title: Factors associated with non-adherence to Buprenorphine-naloxone among opioid dependent African-Americans: A retrospective chart review.
abstract: OBJECTIVE
  Opioid use disorders are common, chronic relapsing disorders. Buprenorphine (BUP) is an FDA approved medication in the treatment of opioid use disorders, but patient adherence to this medication remains a challenge. To identify risk factors for non-adherence, this chart review study examined the association between DSM-IV Axis I psychiatric disorders, substance use, demographics, and adherence to BUP-naloxone in African-American patients.
  
  
  METHODS
  Charts were selected of patients who had ≥5 visits and completed psychometric screens (Patient Health Questionnaire, Mood Disorder Questionnaire, and a posttraumatic stress disorder questionnaire) at the time of the initial visit (N = 50). Urine drug screens (UDS) were also obtained. Treatment adherence was defined as BUP presence in UDS for ≥80% of the visits.
  
  
  RESULTS
  A total of 48% of patients were adherent to treatment. Non-adherent patients had higher rates of use for not only opioids, but also cocaine, and alcohol. Cocaine use was associated with BUP-naloxone non-adherence even after controlling for opioid use. Attendance in cognitive behavioral group therapy sessions (CBT) was significantly associated with adherence. Patients endorsing PTSD symptoms showed higher adherence to treatment compared to those who did not endorse these symptoms.
  
  
  CONCLUSIONS
  Our results indicate that alcohol and illicit substance use is associated with non-adherence to BUP-naloxone treatment, and suggests that CBT and efforts to promote abstinence from non-opioid substance use may improve adherence among African-Americans. These findings contribute to growing literature on understanding adherence to BUP-naloxone, which is critical to reduce morbidity and mortality.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, District of Columbia.
authors.forename: Suneeta
authors.initials: S
authors.lastname: Kumari
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, District of Columbia.
authors.forename: Partam
authors.initials: P
authors.lastname: Manalai
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, District of Columbia.
authors.forename: Sharlene
authors.initials: S
authors.lastname: Leong
authors.affiliation: Department of Criminology, Law and Society, George Mason University, Fairfax, Virginia.
authors.forename: Alese
authors.initials: A
authors.lastname: Wooditch
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, District of Columbia.
authors.forename: Mansoor
authors.initials: M
authors.lastname: Malik
authors.affiliation: Dell Medical School, The University of Texas at Austin, Austin, Texas.
authors.forename: William B
authors.initials: WB
authors.lastname: Lawson
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000069479:Buprenorphine, Naloxone Drug Combination / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000523:psychology* / Q000628:therapy; D010349:Patient Compliance / Q000523:psychology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists