title: Patient perspectives on buprenorphine/naloxone: a qualitative study of retention during the starting treatment with agonist replacement therapies (START) study.
abstract: 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. 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. Ongoing education of patients and staff regarding buprenorphine/naloxone, especially in comparison to methadone, and support from staff and peers are essential.
authors.affiliation: a Investigator, UCLA Integrated Substance Abuse Programs , Los Angeles , CA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Teruya
authors.forename: Robert P
authors.initials: RP
authors.lastname: Schwartz
authors.forename: Shannon Gwin
authors.initials: SG
authors.lastname: Mitchell
authors.forename: Albert L
authors.initials: AL
authors.lastname: Hasson
authors.forename: Christie
authors.initials: C
authors.lastname: Thomas
authors.forename: Samantha H
authors.initials: SH
authors.lastname: Buoncristiani
authors.forename: Yih-Ing
authors.initials: YI
authors.lastname: Hser
authors.forename: Katharina
authors.initials: K
authors.lastname: Wiest
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Cohen
authors.forename: Naomi
authors.initials: N
authors.lastname: Glick
authors.forename: Petra
authors.initials: P
authors.lastname: Jacobs
authors.forename: Paul
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Walter
authors.initials: W
authors.lastname: Ling
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D036301:Qualitative Research; D012107:Research Design
chemical_list: D009270:Naloxone; D002047:Buprenorphine
keywords: buprenorphine; patient perspectives; qualitative; retention