
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References

    1. Anton RF, O’Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, Gastfriend DR, Hosking JD, Johnson BA, LoCastro JS, Longabaugh R, Mason BJ, Mattson ME, Miller WR, Pettinati HM, Randall CL, Swift R, Weiss RD, Williams LD, Zweben A, Group CSR, 2006. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA 295(17), 2003–2017. - PubMed
    1. Bogdanowicz KM, Stewart R, Broadbent M, Hatch SL, Hotopf M, Strang J, Hayes RD, 2015. Double trouble: Psychiatric comorbidity and opioid addiction-all-cause and cause-specific mortality. Drug Alcohol Depend 148, 85–92. - PubMed
    1. Clark RE, Baxter JD, Aweh G, O’Connell E, Fisher WH, Barton BA, 2015. Risk Factors for Relapse and Higher Costs Among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History. J Subst Abuse Treat 57, 75–80. - PMC - PubMed
    1. Darke S, Zador D, 1996. Fatal heroin ‘overdose’: a review. Addiction 91(12), 1765–1772. - PubMed
    1. Dole VP, Nyswander M, 1965. A Medical Treatment for Diacetylmorphine (Heroin) Addiction. A Clinical Trial with Methadone Hydrochloride. JAMA 193, 646–650. - PubMed

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