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Heroin Addiction and Related Clinical Problems: 2024, 26, 30

Recruiting and Retaining Patients in Low Threshold Opioid Agonist Treatment: A Retrospective Cohort Study

Kathleen Henriksen, Jon-Aksel Jacobsen, Elliott Henriksen, Leni Gomes, Linda Elise Wüsthoff, Espen Ajo Arnevik, and Peter Krajci

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2024-30

Summary: Background. Opioid Agonist Treatment (OAT) is known to be effective in both treating Opioid Use Disorders (OUD) and reducing adverse outcomes. The LASSO program in Oslo, Norway, is a low-threshold OAT clinic which initially only offered patients buprenorphine/naloxone (BPNX) until 2017 when buprenorphine (BP) was introduced as an alternative. Aims: To investigate the impact of increased medication options on treatment adherence and enrollment in a low-threshold OAT program. Methods: All patient contacts from January 1st, 2011 until December 31st, 2019 and all medical charts from January 1st 2017 until December 31st 2019 were included. Differences in recruitment and retention were compared between three time periods; 1) when the clinic was established 2011-14, 2) when there was a dip in recruitment 2015-16 and 3) after BP was introduced in 2017-19. A linear regression model was used to predict total treatment time and Kaplan-Meier survival curves were used to identify the most vulnerable period for attrition. Results: Recruitment: There was a 37.8% increase in total number of patients between periods 2-3 and a 12.9% increase between periods 1-3. Treatment time: Both number of induction attempts and attrition within the first 30 days was predictive of total treatment time. Each induction provided 15 additional days in treatment. Remaining in treatment for 30 days was predictive of completing an additional 70 days of treatment. Patients who changed medications at least once remained in treatment 79 days (BPNX to BP) and 158 days (BP to BPNX). Those who remained on one medication (BPNX or BP) remained in treatment for 35 days. Attrition: 25.7% of patients fell out of treatment prior to day 3 while 50% of patients fell out of treatment prior to day 12 during their first treatment episode. Conclusions: Offering patients a choice between BP and BPNX increased both recruitment and treatment retention. The “option to choose” rather than medication choice seems to be of prognostic value. Furthermore, given the high attrition rate within the first two days, it seems appropriate to re-evaluate titration procedures and intensify psychosocial support efforts during this challenging time.

Keywords: Evidence-Based Practice; Opioid Use Disorder; Retention in care; Buprenorphine; Opioid Agonist Treatment