title: Predictors of attrition with buprenorphine/naloxone treatment in opioid dependent youth.
abstract: BACKGROUND
  In opioid dependent youth there is substantial attrition from medication-assisted treatment. If youth at risk for attrition can be identified at treatment entry or early in treatment, they can be targeted for interventions to help retain them in treatment.
  
  
  METHODS
  Opioid dependent adolescents and young adults (n=152), aged 15-21, were randomized to 12 weeks (BUP, n=74) or 2 weeks of detoxification (DETOX, n=78) with buprenorphine/naloxone (Bup/Nal), both in combination with 12 weeks of psychosocial treatment. Baseline and early treatment related predictors of treatment attrition were identified in each group using bivariate and multivariate logistic regression.
  
  
  RESULTS
  In the DETOX group 36% left between weeks 2 and 4, at the end of the dose taper, while in the BUP group only 8% left by week 4. In the BUP group, early adherence to Bup/Nal, early opioid negative urines, use of any medications in the month prior to treatment entry, and lifetime non-heroin opioid use were associated with retention while prior 30-day hallucinogen use was associated with attrition. In the DETOX group, only use of sleep medications was associated with retention although not an independent predictor. A broad range of other pre-treatment characteristics was unrelated to attrition.
  
  
  CONCLUSIONS
  Prompt attention to those with early non-adherence to medication or an early opioid positive urine, markers available in the first 2 weeks of treatment, may improve treatment retention. Extended Bup/Nal treatment appeared effective in improving treatment retention for youth with opioid dependence across a wide range of demographics, and pre-treatment clinical characteristics.
authors.affiliation: Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX 75390-9119, USA. Diane.Warden@UTSouthwestern.edu
authors.forename: Diane
authors.initials: D
authors.lastname: Warden
authors.forename: Geetha A
authors.initials: GA
authors.lastname: Subramaniam
authors.forename: Thomas
authors.initials: T
authors.lastname: Carmody
authors.forename: George E
authors.initials: GE
authors.lastname: Woody
authors.forename: Abu
authors.initials: A
authors.lastname: Minhajuddin
authors.forename: Sabrina A
authors.initials: SA
authors.lastname: Poole
authors.forename: Jennifer
authors.initials: J
authors.lastname: Potter
authors.forename: Marc
authors.initials: M
authors.lastname: Fishman
authors.forename: Michael
authors.initials: M
authors.lastname: Bogenschutz
authors.forename: Ashwin
authors.initials: A
authors.lastname: Patkar
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
mesh_terms: D000293:Adolescent; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine