Ongoing Opioid Use Is a Risk Factor for Early Disengagement From Buprenorphine Treatment

Opioid agonist treatment interruptions put patients at risk of return to opioid use and overdose. Rates of disengagement from buprenorphine treatment are highest within the first month of treatment. The authors of this study sought to characterize: 1) the incidence of treatment disengagement and attributes of patients with treatment disengagement within ≤1 month of treatment initiation of office-based opioid treatment (OBOT) with buprenorphine, and 2) the incidence and attributes of patients who re-engage in care at the same OBOT clinic within 2 years.

  • Early disengagement occurred in 8% (104/1234) of patients.
  • Urine drug screen positive for opioids within the first month was associated with increased odds of early disengagement (adjusted odds ratio [aOR], 2.01). Transferring from another buprenorphine prescriber was associated with decreased odds of very early disengagement (aOR, 0.09).
  • Among the subset of patients with early disengagement, 12% (10/84) re-engaged with the OBOT program in the subsequent 2 years. No characteristics were significantly associated with reengagement.

Comments: In this exploratory analysis of data from one OBOT clinic, disengagement from buprenorphine treatment was rare and associated with ongoing opioid use within the first month of treatment, suggesting that patients with urine toxicology evidence of ongoing opioid use may benefit from added resources.

Jeanette M. Tetrault, MD

Reference: Hui D, Weinstein ZM, Cheng DM, et al. Very early disengagement and subsequent re-engagement in primary care Office Based Opioid Treatment (OBOT) with buprenorphine. J Subst Abuse Treat. 2017;79:12–19.

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