title: Retention in methadone and buprenorphine treatment among African Americans.
abstract: Methadone has been the most commonly used pharmacotherapy for the treatment of opioid dependence in U.S. public sector treatment, but availability of buprenorphine as an alternative medication continues to increase. Drawing data from two community-based clinical trials that were conducted nearly contemporaneously, this study examined retention in methadone versus buprenorphine treatment over 6 months among urban African Americans receiving treatment in one of four publicly-funded programs (N=478; 178 methadone; 300 buprenorphine). Adjusting for confounds related to medication selection, survival analysis revealed that buprenorphine patients are at substantially higher risk of dropout compared to methadone patients (HR=2.43; p<.001). Buprenorphine's retention disadvantage appears to be concentrated in the earlier phases of treatment (approximately the first 50 days), after which risk of subsequent dropout becomes similar for the two medications. These findings confirm a retention disparity between methadone and buprenorphine in this population, and suggest potential avenues for future research to enhance retention in buprenorphine treatment.
authors.affiliation: Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA. jgrycz1@umbc.edu
authors.forename: Jan
authors.initials: J
authors.lastname: Gryczynski
authors.forename: Shannon Gwin
authors.initials: SG
authors.lastname: Mitchell
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Jaffe
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Kelly
authors.forename: C Patrick
authors.initials: CP
authors.lastname: Myers
authors.forename: Kevin E
authors.initials: KE
authors.lastname: O'Grady
authors.forename: Yngvild K
authors.initials: YK
authors.lastname: Olsen
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002047:Buprenorphine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010349:Patient Compliance / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D016320:Substance Abuse Treatment Centers; D014481:United States; D014505:Urban Population
chemical_list: D002047:Buprenorphine; D008691:Methadone
keywords: African Americans; Buprenorphine; Dropout; Methadone; Retention