title: Predictors of early dropout in outpatient buprenorphine/naloxone treatment.
abstract: Identifying predictors of early drop out from outpatient treatment of opioid use disorder (OUD) with buprenorphine/naloxone (BN) may improve care for subgroups requiring more intensive engagement to achieve stabilization. However, previous research on predictors of dropout among this population has yielded mixed results. The aim of the present study was to elucidate these mixed findings by simultaneously evaluating a range of putative risk factors that may predict dropout in BN maintenance treatment.
  
  
  
  Outpatient medical records and weekly supervised urine toxicology results were retrospectively reviewed for patients at two community psychiatric clinics (n = 202): a private hospital clinic (n = 84) and a federally qualified health center (n = 118). A forward stepwise logistic regression was utilized to investigate the association between early dropout (i.e., discontinuing treatment or buprenorphine non-adherence within the first 3 months of clinic entry) and extracted sociodemographic, clinical, substance use, and treatment history variables.
  
  
  
  Overall, 56 of 202 participants (27.7%) dropped out of treatment. The multivariable analysis indicated that age under 25 (B = 1.47, SEB = .52, p < .01) and opioid use in month 1 (B = 1.50, SEB = .41, p < .001) were significantly associated with early dropout; those with a history of suicide attempt were significantly less likely to drop out (B = -1.44, SEB = .67, p < .05).
  
  
  
  Consistent with previous research, younger age and use of opioids during the first month of treatment predicted early dropout. Having a history of prior suicide attempt was associated with 3-month BN treatment retention, which has not been previously reported. (Am J Addict 2016;25:472-477).
authors.affiliation: Harvard Medical School, Department of Psychiatry, Boston, Massachusetts.|Massachusetts General Hospital/McLean Adult Psychiatry Residency, Boston/Belmont, Massachusetts.
authors.forename: David E
authors.initials: DE
authors.lastname: Marcovitz
authors.affiliation: Harvard Medical School, Department of Psychiatry, Boston, Massachusetts.|McLean Hospital, Belmont, Massachusetts.
authors.forename: R Kathryn
authors.initials: RK
authors.lastname: McHugh
authors.affiliation: Community Health Services, Hartford, Connecticut.
authors.forename: Julie
authors.initials: J
authors.lastname: Volpe
authors.affiliation: McLean Hospital, Belmont, Massachusetts.
authors.forename: Victoria
authors.initials: V
authors.lastname: Votaw
authors.affiliation: Harvard Medical School, Department of Psychiatry, Boston, Massachusetts.|McLean Hospital, Belmont, Massachusetts.
authors.forename: Hilary S
authors.initials: HS
authors.lastname: Connery
mesh_terms: D000328:Adult; D000069479:Buprenorphine, Naloxone Drug Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000523:psychology; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists