Medication for opioid use disorder—which include buprenorphine, methadone, and extended-release naltrexone—is known to improve health outcomes in patients with opioid use disorder (OUD). A report published Monday in Psychiatric Services now suggests that patients who take their medication for OUD (MOUD) more frequently are less likely to end up hospitalized or in the emergency room than those who take their MOUD less frequently.
These findings, as reported by Manesh Gopaldas, M.D., of New York State Psychiatric Institute and Columbia University Irving Medical Center and colleagues were based on a secondary analysis of data from a National Institute on Drug Abuse (NIDA) comparative effectiveness trial. In the NIDA trial, individuals seeking treatment for OUD were randomly assigned to receive extended-release naltrexone or buprenorphine-naloxone for 24 weeks. The average age of the 570 participants who received medication was 34 years old; most were male (70%), White (74%), and had completed high school or its equivalent (78%). They were followed for 36 weeks.
Adherence to MOUD was defined as the percentage of days in a month in which a participant took a prescribed medication. The participants were grouped into three levels of adherence: low (less than 20%), medium (20% to 79%), or high (80% or greater).
Gopaldas and colleagues found that those who took their medication 80% or more of the time used inpatient addiction treatment 17.87 fewer days and acute care (such as emergency room) 3.32 fewer days than those who took their MOUD less than 20% of the time. In contrast, those who took their medication 80% or more of the time were more likely to seek care at outpatient settings; for example, those in the high adherence group sought outpatient addiction treatment and other outpatient services 1.28 and 10.45 more days, respectively, than those in the low adherence group. Participants who fell into the medium adherence group were also more likely to seek outpatient treatment (8.90 more days) compared with those in the low adherence group.
Gopaldes and colleagues noted that adherence to medication deteriorated over the course of the study.
“Examining predictors of adherence may be helpful in designing interventions,” they wrote. “Understanding whether negative prognostic indicators (such as severe psychiatric or general medical problems) and indicators of socioeconomic status (such as educational attainment and employment) predict adherence to MOUD, and whether MOUD type and dosage are associated with adherence, would be valuable.”
They concluded, “Our results reinforced the view that greater MOUD adherence is associated with reduced usage of high-cost inpatient addiction treatment and acute care services and increased utilization of outpatient care. Causation cannot be inferred from these data, but the data suggested that interventions that increase MOUD uptake and adherence can reduce health care costs.”
For related information see the Psychiatric News article “Opioid Crisis: Reluctance to Prescribe Lifesaving Medications Must Stop.”
(Image: iStock/LaurenSimmons)