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Reasons for leaving treatment among patients with opioid dependence: A 3-month prospective follow-up study

Virendra Vikram Singh, DM, Siddharth Sarkar, MD, Rakesh Kumar Chadda, MD, Ashwani Kumar Mishra, PhD, Anju Dhawan, MD

Abstract


Objective: This study aimed to ascertain the reasons why patients with opioid dependence leave treatment.

Design: Prospective follow-up observational study.

Setting: This study was carried out at a tertiary care substance use treatment facility in north India with both outpatient and inpatient services. The facility is a public-funded institution.

Participants: One hundred and twenty opioid-dependent male patients with age 18 years or more who were willing to provide a valid telephone number for follow-up and willing to consent for the study were included.

Main outcome measure(s): Enquiries were made using the Reasons to Leave Treatment Questionnaire (RLTQ) and an open-ended question about why the patient left treatment.

Results: As per the RLTQ, the most common reasons for patients with opioid dependence leaving treatment were in the domains of external influence, motivational inconsistencies, and problem severity. Logistic problem was another issue that was highlighted by the patients. On open-ended question, the most common reason for leaving treatment pertained to feeling that one has improved and does not need treatment. Baseline characteristics that predicted patients leaving treatment were not being prescribed buprenorphine at discharge, not being formally educated, and living alone or in a nuclear family.

Conclusion: Several factors may lead to patients with opioid dependence leaving treatment prematurely after receiving inpatient care. Addressing these reasons might help to better retain patients in treatment and improve their outcomes.


Keywords


opioid dependence, reasons to leave treatment, buprenorphine, naltrexone

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References


United Nations Office on Drugs and Crime: World Drug Report 2019. Vienna: United Nations Office on Drugs and Crime, 2019. DOI: 10.18356/a4dd519a-en.

Degenhardt L, Grebely J, Stone J, et al.: Global patterns of opioid use and dependence: Harms to populations, interventions, and future action. Lancet. 2019; 394(10208): 1560-1579. DOI: 10.1016/S0140-6736(19)32229-9.

Ambekar A, Agrawal A, Rao R, et al.: Magnitude of Substance Use in India 2019. New Delhi: Ministry of Social Justice and Empowerment, Government of India, 2019.

Degenhardt L, Whiteford HA, Ferrari AJ, et al.: Global burden of disease attributable to illicit drug use and dependence: Findings from the global burden of disease study 2010. Lancet. 2013; 382(9904): 1564-1574. DOI: 10.1016/S0140-6736(13)61530-5.

Stark MJ: Dropping out of substance abuse treatment: A clinically oriented review. Clin Psychol Rev. 1992; 12(1): 93-116. DOI: 10.1016/0272-7358(92)90092-M.

Capone T, Brahen L, Condren R, et al.: Retention and outcome in a narcotic antagonist treatment program. J Clin Psychol. 1986; 42(5): 825-833.

Gisev N, Degenhardt L, Larney S, et al.: A comparative study of opioid substitution therapy utilisation among opioid-dependent men and women. Drug Alcohol Rev. 2014; 33(5): 499-505. DOI: 10.1111/dar.12151.

Timko C, Schultz NR, Cucciare MA, et al.: Retention in medication-assisted treatment for opiate dependence: A systematic review. J Addict Dis. 2016; 35(1): 22-35. DOI: 10.1080/10550887.2016.1100960.

Zhang Z, Friedmann PD, Gerstein DR: Does retention matter? Treatment duration and improvement in drug use. Addiction. 2003; 98: 673-684.

Chaudhry ZA, Sultan J, Alam F: Predictors for retention in treatment with a UK community-based naltrexone programme for opioid dependence. Psychiatrist. 2012; 36: 218-224. DOI: 10.1192/pb.bp.111.035063.

Dayal P, Balhara YPS, Mishra AK: An open label naturalistic study of predictors of retention and compliance to naltrexone maintenance treatment among patients with opioid dependence. J Subst Use. 2016; 21(3): 309-316. DOI: 10.3109/14659891.2015.1021867.

