title: Long-term retention in Office Based Opioid Treatment with buprenorphine.
abstract: Guidelines recommend long-term treatment for opioid use disorder with buprenorphine; however, little is known about patients in long-term treatment. The aim of this study is to examine the prevalence and patient characteristics of long-term treatment retention (≥1year) in an Office Based Opioid Treatment (OBOT) program with buprenorphine.
  
  
  
  This is a retrospective cohort study of adults on buprenorphine from January 2002 to February 2014 in a large urban safety-net primary care OBOT program. The primary outcome was retention in OBOT for at least one continuous year. Potential predictors included age, race, psychiatric diagnoses, hepatitis C, employment, prior buprenorphine, ever heroin use, current cocaine, benzodiazepine and alcohol use on enrollment. Factors associated with ≥1year OBOT retention were identified using generalized estimating equation logistic regression models. Patients who re-enrolled in the program contributed repeated observations.
  
  
  
  There were 1605 OBOT treatment periods among 1237 patients in this study. Almost half, 45% (717/1605), of all treatment periods were ≥1year and a majority, 53.7% (664/1237), of patients had at least one ≥1year period. In adjusted analyses, female gender (Adjusted Odds Ratio [AOR] 1.55, 95% CI [1.20, 2.00]) psychiatric diagnosis (AOR 1.75 [1.35, 2.27]) and age (AOR 1.19 per 10year increase [1.05, 1.34]) were associated with greater odds of ≥1year retention. Unemployment (AOR 0.72 [0.56, 0.92]), Hepatitis C (AOR 0.59 [0.45, 0.76]), black race/ethnicity (AOR 0.53 [0.36, 0.78]) and Hispanic race/ethnicity (AOR 0.66 [0.48, 0.92]) were associated with lower odds of ≥1year retention.
  
  
  
  Over half of patients who presented to Office Based Opioid Treatment with buprenorphine were ultimately successfully retained for ≥1year. However, significant disparities in one-year treatment retention were observed, including poorer retention for patients who were younger, black, Hispanic, unemployed, or with hepatitis C.
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 Medicine, 72 East Concord St, Boston, MA 02118, United States.
authors.forename: Hyunjoong W
authors.initials: HW
authors.lastname: Kim
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/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: Colleen T
authors.initials: CT
authors.lastname: Labelle
authors.affiliation: Boston University School of Public Health, Department of Health Law, Policy & Management, 715 Albany Street, Talbot Building, T2W, Boston, MA 02118, United States; Boston University School of Medicine, Section of Infectious Diseases, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Rd, Bedford, MA 01730, United States.
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
authors.affiliation: Boston University School of Public Health, Department of Health Law, Policy & Management, 715 Albany Street, Talbot Building, T2W, Boston, MA 02118, United States; Boston University School of Social Work, Department of Social Research, 264 Bay State Rd, Boston, MA 02215, United States.
authors.forename: Sara S
authors.initials: SS
authors.lastname: Bachman
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, 4th Floor, Boston, MA 02118, United States.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010045:Outpatients / Q000706:statistics & numerical data*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data; D012737:Sex Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine
keywords: Buprenorphine; Health disparities; Office Based Opioid Treatment (OBOT); Patient dropout; Substance users