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Twelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV

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Abstract

Although opioid agonist therapy (OAT) is associated with positive health outcomes, including improved HIV management, long-term retention in OAT remains low among patients with opioid use disorder (OUD). Using data from the Veterans Aging Cohort Study (VACS), we identify variables independently associated with OAT retention overall and by HIV status. Among 7,334 patients with OUD, 13.7% initiated OAT, and 27.8% were retained 12-months later. Likelihood of initiation and retention did not vary by HIV status. Variables associated with improved likelihood of retention included receiving buprenorphine (relative to methadone), receiving both buprenorphine and methadone at some point over the 12-month period, or diagnosis of HCV. History of homelessness was associated with a lower likelihood of retention. Predictors of retention were largely distinct between patients with HIV and patients without HIV. Findings highlight the need for clinical, systems, and research initiatives to better understand and improve OAT retention.

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Acknowledgements

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (R01 AA022886 (Kraemer) and U10 AA013566 (Justice)). Dr. Wyse’s time was supported by Career Development Award 1IK2HX003007 from the U.S. Department of Veterans Affairs Health Services Research and Development, K12HS026370 from the Agency for Healthcare Research and Quality and resources from the VA Health Services Research and Development-funded Center to Improve Veteran Involvement in Care at the VA Portland Health Care System (CIN 13-404). Dr. Korthuis’ time was supported by the National Institutes of Health, National Institute on Drug Abuse (UG3DA044831, UG1DA015815). Dr. Edelman’s time was supported by NIDA (R01DA040471). Dr. Crystal’s time was supported by NIDA (R01DA047347) and NCATS (UL1TR003017). A prior version of this research was presented at the College on Problems of Drug Dependence Annual Meeting, 2020. The authors have no relevant financial or non-financial interests to disclose.

Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (R01 AA022886 (Kraemer) and U10 AA013566 (Justice)). Dr. Wyse’s time was supported by Career Development Award 1IK2HX003007 from the U.S. Department of Veterans Affairs Health Services Research and Development, K12HS026370 from the Agency for Healthcare Research and Quality and resources from the VA Health Services Research and Development-funded Center to Improve Veteran Involvement in Care at the VA Portland Health Care System (CIN 13–404). Dr. Korthuis’ time was supported by the National Institutes of Health, National Institute on Drug Abuse (UG3DA044831, UG1DA015815). Dr. Edelman’s time was supported by NIDA (R01DA040471). Dr. Crystal’s time was supported by NIDA (R01DA047347) and NCATS (UL1TR003017).

Author information

Authors and Affiliations

  1. VA Portland Health Care System, Portland, OR, USA

    Jessica J. Wyse

  2. School of Public Health, Oregon Health & Science University, Portland, OR, USA

    Jessica J. Wyse

  3. VA Connecticut Healthcare System, West Haven, CT, USA

    Kathleen A. McGinnis, Brent A. Moore, Kirsha S. Gordon, Melissa Skanderson & Amy C. Justice

  4. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA

    E. Jennifer Edelman, David A. Fiellin, Benjamin J. Oldfield, Kirsha S. Gordon & Amy C. Justice

  5. Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA

    E. Jennifer Edelman, David A. Fiellin & Amy C. Justice

  6. Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA

    Adam J. Gordon

  7. Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

    Adam J. Gordon

  8. Integrative Pain Recovery Service, Hampton VA Medical Center, Hampton, VA, USA

    Ajay Manhapra

  9. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Brent A. Moore & Declan T. Barry

  10. Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA

    P. Todd Korthuis

  11. Los Angeles County Department of Health Services, Los Angeles, CA, USA

    Amy J. Kennedy

  12. Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA

    Julie R. Gaither

  13. APT Foundation, Pain Treatment Services, New Haven, CT, USA

    Ajay Manhapra & Declan T. Barry

  14. National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA

    Kendall Bryant

  15. Center for Health Services Research, Institute for Health, Rutgers University, New Brunswick, NJ, USA

    Stephen Crystal

  16. Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Kevin L. Kraemer

  17. VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Kevin L. Kraemer

Authors
  1. Jessica J. Wyse
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  2. Kathleen A. McGinnis
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  3. E. Jennifer Edelman
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  4. Adam J. Gordon
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  5. Ajay Manhapra
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  6. David A. Fiellin
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  7. Brent A. Moore
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  8. P. Todd Korthuis
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  9. Amy J. Kennedy
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  10. Benjamin J. Oldfield
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  11. Julie R. Gaither
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  12. Kirsha S. Gordon
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  13. Melissa Skanderson
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  14. Declan T. Barry
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  15. Kendall Bryant
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  16. Stephen Crystal
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  17. Amy C. Justice
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  18. Kevin L. Kraemer
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection and acquisition were performed by Kathleen McGinnis, Melissa Skanderson and Amy Justice. Analyses were run by Kathleen McGinnis. The first draft of the manuscript was written by Jessica Wyse and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jessica J. Wyse.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The content of this article is solely the responsibility of the authors and does not represent the official views of the Department of Veterans Affairs or the Agency for Healthcare Research and Quality.

Ethical Approval

The study protocol was approved by the Institutional Review Boards of the University of Pittsburgh, VA Pittsburgh Healthcare System and VA Connecticut Healthcare System and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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A prior version of this research was presented at the College on Problems of Drug Dependence Annual Meeting, 2020.

Appendix

Appendix

figure a

Four trajectory group model: patterns of methadone treatment over 12 months

To identify distinctive pattern of methadone treatment over time, as indicated by number of visit days (OTP/stop code 523 or inpatient) per month, we utilized group-based trajectory modeling. Trajectory modeling sorts each participant’s measurements (number of visits per month) into “clusters” and estimates distinct trajectories. The procedure calculates each individual’s probability of belonging to each trajectory group and assigns the individual to the trajectory with the highest probability of membership. We used months after start of treatment as the time scale. We used a normal model and evaluated a 4-trajectory group model. With methadone retention defined as 4 + visits/month to an OTP in the first month and 1 + visits/month in months 2–12, we calculated 12-month retention within each trajectory group as follows: 0% for group 1, 17% for group 2, 7% for group 3, and 75% for group 4.

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Wyse, J.J., McGinnis, K.A., Edelman, E.J. et al. Twelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV. AIDS Behav 26, 975–985 (2022). https://doi.org/10.1007/s10461-021-03452-0

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