Hser Y, Saxon AJ, Huang D, et al.: Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction. 2014; 109(1): 79-87. DOI: 10.1111/add.12333.

Lee CS, Liebschutz JM, Anderson BJ, et al.: Hospitalized opioid-dependent patients: Exploring predictors of buprenorphine treatment entry and retention after discharge. Am J Addict. 2017; 26: 667-666. DOI: 10.1111/ajad.12533.

Magura S, Nwakeze PC, Demsky SY: Pre- and in-treatment predictors of retention in methadone treatment using survival analysis. Addiction. 1998; 93(1): 51-60.

Soyka M, Zingg C, Koller G, et al.: Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: Results from a randomized study. Int J Neuropsychopharmacol. 2008; 11: 641-653. DOI: 10.1017/S146114570700836X.

Sullivan MA, Rothenberg JL, Vosburg SK, et al.: Predictors of retention in naltrexone maintenance for opioid dependence: Analysis of a stage I trial. Am J Addict. 2006; 15(2): 150-159. DOI: 10.1080/10550490500528464.

Tucker TK, Ritter AJ: Naltrexone in the treatment of heroin dependence: A literature review. Drug Alcohol Rev. 2000; 19: 73-82.

Weinstein ZM, Kim HW, Cheng DM, et al.: Long-term retention in office based opioid treatment with buprenorphine. J Subst Abuse Treat. 2017; 74: 65-70. DOI: 10.1016/j.jsat.2016.12.010.

Pekarik G: The effects of employing different termination classification criteria in dropout research. Psychotherapy. 1985; 22(1): 86-91.

Walker R: Retention in treatment—Indicator or illusion. Subst Use Misuse. 2009; 44: 18-27. DOI: 10.1080/10826080802525967.

Evans E, Li L, Hser YI: Client and program factors associated with dropout from court mandated drug treatment. Eval Progr Plan. 2009; 32(3): 204-212. DOI: 10.1016/j.evalprogplan.2008.12.003.

Gryczynski J, Mitchell SG, Jaffe JH, et al.: Leaving buprenorphine treatment: Patients’ reasons for cessation of care. J Subst Abuse Treat. 2014; 46: 356-361. DOI: 10.1016/j.jsat.2013.10.004.

Palmer RS, Murphy MK, Piselli A, et al.: Dropping out substance user treatment dropout from client and clinician perspectives: A pilot study. Subst Use Misuse. 2009; 44: 1021-1038. DOI: 10.1080/10826080802495237.

Reisinger HS, Schwartz RP, Mitchell SG, et al.: Premature discharge from methadone treatment: Patient perspectives. J Psychoact Drugs. 2009; 41(3): 285-296. DOI: 10.1080/02791072.2009.10400539.

Ball SA, Carroll KM, Canning-Ball M, et al.: Reasons for dropout from drug abuse treatment: Symptoms, personality, and motivation. Addict Behav. 2006; 31(2): 320-330. DOI: 10.1016/j.addbeh.2005.05.013.

Darker C, Sweeney B, El Hassan H, et al.: Non-attendance at counselling therapy in cocaine-using methadone-maintained patients: Lessons learnt from an abandoned randomised controlled trial. Ir J Med Sci. 2012; 181: 483-489. DOI: 10.1007/s11845-011-0803-4.

Hoseinie L, Gholami Z, Shadloo B, et al.: Drop-out from a drug treatment clinic and associated reasons. East Mediterr Health J. 2017; 23(3): 173-181.

Chalana H, Kundal T, Gupta V, et al.: Predictors of relapse after inpatient opioid detoxification during 1-year follow-up. J Addict. 2016; 2016: 1-7. DOI: 10.1155/2016/7620860.

Dayal P, Balhara YPS: A naturalistic study of predictors of retention in treatment among emerging adults entering first buprenorphine maintenance treatment for opioid use disorders. J Subst Abuse Treat. 2017; 80: 1-5. DOI: 10.1016/j.jsat.2017.06.004.

