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Patient Perspectives on Buprenorphine/Naloxone: A Qualitative Study of Retention During the Starting Treatment with Agonist Replacement Therapies (START) Study.

Journal of Psychoactive Drugs 2014;46(5):412-426.. [doi: 10.1080/02791072.2014.921743]

Cheryl Teruya, PhD (University of California, Los Angeles, PR Node), Robert P. Schwartz, MD (Friends Research Institute, Inc., MA Node), Shannon G. Mitchell, PhD (Friends Research Institute, Inc., MA Node), Albert L. Hasson, MSW (University of California, Los Angeles, PR Node), Christie Thomas, MPH (University of California, Los Angeles, PR Node), Samantha H. Buoncristiani, MPH (University of California, Los Angeles, PR Node), Yih-Ing Hser, PhD (University of California, Los Angeles, PR Node), Katharina Wiest, PhD (University of California, Los Angeles, PR Node), Allan J. Cohen, MA, MFT (Bay Area Addiction Research & Treatment, PR Node), Naomi Glick (University of California, Los Angeles, PR Node), Petra Jacobs, MD (National Institute on Drug Abuse), Paul McLaughlin, MA (Hartford Dispensary, NEC Node), Walter Ling, MD (University of California, Los Angeles, PR Node).

This study examines the barriers and facilitators of retention among patients receiving buprenorphine/naloxone at eight community-based opioid treatment programs across the United States, as part of the National Drug Abuse Treatment Clinical Trials Network Long-Term Follow-Up of START (Starting Treatment with Agonist Replacement Therapies) Patients protocol, CTN-0050. Participants (n=105) were recruited up to three and a half years after having participated in a randomized clinical trial comparing the effect of buprenorphine/naloxone and methadone on liver function. Semi-structured interviews were conducted with 67 patients provided with buprenorphine/naloxone who had terminated early and 38 patients who had completed at least 24 weeks of the trial. Qualitative data were analyzed using the constant comparison method.

Barriers to buprenorphine/naloxone retention that emerged included factors associated with: (1) the design of the clinical trial; (2) negative medication or treatment experience; and (3) personal circumstances. The facilitators comprised: (1) positive experience with the medication; (2) personal determination and commitment to complete; and (3) staff encouragement and support. The themes drawn from interviews highlight the importance of considering patients' prior experience with buprenorphine/naloxone and methadone, medication preference, personal circumstances, and motivation to abstain from illicit use or misuse of opioids, as these may influence retention.

Conclusions: These findings contribute to the sparse literature on patient perspectives of barriers to retention among individuals receiving treatment with buprenorphine/naloxone for opioid dependence. Findings suggests a patient-centered approach to identify the treatment option that best meets the patients' needs at the time may be the most effective method. Ongoing education of patients and staff regarding buprenorphine/naloxone, especially in comparison to methadone, and support from staff and peers are essential. Finally, local, state, and federal regulations and policies may need to be revisited to increase patient options to be treated with all FDA-approved medications for opioid dependence in as many practices as possible. (Article (Peer-Reviewed), PDF, English, 2014)

Keywords: Buprenorphine | Buprenorphine/Naloxone | CTN platform/ancillary study | Methadone maintenance | Pharmacological therapy | Retention - Treatment | Suboxone | Journal of Psychoactive Drugs (journal)

Document No: 1076, PMID: 25364994, PMCID: PMC4220245..

Submitted by Jack Blaine, NIDA, 11/12/2014.

Buoncristiani, Samantha H. search
Cohen, Allan J. search mail
Glick, Naomi search
Hasson, Albert search mail
Hser, Yih-Ing search mail
Jacobs, Petra search
Ling, Walter search mail
McLaughlin, Paul search mail
Mitchell, Shannon G. search mail
Schwartz, Robert P. search mail
Teruya, Cheryl search mail
Thomas, Christie search mail
Wiest, Katharina search mail
NIDA-CTN-0050 search www
Pacific Region (Lead) search www
Delaware Valley search www
New England Consortium search www
Pacific Northwest search www
Western States search www

Supported by a grant from the National Institute on Drug Abuse to the University of Washington Alcohol and Drug Abuse Institute.
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