Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone Program
Background: Many patients in methadone treatment have difficulty achieving or maintaining drug abstinence, and many clinics have policies that lead to discharging these patients. We designed a pilot “Second Chance” (SC) program for patients scheduled to be discharged from other local methadone clini...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2022-11-01
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| Series: | Substance Abuse: Research and Treatment |
| Online Access: | https://doi.org/10.1177/11782218221138335 |
| _version_ | 1798017339408515072 |
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| author | Tabitha E Moses Gary L Rhodes Emytis Tavakoli Carl W Christensen Alireza Amirsadri Mark K Greenwald |
| author_facet | Tabitha E Moses Gary L Rhodes Emytis Tavakoli Carl W Christensen Alireza Amirsadri Mark K Greenwald |
| author_sort | Tabitha E Moses |
| collection | DOAJ |
| description | Background: Many patients in methadone treatment have difficulty achieving or maintaining drug abstinence, and many clinics have policies that lead to discharging these patients. We designed a pilot “Second Chance” (SC) program for patients scheduled to be discharged from other local methadone clinics to be transferred to our clinic. Aim: Determine whether SC patients’ retention and opioid use is related to physical or mental health conditions, non-opioid substance use, or treatment features. Methods: From December 2012 to December 2014, this program enrolled 70 patients who were discharged from other clinics in the area; we were their last remaining option for methadone treatment. Unlike the clinic’s standard policies, the treatment focus for SC patients was retention rather than abstinence. This program focused on connection to care (eg, psychiatric services) and enabled patients to continue receiving services despite ongoing substance use. Each patient was assessed at treatment entry and followed until June 2016 to evaluate outcomes. Results: SC patients receiving disability benefits (n = 37) vs. non-disabled (n = 33) had significantly ( P < .05) higher rates of current DSM-IV Axis I psychiatric diagnosis (97% vs 70%), prescriptions for opioids (84% vs 55%) and benzodiazepines (65% vs 27%), and higher methadone doses at admission (58 vs 46 mg) but did not differ significantly in rates of 6-month or 1-year retention (77% and 56%, respectively) or all-drug use (39% positive urine drug screens). Methadone doses >65 mg predicted significantly longer retention and less opioid use, but these effects were not moderated by baseline characteristics. Conclusions: Patients in methadone treatment struggling to achieve abstinence may benefit from retention-oriented harm-reduction programs. Higher methadone doses can improve retention and opioid abstinence despite psychiatric comorbidities. Further work is needed to improve program implementation and outcomes in this complex population. |
| first_indexed | 2024-04-11T16:05:38Z |
| format | Article |
| id | doaj.art-ea3cfe8b30f84d348cda71f61a355d0b |
| institution | Directory Open Access Journal |
| issn | 1178-2218 |
| language | English |
| last_indexed | 2024-04-11T16:05:38Z |
| publishDate | 2022-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Substance Abuse: Research and Treatment |
| spelling | doaj.art-ea3cfe8b30f84d348cda71f61a355d0b2022-12-22T04:14:50ZengSAGE PublishingSubstance Abuse: Research and Treatment1178-22182022-11-011610.1177/11782218221138335Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone ProgramTabitha E Moses0Gary L Rhodes1Emytis Tavakoli2Carl W Christensen3Alireza Amirsadri4Mark K Greenwald5Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USADepartment of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USAOntario Shores Centre for Mental Health Sciences, Toronto, CA, CanadaDepartment of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USADepartment of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USADepartment of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USABackground: Many patients in methadone treatment have difficulty achieving or maintaining drug abstinence, and many clinics have policies that lead to discharging these patients. We designed a pilot “Second Chance” (SC) program for patients scheduled to be discharged from other local methadone clinics to be transferred to our clinic. Aim: Determine whether SC patients’ retention and opioid use is related to physical or mental health conditions, non-opioid substance use, or treatment features. Methods: From December 2012 to December 2014, this program enrolled 70 patients who were discharged from other clinics in the area; we were their last remaining option for methadone treatment. Unlike the clinic’s standard policies, the treatment focus for SC patients was retention rather than abstinence. This program focused on connection to care (eg, psychiatric services) and enabled patients to continue receiving services despite ongoing substance use. Each patient was assessed at treatment entry and followed until June 2016 to evaluate outcomes. Results: SC patients receiving disability benefits (n = 37) vs. non-disabled (n = 33) had significantly ( P < .05) higher rates of current DSM-IV Axis I psychiatric diagnosis (97% vs 70%), prescriptions for opioids (84% vs 55%) and benzodiazepines (65% vs 27%), and higher methadone doses at admission (58 vs 46 mg) but did not differ significantly in rates of 6-month or 1-year retention (77% and 56%, respectively) or all-drug use (39% positive urine drug screens). Methadone doses >65 mg predicted significantly longer retention and less opioid use, but these effects were not moderated by baseline characteristics. Conclusions: Patients in methadone treatment struggling to achieve abstinence may benefit from retention-oriented harm-reduction programs. Higher methadone doses can improve retention and opioid abstinence despite psychiatric comorbidities. Further work is needed to improve program implementation and outcomes in this complex population.https://doi.org/10.1177/11782218221138335 |
| spellingShingle | Tabitha E Moses Gary L Rhodes Emytis Tavakoli Carl W Christensen Alireza Amirsadri Mark K Greenwald Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone Program Substance Abuse: Research and Treatment |
| title | Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone Program |
| title_full | Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone Program |
| title_fullStr | Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone Program |
| title_full_unstemmed | Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone Program |
| title_short | Predictors of Retention and Drug Use Among Patients With Opioid Use Disorder Transferred to a Specialty “Second Chance” Methadone Program |
| title_sort | predictors of retention and drug use among patients with opioid use disorder transferred to a specialty second chance methadone program |
| url | https://doi.org/10.1177/11782218221138335 |
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