Overdose history is associated with postdetoxification treatment preference for persons with opioid use disorder

ABSTRACT

Background: Without aftercare treatment, persons discharged from short-term inpatient detoxification for opioid use disorder are at high risk of relapse. In previous work, those who were recently homeless or had pending legal problems were more likely to prefer residential treatment for aftercare. Here, based on clinical experience, the authors hypothesize that a particular clinical factor, surviving an opioid overdose, will be associated with aftercare preference. Methods: Between May and December 2015, the authors surveyed consecutive persons seeking inpatient opioid detoxification. To assess aftercare treatment preference, participants were asked, “If you had unlimited treatment options and all were free, which one would work best for you when you leave here?” To assess overdose history, participants were asked about overdose “since your first drug use,” and “in the last year.” Results: Participants' (N = 440) mean age was 32.3 (± 8.7) years; 70.7% were male. More than half (51.1%) of participants expressed an aftercare preference for medication-assisted treatment (MAT), 12.7% for outpatient counseling only, 10.7% for residential treatment,18.6% for no formal treatment (Narcotics Anonymous/Alcoholics Anonymous only or a halfway house), and 6.8% did not want any postdetoxification treatment. About 40% reported a history of overdose, and 24.8% reported past year overdose. In the multivariate model, treatment preference was associated with sex (P < .001), homelessness (P = .01), and history of drug overdose (P = .02). Conclusions: Although MAT was preferred by the majority of participants, the experience of a nonfatal overdose was associated with the choice of residential treatment as postdetoxification treatment.

KEYWORDS:

• Detoxification
• opioids
• overdose
• residential treatment

Funding

This study was funded by the National Institute on Drug Abuse (R01 DA034261). Trial registered at clinicaltrials.gov, Clinical Trial NCT01751789. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

The authors declare that they have no conflicts of interest.

Author contributions

Dr. Stein collected the data used in the current manuscript along with authors Flori, Risi, and Conti. Ms. Flori and Dr. Bailey, Dr. Anderson, and Dr. Stein conducted the literature review, wrote the Introduction, Methods, and Discussion, and revised the final draft of the manuscript. Dr. Anderson conducted statistical analyses, wrote the Results section, and reviewed manuscript drafts. Dr. Stein reviewed and provided feedback on drafts of the manuscript, and all authors contributed to and have approved the final manuscript.