Dhawan A, Jain R, Chopra A: Opioid Substitution in India. Vienna: United Nations Office on Drugs and Crime, 2010.

Amirabadi B, Nikbakht M, Nokani M, et al.: Role of temperament, personality traits and onset age of smoking in predicting opiate dependence. Int J High Risk Behav Addict. 2015; 4(4): e24585. DOI: 10.5812/ijhrba.24585.

Chakraborty R, Chatterjee A, Chaudhury S: Impact of substance use disorder on presentation and short-term course of schizophrenia. Psychiatry J. 2014; 2014: 1-9. DOI: 10.1155/2014/280243.

Hernández MÁT, Gómez CF: Validación española del maudsley addiction profile (MAP). Adicciones. 2004; 16(4): 1-10.

Bhat BA, Dar SA, Hussain A: Sociodemographic profile, pattern of opioid use, and clinical profile in patients with opioid use disorders attending the de-addiction center of a tertiary care hospital in North India. Indian J Soc Psychiatry. 2019; 35: 173-178. DOI: 10.4103/ijsp.ijsp_65_18.

Majumder P, Sarkar S, Gupta R, et al.: Predictors of retention in treatment in a tertiary care de-addiction center. Indian J Psychiatry. 2016; 58(1): 27. DOI: 10.4103/0019-5545.174359.

Singh SM, Mattoo SK, Dutt A, et al.: Long-term outcome of in-patients with substance use disorders: A study from North India. Indian J Psychiatry. 2008; 50(4): 269-273.

Saxon AJ, Hser Y, Woody G, et al.: Medication-assisted treatment for opioid addiction: Methadone and buprenorphine. J Food Drug Anal. 2013; 21(4): S69-S72. DOI: 10.1016/j.jfda.2013.09.037.

Parran TV, Adelman CA, Merkin B, et al.: Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy. Drug Alcohol Depend. 2010; 106(1): 56-60. DOI: 10.1016/j.drugalcdep.2009.07.013.

Stein MD, Cioe P, Friedmann PD: Buprenorphine retention in primary care. J Gen Intern Med. 2005; 20: 1038-1041. DOI: 10.1111/j.1525-1497.2005.0228.x.

Sarkar S, Patra B, Kattimani S: Substance use disorder and the family: An Indian perspective. Med J DY Patil Univ. 2016; 9: 7-13. DOI: 10.4103/0975-2870.172413.

Sapkota P, Mattoo SK, Mahintamani T, et al.: Depressive symptoms in early alcohol or opioid abstinence: Course & correlates. J Addict Dis. 2021; 13: 1-27. DOI: 10.1080/10550887.2021.1925617.

Evans-Lacko S, Aguilar-Gaxiola S, Al-Hamzawi A, et al.: Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: Results from the WHO world mental health (WMH) surveys. Psychol Med. 2018; 48(9): 1560-1571. DOI: 10.1017/S0033291717003336.

Bentzley BS, Barth KS, Back SE, et al.: Discontinuation of buprenorphine maintenance therapy: Perspectives and outcomes. J Subst Abuse Treat. 2015; 52: 48-57. DOI: 10.1016/j.jsat.2014.12.011.

Gryczynski J, Mitchell SG, Jaffe JH, et al.: Retention in methadone and buprenorphine treatment among African Americans. J Subst Abuse Treat. 2013; 45(3): 287-292. DOI: 10.1016/j.jsat.2013.02.008.

Hulse GK, Basso MR: The association between naltrexone compliance and daily supervision. Drug Alcohol Rev. 2000; 19: 41-48.

Brorson HH, Ajo Arnevik E, Rand-Hendriksen K, et al.: Drop-out from addiction treatment: A systematic review of risk factors. Clin Psychol Rev. 2013; 33(8): 1010-1024. DOI: 10.1016/j.cpr.2013.07.007.




DOI: https://doi.org/10.5055/jom.2022.0739

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