Buprenorphine Treatment Non-Adherence Associated with Psychiatric Comorbidity and Other Substance Use

In an effort to improve treatment outcomes and minimize adverse events (e.g., accidental overdose, use of other substances), the authors of this study sought to identify factors associated with buprenorphine treatment non-adherence among a sample of patients receiving buprenorphine at a single Veterans Association hospital over a 7-year period. At this site, patients enrolled in buprenorphine treatment are instructed to return to the clinic within 24 hours for a pill count if they are called through the random “call-back” program. Patients were deemed to be compliant if they had a correct pill count at the time of the call-back and a positive urine drug screen (UDS) for buprenorphine/norbuprenorphine.

• Of 209 eligible patients receiving buprenorphine during the study period, only 69 patients were included in the analysis as the other 140 did not have the opportunity to participate in a call-back (e.g., discharged, tapered); 35% (n = 24) of patients were considered non-compliant.
• Factors associated with buprenorphine non-adherence by linear regression analysis were: UDS positive for marijuana or benzodiazepines, smoking cigarettes, and having a psychiatric comorbidity.
• Other factors, including treatment retention, were not associated with medication non-adherence.

Comments:

This study suggests that some patients receiving buprenorphine treatment who smoke cigarettes, have psychiatric comorbidity, or use marijuana or benzodiazepines may be at increased risk for treatment non-adherence. However, these data come from a single site and only include only a small proportion of the patients who were engaged in the call-back program; these factors limit generalizability.

Jeanette M. Tetrault, MD

Reference:

Fareed A, Eilender P, Ketchen B, et al. Factors affecting noncompliance with buprenorphine maintenance treatment. J Addict Med. 2014;8(5):345–350.