title: Psychoactive medications and disengagement from office based opioid treatment (obot) with buprenorphine.
abstract: The prevalence of psychoactive medications (PAMs) use in patients enrolled in Office Based Opioid Treatment (OBOT) and its association with engagement in this care is largely unknown.
  
  
  
  To describe the use of PAMs, including those medications with emerging evidence of misuse ("emerging PAMs" - gabapentin, clonidine and promethazine) among patients on buprenorphine, and its association with disengagement from OBOT.
  
  
  
  This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014. The association between use of PAMs and 6-month disengagement from OBOT was examined using multivariable logistic regression models. A secondary analysis exploring time-to-disengagement was conducted using Cox regression models.
  
  
  
  At OBOT entry, 43% of patients (562/1308) were prescribed any PAM; including 17% (223/1308) on an emerging PAM. In separate adjusted analyses, neither the presence of any PAM (adjusted odds ratio [AOR] 1.07, 95% CI [0.78, 1.46]) nor an emerging PAM (AOR 1.28 [0.95, 1.74]) was significantly associated with 6-month disengagement. The results were similar for the Cox model (any PAM (adjusted hazard ratio [AHR] 1.16, 95% CI [1.00, 1.36]), emerging PAM (AHR 1.18 [0.98, 1.41])). Exploratory analyses suggested gabapentin (AHR 1.30 [1.05-1.62]) and clonidine (AHR 1.33 [1.01-1.73]) specifically, may be associated with an overall shorter time to disengagement.
  
  
  
  Psychoactive medication use is common among patients in buprenorphine treatment. No significant association was found between the presence of any psychoactive medications, including medications with emerging evidence of misuse, and 6-month disengagement from buprenorphine treatment.
authors.affiliation: Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States. Electronic address: zoe.weinstein@bmc.org.
authors.forename: Zoe M
authors.initials: ZM
authors.lastname: Weinstein
authors.affiliation: Boston University School of Public Health, Department of Biostatistics, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, United States.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Boston University School of Public Health, Data Coordinating Center, 85 East Newton St., M921, Boston, MA 02118, United States.
authors.forename: Emily
authors.initials: E
authors.lastname: Quinn
authors.affiliation: Boston University School of Medicine, 72 East Concord St. Boston, MA 02118, United States.
authors.forename: David
authors.initials: D
authors.lastname: Hui
authors.affiliation: Boston University School of Medicine, 72 East Concord St. Boston, MA 02118, United States.
authors.forename: Hyunjoong
authors.initials: H
authors.lastname: Kim
authors.affiliation: Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Gryczynski
authors.affiliation: Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States; Boston University School of Public Health, Department of Community Health Sciences, 801 Massachusetts Avenue, Boston, MA 02118, United States.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000588:Amines / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D003000:Clonidine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D015995:Prevalence; D012189:Retrospective Studies; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000701:Analgesics, Opioid; D003509:Cyclohexanecarboxylic Acids; D002047:Buprenorphine; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D003000:Clonidine
keywords: Buprenorphine; Primary care; Psychoactive medication; Treatment retention