Predictors of attrition with buprenorphine/naloxone treatment in opioid dependent youth.

In opioid dependent youth there is substantial attrition from medication-assisted treatment. If youth at risk for attrition can be identified at treatment entry or early in treatment, they can be targeted for interventions to help retain them in treatment. In this study, part of CTN-0010 (“Buprenorphine/Naloxone-Facilitated Rehabilitation for Opioid Dependent Adolescents/Young Adults”), opioid dependent adolescents and young adults (n=152), aged 15-21, were randomized to 12 weeks (BUP, n=74) or 2 weeks of detoxification (DETOX, n=78) with buprenorphine/naloxone (Bup/Nal), both in combination with 12 weeks of psychosocial treatment. Baseline and early treatment related predictors of treatment attrition were identified in each group using bivariate and multivariate logistic regression.

In the DETOX group, 36% left between weeks 2 and 4, at the end of the dose taper, while in the BUP group, only 8% left by week 4. In the BUP group, early adherence to Bup/Nal, early opioid negative urines, use of any medications in the month prior to treatment entry, and lifetime non-heroin opioid use were associated with retention while prior 30-day hallucinogen use was associated with attrition. In the DETOX group, only use of sleep medications was associated with retention. A broad range of other pretreatment characteristics were unrelated to attrition.

Conclusions: Prompt attention to those with early non-adherence to medication or an early opioid positive urine, markers available in the first two weeks of treatment, may improve treatment retention. Extended Bup/Nal treatment appears to be effective in improving treatment retention for youth with opioid dependence across a wide range of demographics and pre-treatment clinical characteristics.

Related protocols: CTN-0010