Abstract
Abstract
Background and Aims: There is limited evidence on the relationship between retention in opioid agonist treatment for opioid dependence and characteristics of treatment prescribers. This study estimated retention in buprenorphine and methadone treatment and its relationship with person, treatment, and prescriber characteristics.
Design: Retrospective longitudinal study.
Setting: New South Wales, Australia.
Participants: People entering the opioid agonist treatment program for the first time between August 2001 and December 2015.
Measurements: Time in opioid agonist treatment (primary outcome) was modelled using a generalised estimating equation model to estimate associations with person, treatment, and prescriber characteristics.
Findings: The impact of medication type on opioid agonist treatment retention reduced over time; risk of leaving treatment when on buprenorphine compared with methadone was higher among those that entered treatment earlier (e.g. 2001-2003: OR 1.59, 95% CI 1.44-1.74) and lowest among those that entered most recently (2013-2015: OR 1.24, 95% CI 1.12-1.37). In adjusted analyses, risk of leaving was reduced among people whose prescriber had longer tenure of prescribing (e.g. 3 versus 8 years: OR 0.94, 95% CI 0.93-0.95) compared with prescribers with shorter tenure. Aboriginal and Torres Strait Islander people, being of younger age, past-year psychosis disorder, and having been convicted of more criminal charges in the year prior to treatment entry were associated with increased risk of leaving treatment.
Conclusion: In New South Wales, Australia, retention in buprenorphine treatment for opioid dependence, compared with methadone, has improved over time since its introduction in 2001. Opioid agonist treatment (OAT) retention is affected not only by characteristics of the person and his or her treatment, but also of the prescriber, with those of longer prescribing tenure associated with increased retention of people in OAT.
Background and Aims: There is limited evidence on the relationship between retention in opioid agonist treatment for opioid dependence and characteristics of treatment prescribers. This study estimated retention in buprenorphine and methadone treatment and its relationship with person, treatment, and prescriber characteristics.
Design: Retrospective longitudinal study.
Setting: New South Wales, Australia.
Participants: People entering the opioid agonist treatment program for the first time between August 2001 and December 2015.
Measurements: Time in opioid agonist treatment (primary outcome) was modelled using a generalised estimating equation model to estimate associations with person, treatment, and prescriber characteristics.
Findings: The impact of medication type on opioid agonist treatment retention reduced over time; risk of leaving treatment when on buprenorphine compared with methadone was higher among those that entered treatment earlier (e.g. 2001-2003: OR 1.59, 95% CI 1.44-1.74) and lowest among those that entered most recently (2013-2015: OR 1.24, 95% CI 1.12-1.37). In adjusted analyses, risk of leaving was reduced among people whose prescriber had longer tenure of prescribing (e.g. 3 versus 8 years: OR 0.94, 95% CI 0.93-0.95) compared with prescribers with shorter tenure. Aboriginal and Torres Strait Islander people, being of younger age, past-year psychosis disorder, and having been convicted of more criminal charges in the year prior to treatment entry were associated with increased risk of leaving treatment.
Conclusion: In New South Wales, Australia, retention in buprenorphine treatment for opioid dependence, compared with methadone, has improved over time since its introduction in 2001. Opioid agonist treatment (OAT) retention is affected not only by characteristics of the person and his or her treatment, but also of the prescriber, with those of longer prescribing tenure associated with increased retention of people in OAT.
| Original language | English |
|---|---|
| Pages (from-to) | 3139-3152 |
| Number of pages | 14 |
| Journal | Addiction |
| Volume | 116 |
| Issue number | 11 |
| Early online date | 12 May 2021 |
| DOIs | |
| Publication status | Published - Nov 2021 |
Bibliographical note
Funding Information:S.L. has received untied education funding from Indivior. L.D. has received untied educational funding from Reckitt Benckiser, Indivior, Mundipharma Pty Ltd, and Seqirus. These untied grants are all unrelated to the current study. All other authors declare no competing interests.
Funding Information:
This research article was reviewed by the OATS Aboriginal Advisory Group, including Alan Bennett, Doug James, Kim Sullivan and Craig Vaughan. We thank Tom Murphy for his assistance with project management, data documentation and research governance. Record linkage was conducted by the NSW Ministry of Health and the Centre for Health Record Linkage. We wish to acknowledge the data custodians for providing access to the datasets used in this study: the NSW Ministry of Health (PHDAS and EDDC), the NSW Bureau of Crime Statistics and Research (Reoffending Database) and the Australian Coordinating Registry on behalf of the NSW Registry of Births Deaths and Marriages (death notifications). This linkage study was funded by the National Institute on Drug Abuse (R01DA1104470). C.B. is supported by National Drug and Alcohol Research Centre (NDARC) and UNSW Scientia PhD Scholarships. L.D. is supported by an NHMRC Senior Principal Research Fellowship (1135991) and by NIH grant NIDA R01DA1104470. M.H. is supported by NIHR Senior Investigator and NIHR HPRU in Behavioural Science and Evaluation. The NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Programme. The funders of the study had no role in study design, data analysis, data interpretation or writing of the report.
Funding Information:
This research article was reviewed by the OATS Aboriginal Advisory Group, including Alan Bennett, Doug James, Kim Sullivan and Craig Vaughan. We thank Tom Murphy for his assistance with project management, data documentation and research governance. Record linkage was conducted by the NSW Ministry of Health and the Centre for Health Record Linkage. We wish to acknowledge the data custodians for providing access to the datasets used in this study: the NSW Ministry of Health (PHDAS and EDDC), the NSW Bureau of Crime Statistics and Research (Reoffending Database) and the Australian Coordinating Registry on behalf of the NSW Registry of Births Deaths and Marriages (death notifications). This linkage study was funded by the National Institute on Drug Abuse (R01DA1104470). C.B. is supported by National Drug and Alcohol Research Centre (NDARC) and UNSW Scientia PhD Scholarships. L.D. is supported by an NHMRC Senior Principal Research Fellowship (1135991) and by NIH grant NIDA R01DA1104470. M.H. is supported by NIHR Senior Investigator and NIHR HPRU in Behavioural Science and Evaluation. The NDARC is supported by funding from the Australian Government Department of Health under the Drug and Alcohol Programme. The funders of the study had no role in study design, data analysis, data interpretation or writing of the report.
Publisher Copyright:
© 2021 Society for the Study of Addiction.
Keywords
- opioid agonist treatment
- opiate substitution treatment
- methadone
- buprenorphine
- retention
- opioid dependence
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