U. researchers find more outpatient visits lead to higher success rate in treating opioid-use disorder

In a study conducted in collaboration with Columbia University, Rutgers researchers recently determined that patients who are being treated for opioid-use disorder will see more success in their treatment if they participate in more outpatient visits, according to an article from Rutgers Today.

Stephen Crystal, co-author of the study and director of the Center for Health Services Research at the Rutgers Institute for Health, Health Care Policy and Aging Research, said the goal of the study was to observe what factors lead patients to discontinue their treatment.

Crystal said the researchers’ purpose was to better guide clinicians as the effectiveness of treatment for opioid-use disorder has recently been limited due to the frequency of patients choosing to discontinue when early into their treatment.

The researchers also aimed to determine whether the performance measure of engagement, which reflects how often patients attend their treatment appointments, is necessary for examining opioid medication retention in long-term treatment, Crystal said. 

“An important finding was that patients who did not show up for at least two visits in the initial 34 days of treatment had almost no chance of making it to the six-month mark,” he said. “Although a few patients re-engaged in care after this type of poor start, this was very rare, with only 2.9 percent of such patients making it to the 6-month mark and only one in 10,000 making it to the two-year mark.”

The performance measure specifically indicates whether individuals attended two outpatient visits within a 34-day period after the onset of treatment, he said. Those who did attend have the highest chance of medication retention, thus making the performance measure of engagement necessary in examining treatment. 

He said the research in the study used patient data of 19,487 individuals from 2011 to 2019. These patients started treatment during this time and had their treatment retention reexamined for up to an approximately two-year period.

The patients were treated with buprenorphine, a medication commonly used for treating opioid use disorder that lowers the possibility of overdosing by between two-thirds and four-fifths given that the patients continue treatment, Crystal said.

He also said six months of treatment is considered the minimum for those being treated for opioid-use disorder. Any less time is inadequate for patients to be properly treated. 

“Successful induction into treatment requires good professional support because of the powerfully psychologically reinforcing effects of street opioids and the presence of strong cravings for these drugs,” Crystal said. “Even though buprenorphine strongly reduces these cravings, many individuals lack sufficient motivation to avoid relapse and professional support with the process is vital.”

Crystal said while the researchers were not surprised to find that initial engagement is predictive of retention, they did not expect exactly how predictive the performance measure truly was as only a small number of the patients who did not meet the measure received long-term treatment.

He also said another unexpected finding in the study’s research was that individuals who received buprenorphine in a non-prescribed fashion had twice the likelihood of reaching the six-month mark of opioid medication retention. 

"This (finding) is a phenomenon that has not received enough attention, and which we believe may suggest that law enforcement concerns about the risks of diversion of prescribed buprenorphine are misplaced, and indeed that ‘informal’ treatment with non-prescribed buprenorphine is actually likely to be beneficial," he said.

Additionally, Crystal said there are more factors that could contribute to treatment success as well, including mental health care challenges.

Crystal said the findings of this study have major implications for other disorders as adhering to treatment is the major limiting factor in treatment effectiveness.

He also said the researchers are now studying the effectiveness of current opioid-use treatment in populations that are at risk of opioid-use disorder, including individuals with a disability who receive Medicaid and individuals who have been released from prison.

"The goal of this overall program of research is to help health systems transform their approach to helping people with opioid-use disorder by improving the often ineffective approaches that have not yet been successful in reducing the toll of overdoses and implementing evidence-based strategies that can improve outcomes and support a national commitment to overcoming the opioid overdose epidemic,” he said.