Factors associated with methadone maintenance therapy discontinuation among people who inject drugs.
paper
Cited
Public
- Authors
- Lo, Ada; Kerr, Thomas; Hayashi, Kanna; Milloy, M-J; Nosova, Ekaterina; Liu, Yang; Fairbairn, Nadia
- Year
- 2018
- Journal
- Journal of substance abuse treatment
- PMID
- 30243416
- DOI
- 10.1016/j.jsat.2018.08.009
- PMCID
- PMC6375706
BACKGROUND: Methadone maintenance therapy (MMT) continues to be a key treatment for opioid use disorder, although premature discontinuation of MMT can increase risk for overdose and other severe harms. We examined sociodemographic characteristics, substance use patterns and social-structural exposures associated with MMT discontinuation among a cohort of people who use drugs (PWUD) in Vancouver, Canada. METHODS: Data were derived from VIDUS and ACCESS, prospective cohorts of PWUD in Vancouver, Canada. The outcome of interest was self-reported discontinuation of MMT within the last six months. Multivariable Generalized Estimating Equations (GEE) were conducted to identify factors independently associated with MMT discontinuation. RESULTS: Between 2005 and 2015, 1301 PWUD who had accessed MMT were recruited, among whom 288 (22.1%) discontinued MMT at least once during the study period. In multivariable GEE analyses, homelessness (Adjusted Odds Ratio [AOR]โฏ=โฏ1.46, 95% Confidence Interval [95% CI]: 1.09-1.95), daily heroin injection (AORโฏ=โฏ5.17, 95% CI: 3.82-6.99), daily prescription opioid use (injection or non-injection) (AORโฏ=โฏ2.18, 95% CI: 1.30-3.67), recent incarceration (AORโฏ=โฏ1.46, 95% CI: 1.01-2.12), and not being on any form of income assistance (AORโฏ=โฏ2.14, 95% CI: 1.33-3.46) were each independently positively associated with MMT discontinuation. Participants with more study visits on methadone (>50% vs. โค50% of visits) (AORโฏ=โฏ0.63, 95% CI: 0.47-0.85) and those with higher methadone dose (>100โฏmg vs. <60โฏmg per day) (AORโฏ=โฏ0.44, 95% CI: 0.31-0.62) were less likely to discontinue MMT. DISCUSSION AND CONCLUSIONS: Discontinuation of MMT in this urban setting was associated with recent homelessness and incarceration, not accessing social income assistance, as well as daily prescription opioid use and daily heroin injection drug use. These findings underscore a need to reduce potential barriers to MMT retention by providing access to stable housing and preventing treatment interruptions during transitions between community and custodial settings.
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