“Real World†Factors Influencing Dropout from Opiate Treatment with Methadone and Buprenorphine

Background and objective: Comparison of retention in office-based, private-pay, outpatient opiate treatment programs with methadone or buprenorphine. Methods: Descriptive study with a prospective design comparing treatment retention in a licensed opiate treatment program (OTP) and buprenorphine program (BUP) offered in the same office-based setting. Over a period of 4.5 years, 1,372 patients were observed from program admission until six months or dropout, whichever was earlier. Results and conclusion: OTP had greater retention than BUP (36% vs. 15.8%); however, in both programs, retention was lower than reported elsewhere. Hispanic ethnicity, being married, and being unemployed correlate with significant dropout in OTP. Causes of early drop out in BUP were unclear. Percent of positive urine drug screens were significantly associated with drop out in both modalities. Significance: Results reflect the situation in a private pay outpatient program where patients are financially responsible for medications, transportation, and services. This, in addition to higher percentage of Hispanic ethnicity in study population and continuation of abuse of illicit substances, might explain overall low retention. Government supported treatment should improve retention in “real world” opiate dependence maintenance treatment.